You have been told you have fractured your breastbone and usually there is nothing much done about treatment apart from resting.
Are you struggling to find specific information, especially about the healing and recovery time?
As a diagnostic radiographer I have seen a few sternum fractures, and I will rely on medical studies on the subject matter to answer some of your questions.
Feel free to ask questions in the comments if needed.
Happy reading!😃
Last updated: Nov 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links
Take-home message: most sternum fractures usually heal without treatment. Recovery is between 4 to 6 weeks. However, a small number of patients may rarely develop chronic pain or non-union which may take 3 or more months.
▶️What does a sternum fracture look like?
A sternum is a breastbone in the centre of your chest, your ribs and collarbone connect to the sternum. Fractures mainly occur at the manubrium lateral chest x-ray.
Sternal fracture accounts for approximately 3% to 8% of all thoracic trauma admissions (Kara 2022). I have seen very few in x-ray since my practice.
They can be caused by direct trauma due to a motor vehicle collision, sports and falls and sometimes cardiopulmonary resuscitation (CPR)
Or if you have osteoporosis, osteopenia and kyphosis bone problems you are at a higher risk of stress sternum fractures.
▶️Symptoms of a sternal fracture.
Here are the common symptoms of a sternum fracture.
🔴Localised sternal pain which may increase during deep breathing or coughing.
🔴Deformity: Occasionally if the sternum is badly displaced a tender lump can develop over the fracture site.
🔴Sudden onset chest pain at the time of injury. Pain may increase when lying down in certain positions (such as face down or on your side) and on firmly touching the sternum at the site of injury.
🔴Shortness of breath, I have seen a few people feeling like they can not get enough air when they breath
🔴Bruising or swelling on the chest bone area.
Different types of sternum fractures.
Just like any bone the sternum can break.
⏩ In one or multiple places.
⏭️In various ways.
Sternum fracture can be serious
If they disrupt the aortic, cardiac contusion, and pulmonary contusion, or to unrelated injuries, management may become challenging.
However, when you have only fractured your sternum without any associated injuries, treatment is usually conservative.
▶️How are sternum fractures diagnosed
Usually, an x-ray will be taken to see how the sternum has fractured or displaced. In some cases, a CT scan will be done, to show the extent of the damage.
A Chest CT showing an un-displaced sternal fracture albeit in two places (blue ring) (B) Chest CT showing a displaced sternal fracture. The fracture is through the Manubriosternal junction and area of natural weakness of the sternum.
Different checks will be done for example your heart and chest to make sure nothing else was damaged.
▶️What are the treatment options for a sternum fracture?
There are two main types of treatment for sternum fracture, depending on various factors related to the type of fracture, your health condition and the practice of surgical teams you encounter.
1️⃣Conservative or Routine observation
You will have a routine observation to assess your pain control and investigate for possible cardiac complications.
They will assess how pain is affecting your ability to do certain things such as breathe, cough and move.
2️⃣Surgical option.
Regardless of the treatment approach, you might or might not have
Non operative or conservative option is the main treatment used for sternum fractures.
To give you some reassurance most sternum fractures do heal on their own without splinting or any other treatment.
🔵You will be given painkillers such as ibuprofen to help with your pain and other symptoms. If the pain is too severe, stronger pain medication may be necessary.
🔵 The best treatment will be simply resting as your body heals. Try to take time off work for any major activities. However, try not to stay in bed for the whole day, gentle movement will help keep your lungs clear.
🔵You may apply Ice to your chest to help reduce swelling and pain.
Surgical treatment.
Although most of the sternum fractures are treated conservatively, sometimes a surgical titanium fixation becomes necessary. An open Reduction Internal Fixation using a plate and screw.
The sternal anatomy and the stability of the anterior chest wall are restored by a stable fixation employing a locked plate osteosynthesis.
Image showing surgical operation of a sternum fracture.
Sternal reconstruction using titanium plates did prove to be an efficient method of stabilisation with tremendous immediate relief of pain showed by the differences between pre-operative and post-operative pain scale scores in some patients (Ahmed et al. 2020)
However, there was a limitation in the resources about treatment of sternum fractures. Treatment outcomes did not significantly differ from conservative or operation.
These findings indicate that for most patients with sternum fractures, conservative sternal treatment was safe and effective. Sternal fixation was not essential to achieve stern vertebral stability (Klei et.al 2021)
You will be given a follow-up care appointment to see how you are healing.
Surgical correction will usually require a prolonged period of management over many months before recovery can take place
▶️How long does it take for a sternum fracture to heal?
When you have a fracture of the sternum, you are eager to know how long the recovery stage will take.
Recovery will depend on the type of injury and treatment you’ve had. In most cases, a broken sternum will heal on its own. It can take 3 months or longer for the pain to go away.
Here is a rough estimate, based on some empirical data of recovery time.
| Period | Timeline |
| Significantly reduced pain | 6 to 8 weeks |
| Swelling or inflammation | A few weeks to several months |
| Your sternum bone has consolidated | 3 months or longer for the pain to go away completely. Some people may have chronic or non-union pain. |
| Resume working | Depending upon your job and injury severity, you may need to take some time off workwhilst the fracture heals. You may resume 8 to 12 weeks |
| Back to sports / other activities | Avoid lifting more than 10 pounds or active sports in the first 6 to 8 |
| Resume driving | Avoid driving for 6 to 8 weeks, you can resume when you are sure you can wear a seatbelt comfortably and perform manoeuvres and anemergency stops without undue pain. |
| Complete healing with no pain when breathing or coughing | 3 months or more |
Caution: if problems develop any new symptoms or problems later even after you have been checked seek medical help right away.
▶️Tips that can help speed up your recovery from a broken sternum.
1️⃣Try to take 10 deep breaths every hour you are awake. This can help clear fluid from your lungs and prevent infection.
2️⃣Try to do some coughs to help clear your lungs, try to support your chest by tightly hugging a pillow or rolled up towel to reduce pain while
3️⃣Gentle movement will help clear your lungs and avoid staying in bed the whole day.
4️⃣Many people with a sternal fracture find that their shoulders and back get stiff and sore because they stop using their arms as much.
You should avoid reaching overhead or reaching back with both arms at the same time.
5️⃣Do try to move your arms gently by doing some of your normal activities. Start small and work up gradually. Be sure to stop if it makes your pain worse.
6️⃣Avoid or limit smoking during the healing process because it slows bone healing and can raise chances of infection.
▶️Do you need physiotherapy to help with your recovery?
A respiratory physiotherapist will assess your chest and mobility. This includes looking at your ability to take deep breaths and the effectiveness of your cough to clear phlegm.
The goal of a physiotherapy rehabilitation is to help you
🟡 Decrease pain.
🟡 Prevent respiratory complications.
🟡 Restore function.
The therapist will help you with deep-breathing exercises to promote full lung expansion, relieve muscle spasm, and mobilise lung secretions.
To also relieve discomfort, promote chest expansion and functional shoulder mobility, and improve posture.
Simple shoulder and trunk stretching exercises such as walking may be encouraged when the fracture is stable.
▶️How to sleep with a sternum fracture?
You can sleep in any position that does not cause discomfort. Many people are most comfortable on their side, or You may also find sleeping on the opposite side of the break more comfortable.
Some people might find it more comfortable to sleep in an upright position for the first few nights
You can use pillows to help with your comfort sideways or on top of your chest as your cough.
Here is a video retrieved from equimeot.com with some sleeping lessons.
we have come to the end of this article! I wish you a quick recovery!🙋
📚Sources.
Kara H, Bayir A, Degirmenci S, Yildiran H, Kafali ME, Ak A. Sternal Fractures in Blunt Chest Trauma: Retrospective Analysis of 330 Cases. J Coll Physicians Surg Pak. 2022 Jun;32(6):799-803. doi: 10.29271/jpcsp.2022.06.799. PMID: 35686415.
Bentley TP, Ponnarasu S, Journey JD. Sternal Fractures. [Updated 2024 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
Klei DS, Schutte H, Öner FC, van Baal MC, Leenen LP, van Wessem KJ. Traumatic Sternal Fractures can be Safely Treated Conservatively – A 13-Year Retrospective Cohort Study. J Surg Res (Houst). 2021;4(4):572-587. doi: 10.26502/jsr.10020170. Epub 2021 Oct 25. PMID: 37034900; PMCID: PMC10078967.
Ahmed K, Nady MA. Sternal reconstruction using locking compression plates (LCP): our experience in Egypt, a case series. J Cardiothorac Surg. 2020 Aug 21;15(1):224. doi: 10.1186/s13019-020-01266-0. PMID: 32825827; PMCID: PMC7441539.
Hossain M, Ramavath A, Kulangara J, Andrew JG. Current management of isolated sternal fractures in the UK: time for evidence-based practice? A cross-sectional survey and review of literature. Injury. 2010 May;41(5):495-8. doi: 10.1016/j.injury.2009.07.072. Epub 2009 Aug 13. PMID: 19682680.
Image: https://www.royaldevon.nhs.uk/media/z51hk2mn/advice-after-a-chest-wall-injury-926-v1.pdf