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The breastbone or sternum is the long, flat bone found at the center of the chest, just beneath the skin. Attached to it are the collar bones (clavicles) and ribs. Together they protect the soft tissues underneath, such as the heart, lungs and large blood vessels.

Fractures of the sternum are not common, accounting only for less than 0.5% of all fractures. Sternal fractures are often associated with blunt trauma to the chest, and most of these (up to 90%) are due to the chest striking the steering wheel during car accidents. Other causes of sternal fractures include sports-related trauma (contact sports) or stress (in golf and weight lifting), falls, assault, osteoporosis, and trauma after cardiopulmonary resuscitation.

Closed sternal fractures (with no open wound) are often missed during initial workups for trauma evaluation because chest x-rays taken in the lateral view (which are diagnostic for sternal fractures) are not obtained. Unstable or displaced sternal fractures are not common and they are usually associated with complications, including soft tissue trauma to the organs beneath.

Symptoms of sternal fractures include pain over the breastbone (most common), difficulty in breathing, and bruising. Palpitations (irregular heart beats) may be detected if the heart is affected.

Serious complications are not common unless other injuries to the heart, lungs, ribs, or other parts of the body are present.

Imaging studies help confirm an initial suspicion of fracture of the sternum. These include chest x-rays, CT scanning, and ultrasonography. Other tests may be done if there are other associated injuries.

In most patients with closed sternal fractures, no treatment is necessary, except for pain relievers. Patients are usually advised to do deep breathing exercises to prevent lung complications. They are also advised to avoid lifting heavy objects, overhead lifting, pulling and pushing objects. Healing of uncomplicated closed sternal fractures takes several weeks, but they usually heal on their own with no need for hospitalization.

Complications of Sternal Fractures

Aside from associated soft tissue injury to the heart, lungs, blood vessels or bone injury (spine, clavicles, ribs, etc), other possible complications include osteomyelitis (bone infection), soft tissue infection, pneumonia, collapsed lung, and non-union of the bone fragments of the sternum.

Non-union or mal-union of fractured sternum can cause deformity and intractable pain when breathing.

The treatment for this type of complication may involve conservative methods or surgery. Conservative treatment by closed reduction may be done by hyperextending the spine. The patient is asked to lie on his back with a pillow under the thoracic spine to realign the bone fragments.

If conservative treatment does not fix the deformity, open reduction may be done. This involves sewing together the bone fragments in a figure-of-eight style with the use of sutures or stainless steel wires. More recently, it has been found that applying a T-shaped compression plate to the bone fragments provide a stable alignment of the bones and better healing.

If you have experienced blunt trauma to the chest, you must seek medical evaluation and care, especially if there is significant pain, difficulty in breathing, and other symptoms. Although sternal fractures are not often serious, associated soft tissue trauma to the underlying structures may be present and may cause complications.

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