A sternum fracture, or broken breastbone, is an injury often resulting from high-impact events. It can cause pain and may indicate other internal injuries.
Understanding the Injury
The sternum is a flat, elongated bone situated in the center of the chest. It connects to the ribs via cartilage, forming the front of the rib cage. It protects vital organs like the heart and lungs from external trauma.
Sternal fractures most frequently occur due to direct, blunt force trauma to the chest. Motor vehicle collisions are a leading cause, accounting for 60% to 90% of cases, often when the chest strikes the steering wheel or is impacted by a seatbelt during sudden deceleration. Other common mechanisms include falls from significant heights, high-impact sports injuries, and physical assaults. Less commonly, sternum fractures can result from cardiopulmonary resuscitation (CPR) or as stress fractures in individuals with weakened bones or those engaging in repetitive upper body activities.
Recognizing the Signs
Individuals with a sternum fracture typically experience chest pain. This pain is often sharp and intense, worsening with movements such as deep breathing, coughing, sneezing, or laughing. The area over the sternum becomes tender, and there may be visible bruising and swelling.
In some cases, a palpable “step” or an obvious deformity may be present along the fracture line, indicating a displaced break. Discomfort may also occur with movements of the upper back and chest, like twisting or bending, and with arm movements such as pushing, pulling, or lifting. Shortness of breath can also occur, affecting up to 20% of patients, often due to pain preventing full lung expansion.
Diagnosis and Medical Evaluation
Confirming a sternum fracture typically begins with a physical examination. A healthcare provider assesses the chest for tenderness, swelling, and deformities, and listens to the patient’s breathing. Following this, imaging tests are performed to visualize the bone and determine the injury’s extent.
Lateral chest X-rays are often used, though a CT scan is more sensitive for identifying sternal fractures, displacements, and potential internal thoracic injuries. An ultrasound may also be employed. Associated injuries to underlying organs, such as the heart and lungs, are also assessed. This evaluation may involve cardiac monitoring, electrocardiograms (ECGs), and in some cases, echocardiography to rule out heart bruising or other cardiac complications.
Treatment Approaches
Most sternum fractures are managed conservatively without the need for surgery. Conservative treatment focuses on managing pain, promoting adequate breathing, and healing through rest. Pain relief can be achieved with over-the-counter medications like acetaminophen or ibuprofen; stronger prescription medications may be provided for severe pain. Applying ice packs to the chest for 10-20 minutes at a time, several times a day, can help reduce swelling and discomfort.
Patients are advised to avoid activities that put pressure on the chest, such as heavy lifting, pushing, or pulling, until the pain subsides. While surgery is uncommon for sternum fractures, it may be considered for severe, unstable, or significantly displaced fractures, or in rare cases of chronic pain or non-union where the bone fails to heal. The decision for surgical intervention is based on the fracture’s stability, displacement, and the presence of complications.
Recovery and Healing
The healing process for a sternum fracture can take several weeks to months, with pain gradually improving. Most patients recover fully within an average of 10 weeks, though some may experience discomfort for up to 3 months or longer, especially with more severe injuries. During recovery, individuals should avoid strenuous activities and any movements that aggravate chest pain.
Physical therapy plays a role in rehabilitation, focusing on pain reduction, restoring range of motion, and preventing complications. Deep breathing exercises are encouraged to improve lung function and reduce the risk of respiratory complications like pneumonia, which can occur if shallow breathing leads to fluid buildup in the lungs. Supporting the chest with a pillow while coughing can make this less painful. Gentle range-of-motion exercises for the arms and shoulders are recommended to prevent stiffness, while avoiding movements that cause sternal tension for up to three months. Patients are advised to gradually increase activity levels and consult their healthcare provider if pain persists or new symptoms develop.