Fractured Sternum: Causes, Symptoms, and Treatment

A fractured sternum refers to a break or crack in the breastbone (also known as a broken sternum), usually caused by blunt chest trauma. This article will cover the causes, symptoms, and treatment options for a fractured sternum, providing you with essential information to understand and manage this injury.

Key Takeaways

• Sternal fractures typically result from blunt trauma, particularly car accidents and falls, with older adults being more vulnerable due to weakened bone health.

• Although a fractured sternum may appear to be a minor injury, it can result in significant pain, complications, and medical costs.

• Symptoms include sharp chest pain, swelling, and bruising, and diagnosis generally involves imaging techniques like chest X-rays and CT scans.

• Treatment ranges from conservative management for isolated fractures to surgical intervention for displaced fractures, with a favorable prognosis for most patients if managed properly.

Understanding a Fractured Sternum

A sternal fracture involves a break or crack in the breast bone, situated at the center of the chest. This flat bone plays a crucial role in protecting the heart and lungs, making any injury to it particularly concerning. A fractured sternum is considered a rare injury compared to other chest injuries, but when it occurs, it can have serious consequences. Sternal fractures are not uncommon and can result from various forms of chest trauma. Understanding the anatomy of the sternum and its significance in the chest wall helps in appreciating the severity of these injuries.

Most sternal fractures occur due to blunt chest trauma, such as that sustained in car accidents or falls. A fractured sternum is a specific type of chest injury that requires careful evaluation. Unlike rib fractures, which are more common, sternal fractures are often isolated, meaning they occur without other fractures. However, when they do occur, they can be quite painful and require immediate medical attention. This sternal injury can also be associated with other chest wall injuries and sternal injuries, including blunt anterior chest trauma, making a comprehensive understanding of the condition essential for proper diagnosis and treatment.

Sternal fractures compared to other chest injuries are less frequent but may present unique diagnostic and management challenges. Detailed evaluation, including imaging, is important to distinguish sternal fractures from other types of chest injury and to address potential complications.

Causes of Sternal Fractures

Sternal fractures often result from significant blunt trauma or sudden stopping forces. Key points include:

• Motor vehicle collisions, particularly car accidents, are a leading cause, accounting for nearly 48% of all cases. Direct trauma, such as impact with a steering wheel during a car accident, is a common mechanism leading to sternal fractures.

• The impact of a collision, especially when a seatbelt is worn, can exert considerable force on the sternum, leading to fractures.

• While seatbelt laws have saved lives, they have also contributed to an increase in sternal fractures due to deceleration injuries caused by the force exerted by the seatbelt during abrupt stops. Technical collision variables, such as speed and angle of impact, influence the likelihood and severity of sternal fractures.

Other common scenarios leading to sternal fractures include falls and sports injuries. Athletes involved in contact sports or individuals who experience a significant fall are at risk. Additionally, certain demographic factors can increase susceptibility in patients with sternal fractures. Older adults, particularly postmenopausal women and those on long-term steroid therapy, are at higher risk due to weakened bone structure and conditions like advanced osteoporosis and severe thoracic kyphosis. Intravenous drug abuse can also increase the risk of complications following a sternal fracture.

It’s crucial to understand that while anyone can sustain a sternal fracture, individuals over the age of 50 or those with weakened or inelastic bony thorax are particularly vulnerable. By recognizing these risk factors and the common causes, one can take preventive measures and seek immediate medical attention when necessary.

Symptoms of a Fractured Sternum and Chest Pain

The immediate aftermath of a sternal fracture often presents with:

• Sharp, intense chest pain localized to the center of the chest

• Pain exacerbated by certain movements, such as twisting or bending the upper body

• Shortness of breath, making it difficult to carry out everyday activities comfortably

Swelling and bruising around the sternum are common physical symptoms following the injury. These visible signs, along with tenderness and crepitus (a crackling sensation under the skin), are telltale indicators of a sternal fracture:

• Swelling around the sternum

• Bruising around the sternum

• Tenderness

• Crepitus (a crackling sensation under the skin)

These symptoms, together with imaging results such as X-rays or CT scans, make up the key clinical findings used to diagnose a fractured sternum and assess the severity of associated injuries.

In severe cases, the fracture may lead to visible deformities, such as a noticeable step or lump on the chest.

The severity of the symptoms can vary widely. While some may experience mild discomfort, others might endure severe pain that significantly impacts their quality of life. Recognizing these symptoms early and seeking medical evaluation can prevent further complications and aid in a smoother recovery process.

Diagnosing a Sternal Fracture

Diagnosing a sternal fracture involves a combination of physical examinations and imaging techniques. A chest X-ray is often the first step, providing a clear image of the sternum and helping to identify the fracture. For a more detailed evaluation, a chest CT scan can be utilized, offering a comprehensive view of the extent of the injury. These imaging techniques are crucial in assessing the degree of fracture displacement and planning appropriate treatment.

Lateral radiograph chest radiographs are considered the gold standard for diagnosing sternal fractures, offering critical views that enhance diagnostic accuracy. In some cases, bone scans may be used to detect stress fractures that are not visible on standard imaging.

Monitoring, especially in patients with unstable fractures, prevents complications and ensures effective medical treatment.

Guidelines from trauma literature, such as those found in J trauma, inform the diagnostic approach to sternal fractures and highlight the importance of thorough assessment in the context of thoracic trauma.

Treatment Options for Sternal Fractures

Treating a sternal fracture starts with immediate management to ensure the patient’s safety and comfort. This includes resuscitation, airway management, and assessing breathing and circulation. Sternal fractures can also result from chest compressions during cardiopulmonary resuscitation. For patients with significant associated injuries or major co-morbidities, hospitalization may be necessary to provide comprehensive care and monitoring. In cases of severe chest trauma, it is crucial to assess for and manage emerg trauma shock to stabilize the patient. Stable patients with isolated sternal fractures can often be discharged with pain management prescriptions and advised to follow up within 24 hours.

The treatment approach for sternal fractures can be categorized into conservative management and surgical intervention. Conservative management is typically recommended for isolated fractures, emphasizing rest and effective pain management. Surgery, on the other hand, is reserved for more severe cases involving displaced sternal fracture or nonunion.

Conservative Management

Conservative management of sternal fractures focuses on:

• Rest and pain management.

• Advising patients to avoid strenuous activities and allow the fracture to heal naturally.

• Effective pain management to improve comfort and enable proper breathing and mobility during recovery.

• Continuous monitoring for complications, such as respiratory issues, to ensure a smooth recovery process.

Physical therapy during recovery may also focus on restoring upper limb mobility and strength to support overall rehabilitation.

This approach is suitable for stable patients with isolated sternal fractures, as it promotes natural healing while minimizing the risk of additional stress on the fracture site. Adhering to these guidelines allows for gradual improvement without the need for invasive procedures.

Surgical Intervention

Surgical intervention is necessary for sternal fractures that are displaced or pressing on vital organs. Operative fixation, which may involve the use of sternal wires or more complex osteosynthesis techniques, is indicated for these severe cases. The choice of surgical procedure depends on the extent of the injury, with options ranging from simple stabilization to more intricate repair methods.

In rare cases, surgical fixation may be required for nonunion or chronic pain associated with sternal fractures. Surgical intervention may also be necessary for complications such as the development of a false joint (pseudoarthrosis) or chronic sternal pain, which can occur when the fracture fails to heal properly. Delayed surgical repair is considered for painful pseudoarthroses and overlap deformities that do not heal naturally. These procedures aim to alleviate pain and restore normal function, ensuring a better quality of life for the patient.

Complications Associated with Sternal Fractures

Sternal fractures can lead to serious complications, particularly when the fracture is displaced. These complications include:

• Injuries to vital thoracic organs, such as the heart and lungs

• Higher risk for pulmonary injuries and cardiac complications, including myocardial contusion and pulmonary contusion

• Chronic pain

• Respiratory issues affecting the patient’s overall well-being, including the potential for thoracic trauma and thoracic injury

• Chest infection, such as pneumonia, due to impaired ventilation and inadequate airway clearance after a sternal fracture

• Flail chest as a severe complication that may accompany sternal fractures

Sternal fractures are often associated with other injuries, including cardiac, pulmonary, and vascular trauma. Concomitant spinal injuries should also be assessed in patients with sternal fractures, as they can influence management and prognosis.

Older individuals and those with osteoporosis are at greater risk for delayed healing and complications. The severity of these complications can be life-threatening, with some studies indicating a mortality rate of 7.63% within 30 days of the fracture. Rib fractures, lung contusions, and haemothorax are common associated injuries, further increasing the complexity of treatment and recovery.

Managing these complications requires a comprehensive approach, including continuous monitoring and timely interventions. By understanding the potential risks, healthcare providers can better prepare for and mitigate these complications.

Prognosis and Recovery

The prognosis for most isolated sternal fracture is generally positive, with natural healing occurring over an average duration of about 10 weeks. Most individuals achieve full recovery without significant complications. The mortality rate for isolated sternal fractures is extremely low, at 0.7%, indicating a favorable outcome for most patients.

Factors like age, pain levels, and bone health can impact the recovery time, especially in elderly patients. While most stable patients do not require hospitalization, proper follow-up care is essential to ensure complete healing and address any residual pain or discomfort.

In cases of nonunion or chronic pain, surgical fixation and physical therapy may be necessary to alleviate symptoms and restore function.

Preventing Sternal Fractures

Preventing sternal fractures involves taking proactive measures to reduce the risk of injury, including:

• Avoiding high-risk activities or environments where falls are likely

• Engaging in proper body mechanics during physical activities

• Wearing seatbelts in vehicles, which is a crucial preventive measure

Additionally, practicing deep breathing exercises and taking deep breaths can help avoid pulmonary complications and other pulmonary complications during recovery, ensuring better overall health. By incorporating these preventive strategies into daily life, individuals can protect themselves from the pain and complications associated with sternal fractures. Taking a deep breath can also enhance relaxation during this process. Remember to breathe deeply for added benefits.

Healthcare Team Collaboration in Sternal Fracture Care

Effective care for patients with a sternal fracture relies on strong collaboration among a multidisciplinary healthcare team. Sternal fractures, especially those resulting from blunt chest trauma, can present with a range of complexities—from isolated sternal fractures to displaced sternal fractures and those accompanied by other associated injuries. By working together, emergency medicine physicians, trauma surgeons, cardiologists, pulmonologists, and physical therapists ensure that every aspect of the patient’s condition is addressed.

When a patient presents with chest pain following chest trauma, the healthcare team’s first priority is a thorough assessment. This includes evaluating for sternal injuries, associated injuries, and risk factors such as severe thoracic kyphosis, osteoporosis, or weakened bone, which can increase the likelihood of insufficiency fractures or unstable fractures. Early identification of these risk factors allows the team to tailor medical treatment and pain management strategies to the individual’s needs.

For most isolated sternal fractures, conservative management with rest, pain management, and monitoring for complications is sufficient. However, displaced sternal fractures, unstable fractures, or those with overlap deformities may require surgical fixation and more intensive follow-up care. The team’s expertise in recognizing different types of sternal fractures—including stress fractures and insufficiency fractures—ensures that each patient receives the most appropriate care.

Patient education is another critical component of collaborative care. The healthcare team provides guidance on deep breathing exercises to prevent pulmonary complications, as well as advice on pain management and the importance of follow-up care. This education helps patients avoid chronic pain and other long-term issues associated with sternal fractures.

Physical therapy is often integrated into the recovery plan, especially for patients with sternal fractures who are at risk for muscle mass loss or chronic pain. Physical therapists work closely with the rest of the team to help patients regain strength, mobility, and confidence, reducing the risk of disability and improving overall outcomes.

Ultimately, healthcare team collaboration ensures that patients with sternal fractures receive comprehensive, coordinated care. By combining their expertise, healthcare professionals can address the full spectrum of medical, physical, and emotional needs, leading to better recovery, fewer complications, and improved quality of life for those affected by sternal injuries.

Summary

Sternal fractures, though less common than other bone injuries, require careful attention due to their potential complications and impact on vital organs. Understanding the causes, recognizing the symptoms, and knowing the treatment options can significantly improve outcomes for those affected. Preventive measures and early diagnosis play a crucial role in managing these injuries effectively.

By staying informed and proactive, individuals can better protect themselves and seek appropriate care when needed. Awareness and education about sternal fractures can lead to timely interventions, reducing the risk of severe complications and ensuring a smoother recovery process. Remember, knowledge is the first step towards prevention and effective treatment.

Frequently Asked Questions

What are the main causes of sternal fractures?

Sternal fractures primarily occur due to blunt force trauma, with motor vehicle accidents being responsible for about 48% of cases, along with falls and sports injuries. Understanding these causes can help in prevention and awareness efforts.

What are the common symptoms of a sternal fracture?

Common symptoms of a sternal fracture include sharp chest pain, swelling, bruising, and tenderness in the affected area. In severe cases, there may also be visible deformities.

How is a sternal fracture diagnosed?

Sternal fractures are diagnosed primarily through chest X-rays and CT scans, which effectively assess the extent of the injury and inform the treatment plan.

What treatment options are available for sternal fractures?

For sternal fractures, conservative management with rest and pain relief is suitable for stable cases, while surgical intervention is necessary for displaced or nonunion fractures. It's important to assess the severity of the fracture to determine the appropriate treatment approach.

How can one prevent sternal fractures?

To prevent sternal fractures, it is crucial to avoid high-risk activities, practice proper body mechanics, and consistently wear seatbelts. Implementing these measures can significantly reduce the risk of injury.