In this guide, I will cover, in easy-to-understand terms, what sternal fractures are, when they are most likely to occur, and why it is sometimes essential to surgically stabilise the sternum.
The sternum, or breastbone, is a flat bone in the centre of the chest that connects to the ribs and protects vital organs like the heart and lungs.
The sternum consists of three distinct parts: the manubrium at the top, the body (or gladiolus) in the middle, and the small xiphoid process at the bottom. Together, these sections form a protective barrier that’s both strong and surprisingly flexible. When functioning correctly, your sternum allows your chest to expand and contract naturally during breathing while providing structural support for your entire torso. Cartilage also connects the ribs to the sternum and can be broken in rare cases.
Traumatic Sternal fractures typically result from significant blunt chest trauma. The most common cause is motor vehicle collisions, particularly when the driver or passenger’s chest strikes the steering wheel or dashboard (deceleration injuries). However, these injuries can also occur from:
Insufficiency fracture
Sports-related collisions
Falls from significant heights
Physical altercations
Stress Fracture
Workplace accidents
A sternal fracture is a break in the breastbone that weakens the anterior chest wall. Sternal fractures are more complex than typical bone injuries because of their location near vital organs. Unlike fractures of the arms or legs, sternal fractures carry unique implications due to their location and the essential structures they protect.
When I see a patient with a suspected sternal fracture, I’m not just looking at a broken bone. I’m evaluating the potential for underlying cardiac injury, pulmonary complications, and pulmonary contusion, and the overall impact on the patient’s breathing and circulation.
When antibiotics and simple chest tube drainage fail to resolve the infection, doctors must consider surgical options. Studies show that delayed surgical intervention can lead to prolonged hospital stays, increased complications, and higher healthcare costs.
With suspected sternal fractures, we follow a systematic approach; time is critical, not just for the fracture itself, but for any associated injuries that might be life-threatening.
The healthcare provider begins with a thorough physical examination, carefully palpating the chest wall to identify areas of tenderness, deformity, or instability. They’ll also assess breathing patterns, listen to heart and lung sounds, and check for signs of associated injuries. A thorough history is also always taken.
Because the sternum is close to the heart, patients with sternal fractures often receive cardiac monitoring to detect signs of heart injury or rhythm abnormalities.
While standard chest X-rays can sometimes miss sternal fractures, they’re still the initial imaging study of choice. They help rule out other chest injuries and may show indirect signs of a sternal fracture.
Computed tomography is the gold standard for diagnosing sternal fractures. CT scans provide detailed images that can reveal even subtle fractures and help assess for associated injuries.
This specialised view can sometimes better visualise sternal fractures than standard frontal chest X-rays.
Blood tests, including cardiac enzymes, may be ordered to check for heart muscle damage that could indicate associated cardiac injury.
Not all sternal fractures are created equal. Medical professionals classify these injuries based on several factors, each of which affects treatment decisions and prognosis.
The treatment of sternal fractures has evolved significantly over the past several decades. The approach depends on numerous factors, including fracture type, patient age, associated injuries, and overall health status.
For most patients with stable, isolated sternal fractures, conservative treatment remains the cornerstone of management. This approach focuses on pain control, monitoring for complications, and supporting the body’s natural healing process.
Pain Management: Effective pain control is crucial for proper healing and the prevention of complications. Treatment typically includes:
Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
Prescribed pain medications for severe pain
Muscle relaxants for associated muscle spasms
Topical analgesics for localised relief
Activity Modification: Doctors typically advise patients to:
Avoid heavy lifting (usually anything over 10-15 pounds initially)
Limit overhead arm movements
Gradually increase activity as healing progresses
Topical analgesics for localised relief
Breathing Exercises: To prevent pulmonary complications, patients are taught specific breathing exercises and may work with respiratory therapists.
While most sternal fractures heal well with conservative treatment, certain situations may require surgical intervention:
Indications for Surgery:
Severely displaced fractures
Unstable chest wall (flail chest)
Associated cardiac or significant vascular injury
Failed conservative treatment
Chronic pain syndromes
Surgical Techniques: Modern surgical repair of sternal fractures may involve:
Internal fixation with plates and screws
Wire cerclage techniques
Bioabsorbable implants
Minimally invasive approaches
The first two weeks after the injury are the most challenging. The pain is significant, making simple activities like getting dressed or sleeping difficult.
Physical therapy played a crucial role during this time. Sarah worked with Lisa Martinez, a physical therapist experienced in treating chest injuries.
A typical physical therapy program included:
The middle phase of recovery brought both challenges and encouragement.
During this phase, treatment focused on:
As our understanding of chest wall injuries continues to evolve, several trends are shaping the future of sternal fracture care:
How Do We Find the Right Treatment for You?
Treatment approaches are becoming increasingly individualised based on patient-specific factors, including genetics, healing capacity, and lifestyle factors.
The management of sternal fractures continues to evolve, with new techniques and technologies offering improved patient outcomes. However, the fundamental principles remain constant: careful assessment, appropriate treatment, patience with the healing process, and comprehensive support for the patient’s physical and emotional well-being.
For anyone facing a sternal fracture diagnosis, remember that while the journey may be challenging, the vast majority of patients go on to make complete recoveries and return to their normal activities. With proper medical care, patience, and support, the human body’s capacity for healing truly is remarkable.
The story of sternal fractures is ultimately one of hope—a testament to medical advancement, human resilience, and the power of comprehensive, compassionate care in facilitating healing and recovery.Treatment approaches are becoming increasingly individualised based on patient-specific factors, including genetics, healing capacity, and lifestyle factors.
If you or someone you know has experienced chest trauma, it’s vital to seek immediate medical attention. This article is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment.
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