(Also known as a fractured sternum, sternum fracture, broken sternum)

What is a sternal fracture?
A sternal fracture is a break in the sternum (breast bone) situated at the front of the chest.

The chest comprises 12 rib bones in addition to the sternum, forming the front wall of the chest. The sternum provides the attachment point for the two clavicles (collar bones) on either side of the upper chest and the upper seven ribs.

Following a direct blow to the chest, stress is placed on the sternum, which may cause injury. This can result in a bruised sternum, or, if the impact is traumatic and beyond what the bone can withstand, a break may occur. When the latter occurs, the condition is known as a sternal fracture.

Due to the large forces required to break the sternum bone, a sternal fracture may be associated with damage to other structures and organs of the body such as the ribs, vertebrae, heart, lungs, soft tissue and local blood vessels. These injuries (particularly to the heart and lungs) may be very serious and are more common if the fracture is severe and/or displaced.

Cause of a sternal fracture
A sternal fracture usually occurs following a traumatic, direct blow to the chest from an object or person. This most commonly occurs due to a car accident whereby the moving chest strikes the steering wheel or seat belt. Occasionally it may occur due to a collision with another player during contact sports, or from an impact from a ball in sports such as hockey or cricket.

Signs and symptoms of a sternal fracture
Patients with a sternal fracture typically experience a sudden onset of chest pain at the time of injury. Pain is often sharp and intense and may increase during deep breathing, coughing, laughing or sneezing. Patients may also experience an ache in the front of the chest that is particularly prominent at night or first thing in the morning (particularly in the first few days following injury). Pain may increase when lying down in certain positions (such as face down or on your side) and on firmly touching the sternum. Swelling and/or bruising may also be evident. In severe sternal fractures with bone displacement, an obvious deformity may be present. Patients with this condition may also experience pain with certain movements of the upper back and chest (such as twisting, bending or arching backwards) and with certain movements of the upper limb (such as pushing, pulling, heavy lifting or with overhead activities).

Diagnosis of a sternal fracture
A thorough subjective and objective examination from a physiotherapist or doctor is important to assist with diagnosis of a sternal fracture and to determine the likelihood of associated damage to other organs such as the lungs (e.g. a pneumothorax) or heart. An X-ray is required to confirm diagnosis. Other investigations such as an MRI or CT scan may also be performed to confirm diagnosis and assess the severity of injury, as well as other tests to assess heart and lung function.

Treatment for a sternal fracture
Before commencing treatment, patients with a sternal fracture should undergo a thorough medical examination to exclude serious conditions such as damage to the heart, lungs, local blood vessels or other vital organs. Once these conditions have been excluded, and the sternal fracture has been confirmed as only minor and non-displaced, treatment will typically consists of rest from aggravating activities, pain relieving medication and the encouragement of pain free deep breathing exercises to prevent the lungs collapsing.

In more severe sternal fractures, such as those with bone displacement, surgical intervention may be required to restore bone alignment and fixate the bones using pins or plates.

It is important that all patients with a fractured sternum rest sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the sternum should also be avoided, particularly lying face down and applying direct pressure or impact to the chest. Rest from aggravating activities allows the healing process to take place. Once the patient can perform these particular activities pain free, and, once healing has been confirmed, a gradual return to these activities is allowed, provided there is no increase in symptoms. This should take place over a period of weeks or months with direction from the treating physiotherapist or surgeon.

Ignoring symptoms or adopting a ‘no pain no gain’ attitude is likely to cause further damage and may slow healing or prevent healing of the sternal fracture altogether.

Gently icing the sternum in the initial phase of injury (first 72 hours) can assist in reducing pain and swelling. This should generally be applied on the way to receiving urgent medical attention and can be maintained for 20 minutes every two hours.

Exercises to improve posture, flexibility and strength should also be performed to prevent stiffness and weakness from developing. The treating physiotherapist can advise which exercises are appropriate and when they should be commenced.

In the final stages of rehabilitation, a gradual return to activity or sport can occur as guided by the treating physiotherapist and provided symptoms do not increase. The use of protective padding or chest guards may be required when returning to contact sports or ball sports following a sternal fracture to prevent further injury.

Prognosis of a sternal fracture
Patients with an isolated sternal fracture in the absence of damage to other structures or organs of the body usually make a full recovery with appropriate management. Patients can usually return to activity or sport in weeks or months, although care must be taken when returning to contact sports as the sternum is unlikely to regain full strength for many months. Patients with more severe sternal fractures, particularly those which require surgical correction, or when other structures have been involved, will usually require a prolonged period of management over many months before recovery can take place.

Physiotherapy for a sternal fracture
Physiotherapy treatment can assist patients with this condition and help to ensure they have a safe return to activity. Treatment may comprise:

  • Electrotherapy
  • Protective padding
  • Soft tissue massage
  • Joint mobilisation (following completion of fracture healing)
  • Exercises to improve posture, flexibility and strength
  • Breathing exercises to prevent localized lung collapse
  • Activity modification advice
  • A graduated return to activity

Other intervention for a sternal fracture
Despite appropriate management, some patients with a fractured sternum do not improve and require other intervention to ensure an optimal outcome. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan or MRI or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.