This 9 year old was a back seat passenger in a motor vehicle accident. He had been wearing a seatbelt.
He complained of chest wall pain anteriorly but was otherwise uninjured.
This is the longitudinal view of the child's sternum.
The sternebrae are clearly visible with cartilaginous junctions seen between the ossifying centres.
In the first sternebrae (below the manubrium) a cortical step is seen. This corresponded exactly to his site of tenderness and represents a sternal fracture.
Sternal fracture is infrequent in children and often even when present is probably missed.
Ultrasound is an easy, rapidly reproducible, safe investigation that can be used to detect these fractures.
It can also assess for pneumothorax, be used to guide local anaesthetic infiltration, and assess the heart and pericardium.