Fractured Sternum: Causes, Symptoms, Treatment, Exercise, Prognosis, Signs

A fractured sternum or a sternal fracture occurs when there is a break or a crack in our breastbone which is also known as sternum. The sternum is a long vertical bone present in the center of our chest, which along with the 12 ribs, forms the anterior part of our chest. The sternum along with the ribs (to which it is also attached) forms a protective enclosure for tissue and vital organs including the lungs and the heart. A direct blow to the chest can result in a fractured sternum or sternal fracture. The most common cause for this is trauma occurring in motor vehicle accidents where the steering wheel hits the chest of the driver. If the impact of the blow is less, then it can cause a bruised sternum. Diagnosis of a fractured sternum can be confirmed with a chest x-ray or CT scan. A fractured sternum can usually heal on its own; but needs rest, cold compresses and medication to speed up the healing process. As the force or the impact required for fracturing the sternum is quite high, there is always a risk of damage to other organs and structures of the body, such as the vertebrae, ribs, lungs, heart, soft tissue and adjacent blood vessels. The injury to the heart and lungs can be very serious in nature and tend to occur if there is a severe or a displaced fracture.

Fractured sternum can also be seen during a physical examination. Immediate medical attention should be sought if there is a suspicion of a fractured sternum.

As mentioned before, a direct and traumatic blow caused by an object or a person to the chest is the common cause for a fractured sternum or sterna fracture. This is often seen during motor vehicle accidents where the chest forcefully hits the seat belt or the steering wheel.

Sports injuries, which are violent in nature, such as rugby and hockey where a person can be hit by a ball, can also cause a fractured sternum.

• Symptoms of fractured sternum or sternal fracture should not be ignored, as they can cause further damage and slow down the healing process or even prevent healing of the fracture.
• Patient feels an abrupt onset of pain in the chest when the injury occurs. Patient with fractured sternum also feels spasm type of sensation in the center of the chest.
• The pain associated with fractured sternum is often intense and sharp in nature and increases when the patient coughs, deeply inhales, sneezes or laughs.
• The ache present in the front of the chest can worsen during night or immediately after getting up in the morning.
• Pain is felt upon firm pressure to the sternum at the site of fracture.
• Pain associated with broken sternum increases when the patient is lying down in certain positions, such as on the side or face down.
• Pain is also felt with certain movements of the chest and upper back such as bending forwards, sideways, twisting or arching backwards. Certain movements of the upper limb can also cause pain such as pulling, pushing, heavy lifting and overhead activities.
• There is swelling as well as bruising in the area of the fracture.
• In severe cases of a fractured sternum, there is bony displacement, which appears as an obvious deformity.
• Patient may also find difficulty in breathing if there is a fractured sternum. Heavy breathing causes pain or pressure sensation which is quite uncomfortable.
• The chest area can be visibly deformed if there has been a sternum fracture, as the break in the sternum causes an indentation on the chest that can be felt or seen.

• A thorough physical examination is conducted by the doctor for diagnosis of a fractured sternum and to assess if there is any damage to other structures and organs, such as the heart or the lungs.
• An x-ray is needed to confirm the diagnosis of a fractured sternum.
• Other tests, such as CT scan or MRI scan also helps in confirmation of the diagnosis. They also help in assessing the severity of fracture of the sternum.
• Other tests are also done to assess the function of the heart and lungs.

• Treatment for fractured sternum depends on the severity of the fracture and also includes excluding other serious conditions, such as damage to the lungs, heart, local blood vessels and other vital organs.
• Treatment for fractured sternum or sternal fracture usually consists of rest especially from activities which worsen the pain, such as lying face down and application of pressure on the site of injury. Rest allows the sternal fracture to heal faster without causing more damage. Rest alone with activity restriction is often sufficient for treating minor fractures in the sternum. The average time needed for healing a fractured sternum or sternal fracture is about 2 to 3 months.
• The fractured sternum also needs to be confirmed as to whether it is a minor and non-displaced fracture or a more serious fracture.
• Treatment for a fractured sternum also comprises of educating the patient about his/her injury.
• Cold compresses or ice application in the acute phase of the injury, which is the first 72 hours, helps with reducing the pain and swelling associated with fractured sternum. Ice application can be done for about 15-20 minutes for every couple of hours. Direct application of the ice to the skin should be avoided as it can damage the skin.
• Medications, such as pain killers are prescribed to alleviate pain and swelling. Pain in a fractured sternum causes restriction on respiration of the patient, such as coughing and deep breathing. This increases the risk of developing pneumonia. Pain killers also help in relieving pain felt from coexisting injuries, such as a collapsed lung, broken ribs or heart contusions. Anti-inflammatory medications, such as naproxen and ibuprofen, also help in relieving pain, swelling and inflammation. In severe pain, narcotics can be prescribed, but the smallest effective dose should be given to avoid respiratory depression.
• Joint immobilization helps in speedy healing of the fracture along with helping the fracture to heal in its proper alignment.
• Deep breathing exercises, which do not cause pain, are recommended in order to prevent localized collapse of the lungs. But these should be done once the healing of the fractured sternum or sternal fracture is complete.
• Surgery is needed in severe cases of a fractured sternum, which has bony displacement and also if the patient has difficulty in breathing. Surgery helps in restoring the bony alignment and in attaching the bones with the help of plates or pins.
• Persistent severe pain and the need for continued ventilator support also indicates that surgery may be needed. The fragments of the bone are removed and the remaining pieces of the bone are joined together using wires, plates and screws.
• Once the fractured sternum has healed, patient can make a gradual return to his/her activities, as long as there is no worsening of the symptoms. Healing time for fractured sternum or sternal fracture can take about a few weeks to months with treatment.
• Exercises which help in improving the flexibility, strength and posture should be started once complete healing of fractured sternum has been achieved in order to prevent weakness and stiffness. The exercises should be done under the supervision of an experienced physiotherapist to avoid any re-injury.
• There should be a gradual return to the patient’s daily activities or sports. Athletes should use chest guards or protective padding when returning back to sports to prevent future sternal fractures and other injuries.
• Electrotherapy for fractured sternum or sterna fracture can also be done as it is beneficial with the healing process.
• Sometimes, there is no improvement in a fractured sternum despite the right treatment/management. In such cases, the attending physician is the best person to decide on the appropriate course of treatment. Further investigations may be done, such as x-rays, MRI or CT scan. The patient can be referred to other specialties also if required.

The prognosis of a fractured sternum is often good. If there is an isolated sternum fracture with no damage to other important organs and structures to the body, then the patient can make a complete recovery with the right treatment/management. Patient can usually return to his/her normal activities or sports in about 2 to 3 months. However, regaining complete strength takes more time, especially if the patient is actively returning to sports. Severe sternal fractures, especially which need surgery or sternal fracture which involves other organs or structures, need more time to heal before achieving complete recovery. Physiotherapy can be started for a fractured sternum after achieving complete healing.

Given below are some exercises, which help in the different stages of the recovery process of a fractured sternum. These exercises should be done under the guidance of a doctor or a physiotherapist and should only be done if the patient is no longer having any symptoms.

• Stand up keeping your back straight (or you can sit straight also).
• Try to inhale as deeply as possible so that there is no worsening of the symptoms.
• Concentrate on your breathing using your lower lungs.
• Avoid elevating your shoulders and let your stomach expand gently.
• Repeat this exercise about 5 times for thrice a day.

• Stand up keeping your back straight (or you can sit straight also).
• Squeeze your shoulder blades together as much as possible, but it should be pain-free.
• Hold this position for a couple of seconds.
• Repeat this for 10 times about thrice a day; however, there should be no worsening of the symptoms.

• Sit straight and fold your arms across your chest.
• Do not move your legs and keep them still.
• Rotate them gently to one side till you feel a mild to moderate stretch which should be pain free.
• Hold this position for a couple of seconds.
• Repeat this exercise for 10 times about thrice a day.

Also Read:

• Pain in Sternum: Causes, Symptoms, Treatment