The sternum, commonly known as the breastbone, is a flat bone in the center of your chest that connects to your collarbone and the first seven ribs, forming a protective part of your rib cage. A sternum fracture occurs when this bone breaks, typically due to direct trauma. While a fractured sternum can be a serious injury, it is often treatable, and many individuals make a full recovery.
Recognizing a Sternum Fracture and Seeking Help
A fractured sternum often presents with severe pain in the chest area, which can worsen with deep breathing, coughing, laughing, or sneezing. You might also notice tenderness, swelling, or bruising over the breastbone, and in some cases, a visible deformity.
These fractures are most commonly caused by direct impact to the chest, frequently resulting from motor vehicle accidents, particularly from seatbelt impact. Other causes include falls from a significant height, high-impact sports, or vehicle-to-pedestrian collisions.
Due to the sternum’s proximity to vital organs like the heart and lungs, any suspected sternum injury requires immediate medical attention to assess the fracture and rule out underlying injuries, such as bruised lung tissue, a collapsed lung, or heart damage. Medical professionals typically diagnose a sternum fracture through a physical examination, followed by imaging tests like X-rays and computed tomography (CT) scans to visualize the bone and surrounding structures.
Medical Treatment Options
The majority of sternum fractures are managed without surgery, focusing instead on conservative approaches to promote healing and manage symptoms. Pain management is a primary concern, often involving rest, applying ice or a cold pack to the chest for 10 to 20 minutes at a time, and over-the-counter pain relievers such as NSAIDs. For more severe pain, prescription pain medication may be necessary.
Maintaining lung function and preventing complications like pneumonia are also important during recovery. Patients are encouraged to perform deep breathing exercises regularly, at least once every hour, even if it causes discomfort. Supporting the chest wall with a pillow while coughing can help alleviate pain during these necessary actions. Avoiding strenuous activities, heavy lifting, twisting motions, and direct pressure on the chest is also advised to prevent further injury and allow the bone to heal.
Surgical intervention for a sternum fracture is less common but may be considered in specific circumstances. These include significantly displaced fractures where the bone fragments are misaligned, multiple fractures, or a non-union where the bone fails to heal properly. Surgery might also be necessary if there are associated severe internal injuries that require repair. During surgery, fixation with plates or screws may be used to stabilize the fractured sternum.
The choice of treatment depends on several factors, including the severity and type of the fracture, whether other injuries are present, and the patient’s overall health. Isolated and stable sternal fractures are typically managed conservatively, while unstable fractures often necessitate surgical fixation.
The Recovery Journey
The healing timeline for a sternum fracture typically spans several weeks, with most patients experiencing a good recovery within 4 to 6 weeks, though pain can persist for 8 to 12 weeks. Full recovery and a return to normal activities can take longer, with an average recovery time reported around 10 to 10.5 weeks, and even longer if surgery was required. Ongoing pain management strategies, including prescribed medications and ice application, remain important throughout this period.
A gradual return to normal activities is crucial to prevent re-injury and support proper healing. Patients should avoid high-impact activities, heavy lifting, and any movements that put direct pressure on the chest until cleared by a healthcare professional. This phased approach helps the sternum regain strength and stability without undue stress.
Physical therapy plays a significant role in the recovery journey, helping to restore range of motion, build strength in the surrounding muscles, and improve breathing mechanics. Specific exercises are designed to address any stiffness that may develop in the shoulders, neck, and back due to reduced movement during the initial healing phase. Regular medical check-ups and follow-up imaging are also important to monitor the healing progress and ensure the bone is mending correctly.
While most individuals recover fully, some less common complications can arise during recovery. These include chronic pain that persists beyond the typical healing period, non-union where the bone does not heal properly, or the development of a false joint (pseudarthrosis). In rare instances, infections like osteomyelitis or mediastinitis may occur. Patients should contact their doctor if they experience worsening pain, fever, shortness of breath, or a persistent cough with colored phlegm.