CONTRECOUP FRACTURE OF THE STERNUM

Abstract

was thrown from the lad¬ der on which he was standing.His fellow-workmen stated that he fell on his head and his body hent forward and " doubled up on itself."In other words, after striking the ground, his body completed a somersault, and he landed on his feet in a doubled-up condition.When called to see him a few minutes after the accident, I found him semidelirious, bleeding profusely from scalp wounds, and complaining during lucid intervals of pain in his chest.An extensive stellate scalp wound over the left parietal eminence made examination of the skull easy; no fracture or depression was noted, and the wounds were sutured.Examination of the thorax showed a distinct protuberance over the sternum at the level of the second and third chondrosternal articulations.Tenderness over this area was exquisite and slight crepitus was probably elicited once, but the great pain forbade confirmation of this symptom.There were no external discolora¬ tions, bruises, or marks such as would undoubtedly have been present had the patient's sternum struck any solid body in fall¬ ing.The man was scut home and put to bed with hot moist dressings over the sternum.The scalp wounds healed per primam, and will not he further considered in this paper.April 29.Patient bedridden; temperature, 101° F.; pulse, 104; respirations, 34.The midstcrnal region is discolored; the protuberance has increased and tenderness is still very acute.An attempt was made to keep patient's head and shoulders thrown back in order to reduce the deformity, but we had to desist on account of increased pain and discomfort.Adhesive strips over the fractured area were also tried, but promptly discontinued, as they only aggravated the pain.The patient coughs frequently, and on two occasions the sputum was tinged with blood.Respi-