P2D124: Sternal Fracture After a Trampoline Fall: A Case Report

Introduction: Trampoline use has increased in popularity over the last decade due to the rise in commercial trampoline parks resulting in a variety of injuries such as fractures, sprains/strains, and skin contusions/abrasions which can prompt a visit to the pediatric urgent care or emergency department. Bounce houses provide a similar mechanism of injury. Sternal fractures have previously been reported as a result of either direct or indirect trauma, with motor vehicle collision being the most common culprit and can have associated intrathoracic injuries. There have been few reports of isolated sternal fracture, none of which have been secondary to trampoline use.

Case Description: A 7-year-old male presented to the pediatric emergency department with chest pain after jumping off a zipline onto a trampoline the day prior. He landed on his side and had no loss of consciousness. On exam, there were no external signs of trauma. Patient was noted to be tender to palpation over the upper sternum without crepitus or deformity. There was no tenderness to palpation, crepitus or deformity over the clavicles. He had full range of motion of bilateral upper extremities. Sternal x-ray was obtained which showed a buckle fracture of the sternum (Figure 1). Family was advised to apply ice to the chest, use Ibuprofen as needed, and to avoid strenuous activity for the next several weeks. Return precautions were discussed and pediatrician follow up was advised. The patient had no complications resulting from the injury requiring a subsequent emergency department or urgent care visit.

Discussion: Patients with isolated sternal fractures from relatively minor trauma such as a fall from a trampoline do not require an aggressive workup. Upon review of patients from our institution over the past 5 years (2018-2022), there were 24 patients (median 7.5 years, 62% male) with a sternal fracture resulting from a trampoline or bounce house fall who presented to either the ambulatory urgent care sites or emergency department (Table 1). All patients had chest or sternal x-rays which showed an isolated sternal fracture. Nine of 24 patients had an EKG ordered, 7 of 9 of which were normal. Two of the 9 patients followed up with cardiology and all were subsequently cleared. There were 11 of 24 orthopedics referrals from the urgent care setting for outpatient follow up. There was one patient who returned to urgent care for sports clearance.

Conclusion: Although sternal fractures are an uncommon injury in the pediatric population, clinicians should be aware that this is an injury that can occur from relatively minor trauma, such as a trampoline or bounce house fall. A sternal fracture from this type of injury typically does not have associated intrathoracic injuries, and patients can be managed conservatively with minimal work up.