A fractured sternum, also known as a broken breastbone, involves a break in the long, flat bone located in the center of the chest. This bone forms the front of the rib cage and protects organs like the heart and lungs. These fractures commonly result from direct impact trauma, such as car accidents (from seatbelt forces or steering wheel impact), falls from significant heights, or high-impact sports. A fractured sternum requires prompt medical attention to ensure proper healing and to identify any associated internal injuries.
Initial Medical Assessment and Diagnosis
Sternal fractures are confirmed through a diagnostic process. Diagnosis begins with a physical examination, checking for tenderness, swelling, bruising, or visible deformity over the sternum. Pain is often sharp and intense, worsening with deep breathing, coughing, or movement.
Imaging tests visualize the fracture and assess for other injuries. A lateral chest X-ray is often the initial imaging, as it can show the fracture and displacement. Computed tomography (CT) scans are effective for detecting sternal fractures and associated injuries to the heart and lungs. Ultrasound can also quickly identify sternal fractures.
Non-Surgical Management
Most sternal fractures do not require surgery and are managed conservatively. Rest allows the bone fragments to remain stable and promotes natural healing. Activity modification is necessary; avoid strenuous activities, heavy lifting, or movements that stress the chest, such as pushing or pulling, for several weeks.
Pain control is important during non-surgical management. Over-the-counter pain relievers like acetaminophen or ibuprofen are often recommended for mild to moderate pain, while prescription medication may be used for severe pain. Applying ice to the chest for 10-20 minutes at a time, several times daily, can help reduce swelling and pain. Breathing exercises are important to prevent lung complications like pneumonia, which can occur from shallow breathing due to pain. Deep breaths should be taken regularly, and supporting the chest with a pillow during coughing can make it less painful.
Surgical Intervention
Surgery for a fractured sternum is less common, as most cases heal without it. Surgery may be considered under specific circumstances. These include severe displacement of bone fragments, which can lead to instability or deformity of the chest wall. It may also be necessary if the fracture fails to heal properly (non-union) or if persistent, severe pain does not respond to conservative management.
Surgical repair typically involves stabilizing the sternum. This is achieved through techniques such as plating or wiring the bone fragments. The goal is to restore the anatomical shape and function of the chest wall, especially when underlying organs are damaged and require repair.
Recovery and Rehabilitation
Recovery from a fractured sternum typically spans several weeks to a few months, averaging 10-12 weeks for most. Pain gradually subsides, allowing for a progressive return to daily activities. Balance rest with activity, gradually increasing movement without exacerbating pain.
Avoiding re-injury means refraining from heavy lifting or contact sports for at least 4-6 weeks, or until cleared by a medical professional. Physical therapy restores chest wall mobility and strength. This may involve gentle range-of-motion exercises for the arms and shoulders, strengthening exercises for the chest and upper body, and continued breathing exercises to improve lung function. Patience is important throughout the healing process, as rushing recovery can delay healing.
Potential Complications and When to Seek Help
While most sternal fractures heal without major issues, complications can occur. These include chronic pain (persisting for weeks or months) or non-union (where the bone does not heal completely). More serious, though rare, complications involve injuries to underlying organs like the heart or lungs from the initial trauma.
Seek immediate medical attention if certain symptoms arise during recovery. These “red flag” symptoms include worsening chest pain, difficulty breathing or shortness of breath, or a fever. Signs of infection at a surgical site, such as increased redness, swelling, pus, or warmth, also warrant prompt evaluation. These symptoms could indicate a more serious underlying issue or a developing complication that requires medical attention.