The sternum is a flat, T-shaped bone positioned in the center of the chest. It connects to the ribs via cartilage, forming the front portion of the rib cage. It protects vital organs within the chest, including the heart, lungs, and major blood vessels. A broken sternum typically results from significant blunt force trauma to the chest.
Diagnosing a Sternum Fracture
Diagnosis begins with a patient history to understand how the injury occurred. This is followed by a physical examination where the area is checked for localized pain, tenderness, bruising, or any visible deformity. Sometimes, a crunching sound, known as crepitus, or a palpable step-off at the fracture site may be present.
Imaging tests are then used to confirm the diagnosis and assess the extent of the injury. A lateral chest X-ray is often the initial diagnostic tool. For a more detailed assessment or to identify associated injuries, a computed tomography (CT) scan of the chest is often used. CT scans can reveal additional thoracic injuries.
Treatment Options
The approach to treating a sternum fracture depends on the severity of the break. Most sternum fractures are managed non-surgically. This conservative management primarily involves pain control through medication, including over-the-counter or prescription pain relievers. Applying ice packs to the affected area regularly can also help reduce swelling and discomfort.
Rest and activity modification are also important components of non-surgical treatment. Patients are advised to avoid activities that place pressure on the chest, cause discomfort, or involve heavy lifting or twisting movements. The sternum generally heals on its own over time with proper support and reduced strain.
In some cases, surgical intervention may be necessary, although this is less common for isolated sternum fractures. Surgery is typically considered for severe displacement of the bone fragments, persistent and unmanageable pain, non-union (when the bone fails to heal), or if the fracture affects breathing. The main goal of surgery is to stabilize the fractured bone, which can promote healing and alleviate pain.
Navigating Recovery
Recovery from a sternum fracture usually involves a healing period of approximately 4 to 6 weeks for the bone itself, though pain and discomfort may persist for several months. During this time, managing pain at home is important, often with prescribed medication and continued application of ice. It is advisable to get plenty of rest and avoid activities that might strain the chest, such as lifting heavy objects or engaging in strenuous upper body movements.
Deep breathing exercises are an important part of recovery to prevent lung complications like pneumonia. Patients are encouraged to take slow, deep breaths every hour, even if it causes some discomfort, and to cough gently to clear the lungs. Holding a pillow against the chest can provide support and make these actions less painful. Regular follow-up appointments with a healthcare provider are important to monitor the healing process and ensure a safe, gradual return to normal activities.
Possible Issues
While many sternum fractures heal without complications, some issues can arise. Persistent pain is a common concern and can last for 8 to 12 weeks or even longer after the initial injury. In rare instances, the bone may not heal correctly, a condition known as non-union, or it may heal in an improper alignment, called malunion. These issues can lead to chronic pain and may sometimes require surgical correction.
Of greater concern are potential associated internal injuries, as the force required to fracture the sternum can also affect nearby organs. These can include injuries to the heart, lungs, or major blood vessels. Symptoms such as new or worsening trouble breathing, increased pain, dizziness, a fever, or a new or worsening cough warrant immediate medical attention.