Sternal Fracture - Symptoms, Causes, Treatment & Prevention

Overview

A sternal fracture is a break in the breastbone (sternum), the flat bone that connects the rib cage in the center of the chest. Although the sternum is protected by the ribs, muscular tissue, and the sternocostal joints, it can crack or shatter when a significant blunt force is applied to the chest.

Who it affects: The injury most commonly occurs in adults aged 30‑70 years, especially males, due to higher exposure to high‑energy trauma (motor‑vehicle collisions, falls from height, or contact sports). Pediatric sternal fractures are rare because the bone is more flexible, but they can occur in severe accidents.

Prevalence: Sternal fractures account for roughly 0.5–1.5 % of all blunt thoracic injuries. In motor‑vehicle crashes, they are reported in up to 6 % of occupants who sustain chest trauma, making them an important marker for potentially life‑threatening injuries.

Symptoms

Symptoms can range from mild discomfort to severe, life‑threatening pain. Common findings include:

• Chest pain – Sharp, stabbing, or tearing pain that worsens with deep breathing, coughing, or movement of the upper body.
• Localized tenderness – Palpable pain over the mid‑sternum or at the fracture’s edges.
• Swelling or bruising – Visible discoloration or a palpable lump may develop over days.
• Crepitus – A crackling sensation felt under the skin when the broken fragments move.
• Difficulty breathing – Due to pain‑induced shallow breathing (splinting).
• Rapid, shallow respirations – The body’s response to pain and reduced lung expansion.
• Radiating pain – Pain may travel to the shoulders, upper back, or neck.
• Associated injuries – Because sternal fractures often result from high‑energy trauma, patients may also experience rib fractures, pulmonary contusion, cardiac contusion, or aortic injury.

Symptoms typically appear immediately after the trauma but may be delayed for several hours, especially if swelling obscures the area.

Causes and Risk Factors

Primary Causes

• Motor‑vehicle collisions – The most common cause; the force of a sudden deceleration can compress the sternum against the steering wheel or seatbelt.
• Falls from height – Landing on the chest or a hard surface transmits enough force to fracture the bone.
• Contact sports – Football, rugby, hockey, and martial arts can produce direct blows to the chest.
• Physical assault – Direct punches or kicks to the chest.
• Industrial accidents – Being struck by heavy objects or machinery.

Risk Factors

• Age – Bone density decreases with age, making older adults more susceptible.
• Male gender – Higher exposure to high‑energy trauma.
• Osteoporosis or low bone mineral density – Weakens the sternum.
• Seat‑belt misuse – Improper positioning increases focal pressure on the sternum.
• High‑speed collisions – Greater kinetic energy translates to higher fracture risk.

Diagnosis

Accurate diagnosis is essential because a sternal fracture can mask or coexist with more serious thoracic injuries.

Clinical Evaluation

• History – Details of the mechanism of injury, onset of pain, and associated symptoms.
• Physical exam – Palpation of the sternum for tenderness, crepitus, deformity, and assessment of respiratory effort.

Imaging Studies

• Chest X‑ray – First‑line tool; detects obvious fractures, displacement, and associated rib fractures. Sensitivity is limited for nondisplaced sternal fractures.
• Computed Tomography (CT) scan – Gold standard. Thin‑slice, multidetector CT provides detailed images of bone fragments, displacement, and any concurrent mediastinal injury (e.g., cardiac contusion, aortic injury). Often performed for high‑energy trauma.
• Ultrasound (Point‑of‑care) – Can identify superficial fractures and guide pain‑relieving injections, but not reliable for deep or nondisplaced fractures.
• Magnetic Resonance Imaging (MRI) – Reserved for evaluating soft‑tissue injury (e.g., myocardial contusion) when CT is contraindicated.

Additional Tests

• Electrocardiogram (ECG) – To screen for cardiac contusion or arrhythmias.
• Cardiac enzymes (troponin) – Elevated levels may indicate myocardial injury.
• Pulmonary function tests – Rarely needed, but may be useful in persistent dyspnea.

Treatment Options

Treatment is dictated by fracture severity, displacement, and presence of associated injuries.

Conservative Management

• Analgesia – First‑line pain control:
  • Acetaminophen + NSAIDs (ibuprofen, naproxen) unless contraindicated.
  • Short‑course opioids (e.g., oxycodone) for severe pain, used sparingly.
• Chest physiotherapy – Incentive spirometry and deep‑breathing exercises to prevent atelectasis and pneumonia.
• Immobilization – No rigid brace is routinely required; a snug, supportive chest binder may be used for comfort in the first few days.
• Activity modification – Limit heavy lifting, strenuous upper‑body activities, and contact sports for 4‑6 weeks.

Interventional Options

• Closed reduction – Rarely needed; performed when fragments are significantly displaced but still amenable to non‑surgical realignment.
• Surgical fixation – Indications include:
  • Severe displacement or comminution.
  • Persistent pain despite optimal analgesia.
  • Associated flail chest or unstable thoracic cage.
  • Concurrent cardiac or great‑vessel injury requiring thoracotomy.

  Techniques involve plating or wiring the fragments under general anesthesia. Post‑operative care includes pain management and gradual return to activity.

Adjunctive Care

• Vaccinations – If the patient has a splint or brace that may limit mobility, ensure up‑to‑date pneumococcal and influenza vaccines to reduce infection risk.
• Psychological support – Trauma patients may develop anxiety or PTSD; counseling or referral to mental‑health services can be beneficial.

Living with Sternal Fracture

Most patients recover fully within 6‑12 weeks, but proper self‑care can hasten healing and prevent complications.

Daily Management Tips

• Pain control – Take medications as prescribed; use a cold pack (15 min on, 30 min off) for the first 48 hours to reduce swelling.
• Breathing exercises – Perform incentive spirometry 10‑15 breaths every hour while awake for the first few days.
• Posture – Sit upright with shoulders back; avoid slouching which increases chest wall pressure.
• Sleep – Use a supportive pillow and sleep on the back or side with a pillow placed under the arm on the injured side to reduce stretch.
• Activity progression – Gradually increase activity:
  1. Week 1–2: Light household tasks, short walks.
  2. Week 3–4: Light resistance band work for the lower body.
  3. Week 5‑6: Gentle upper‑body strengthening (e.g., wall push‑ups).
  4. Beyond week 6: Return to normal activities if pain‑free and physician clears.
• Nutrition – Adequate protein (1.0‑1.2 g/kg/day), calcium (1,000 mg), and vitamin D (800‑1,000 IU) support bone healing.
• Follow‑up appointments – Typically at 1‑2 weeks, then at 6‑8 weeks to reassess healing via repeat X‑ray or CT if indicated.

Prevention

Because most fractures stem from high‑energy trauma, prevention focuses on reducing accident risk and protecting the chest during unavoidable impacts.

• Seat‑belt use – Wear a properly positioned three‑point restraint; the shoulder strap should cross the chest, not the neck.
• Vehicle safety – Choose cars with airbags and advanced crash‑worthiness; ensure airbags are functional.
• Protective equipment in sports – Use chest protectors in football, hockey, and rugby; ensure they meet safety standards.
• Fall prevention – Install handrails, maintain clear walkways, and address vision or balance issues in older adults.
• Bone health maintenance – Regular weight‑bearing exercise, adequate calcium/vitamin D intake, and screening for osteoporosis in at‑risk populations.
• Workplace safety – Follow OSHA guidelines for handling heavy objects and wearing appropriate protective gear on construction sites.

Complications

While many sternal fractures heal uneventfully, delayed or missed diagnosis can lead to serious outcomes.

• Cardiac contusion – Bruising of the myocardium can cause arrhythmias, heart failure, or even cardiac rupture.
• Great‑vessel injury – Traumatic aortic or pulmonary artery damage may present later with chest pain or haemodynamic instability.
• Pneumothorax / hemothorax – Air or blood accumulation in the pleural space from associated rib fractures.
• Flail chest – Multiple rib fractures leading to paradoxical chest movement, compromising ventilation.
• Non‑union or malunion – Persistent pain, deformity, or limited chest wall movement if the fracture does not heal properly.
• Post‑traumatic stress disorder (PTSD) – Psychological sequelae after severe accidents.

When to Seek Emergency Care

References

• Mayo Clinic. Sternal fracture. Accessed May 2026.
• Centers for Disease Control and Prevention (CDC). Traumatic Injuries. 2023.
• National Institutes of Health (NIH). Epidemiology of Sternal Fractures. 2012.
• World Health Organization. Road Traffic Injuries. 2021.
• Cleveland Clinic. Sternal Fracture. Updated 2024.
• American College of Surgeons. ATLS Guidelines for Thoracic Trauma. 2022.