What is a sternal fracture?
A sternal fracture is the term for a break or fracture of the sternum, more commonly known as the breastbone. The rib cage consists of 24 ribs, 12 on each side joining to the thoracic spine at the back and the sternum (breastbone) at the front, forming the chest wall. The breastbone not only provides the attachment site for the ribs but also for the 2 clavicles (collar bones) and additionally provides protection for the internal organs of the chest. Occasionally a sternal fracture is classed as a stress fracture this is similar to a fracture only the break along the sternum is incomplete and more like a crack than a break
Why and when do sternal fractures happen?
The most common cause of a sternal fracture is a direct trauma to the chest. It is estimated that 60-90% of sternal fractures happen as a result of motor vehicle accidents, often caused by the violent compression of the chest against the seatbelt or steering wheel. The incidence rate of sternal fractures from a car accident has decreased since the implementation of airbag safety. Sternal fractures often happen as a tackle injury during contact sports or from being struck by a ball, bat or stick in other sports. Sternal fractures have been known to be caused by minor injuries like mild knocks to the chest or falls this typically only happens when there is an underlying bone weakening condition like osteoporosis and therefore is more commonly seen in the elderly, in particular elderly females. A sternal fracture is considered a medical emergency as the original injury, impact or fractured bone can cause serious injury to organs, arteries and nerves of the chest.
What does a sternal fracture feel like?
A sternal fracture from trauma causes a very intense immediate sharp pain around the fracture site this pain can radiate around into the sides, up into the neck, round into the mid back or down into the abdomen. The fracture is often accompanied by swelling and bruising and aggravated by most movements that use the pectoral muscles including arm and neck movements. There will be a certain amount of discomfort whilst breathing with deep breathing or coughing causing excruciatingly sharp pains. Pressure over your breastbone will reproduce sharp pains making it awkward to sleep on your side or front.
The intense pain after a break will last for several hours to days which will be aggravated by movement and examination. When the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a sternal fracture be diagnosed?
Patients will be taken to A&E and a full examination of your chest and lungs will be done to rule out any additional injuries or complications. Your doctor will order a chest X-ray to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally if the extent of the fracture isn’t fully visible on an X-ray then an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Doctors may also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the muscles, ligaments or cartilage and not indeed from a fracture. The occurrence of a chest fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for sternal fractures?
There is no specific treatment for sternal fractures only supportive measures to help with the pain control and rest. Healing times for sternal fractures vary depending on the position and severity of the fracture and also on the complications from any additional injuries. Most cases of sternal fractures do not need surgery however it is occasionally necessary to surgically stabilise displaced fractures were the fractured pieces of sternum has broken away. Patients will initially have to rest and avoid aggravating activities whilst recovering, which includes activities like pulling open heavy doors and lying on their front. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling and will most likely advice you to apply a covered ice pack to the area for 10-15 minutes with 30 minute intervals. A sternal fracture can take anything from 8 -12 weeks to heal if not longer for more severe breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen and mobilise the upper body to aid the healing process as well as breathing exercises. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. Rehabilitation exercises as well as massage and some manipulative therapies will aid in recovering the mobility in your chest and mid back. It is recommended that you only use these therapies once your sternum has completely healed. It is advisable that you concentrate on the rehabilitative exercises before attempting to return to any aggravating activities, gentle Yoga or Pilates is ideal for strengthening your posture and upper body strength. Any return to playing sports in particular contact sports should be staged gradually over a couple of weeks to a month to prevent any further damage or flare up.