Sternal Fracture
A break in the breastbone at the front of the chest
Quick Facts
- Type: Bone (orthopedic) injury
- Common causes: Car crashes, falls, direct chest blows
- Typical recovery: Several weeks to a few months
- Watch for: Trouble breathing, palpitations, severe pain
Overview
The sternum, or breastbone, is the flat bone in the center of the chest that connects to the ribs and helps protect the heart and lungs. A sternal fracture is a break in this bone. It most often happens when the chest strikes something with force, such as a steering wheel or seatbelt during a car crash, or in a hard fall.
Most sternal fractures heal well with rest and pain control. However, because the breastbone sits directly over the heart and major vessels, doctors check carefully for injury to the structures beneath it. The main concern is usually not the bone itself but what may have been injured along with it.
Symptoms
A sternal fracture typically causes pain at the front of the chest that worsens with movement.
- Pain over the breastbone, made worse by breathing deeply, coughing, or moving
- Tenderness and swelling over the center of the chest
- Bruising across the front of the chest
- A feeling or sound of grinding at the break site
- Difficulty taking a full breath because of pain
Seek emergency care if you have severe shortness of breath, chest pain that spreads to the arm or jaw, palpitations, or faintness, as these can signal injury to the heart or lungs beneath the bone.
Causes
Sternal fractures result from force applied directly to the front of the chest.
- Motor vehicle crashes: The most common cause, often from the chest hitting the steering wheel or being restrained by a seatbelt.
- Falls: Landing on or striking the chest, especially in older adults.
- Direct blows: Sports impacts, assaults, or being struck by an object.
- Stress fractures: Rarely, repeated strain or weakened bone leads to a break with little force.
Bone-weakening conditions such as osteoporosis make a fracture more likely from a smaller impact.
Risk Factors
- Motor vehicle travel without or despite seatbelt use
- Older age and reduced bone density
- Osteoporosis or long-term steroid use
- High-impact or contact sports
- Falls, especially in frail individuals
Diagnosis
Doctors diagnose a sternal fracture from the injury, the symptoms, and imaging, while looking for associated injuries.
- Chest X-ray: A side-view X-ray often shows the break.
- CT scan: Gives a detailed view of the sternum and checks for injury to the heart, lungs, and vessels.
- Electrocardiogram (ECG): Used to look for signs of a bruised heart.
- Blood tests and echocardiogram: May be done if heart injury is suspected.
Treatment
Most sternal fractures are treated without surgery, focusing on pain relief and allowing the bone to heal.
- Pain control: Pain medication allows for deeper breathing and coughing, which helps prevent lung complications.
- Rest and activity limits: Avoiding heavy lifting and strenuous activity while the bone heals.
- Breathing exercises: Gentle deep breathing keeps the lungs clear and lowers the risk of pneumonia.
- Surgery: Rarely needed, reserved for badly displaced fractures or those that fail to heal and cause ongoing pain or instability.
Healing usually takes several weeks to a few months, with pain gradually improving.
Prevention
- Always wear a seatbelt, which reduces the severity of chest injuries even though it can sometimes cause a fracture
- Use protective gear in contact sports
- Keep bones strong with adequate calcium, vitamin D, and weight-bearing exercise
- Reduce fall risks at home, especially for older adults
- Manage osteoporosis with your doctor
When to See a Doctor
See a doctor for any significant chest pain after an impact, since a sternal fracture can be a marker of deeper injury. Seek emergency care immediately for:
- Severe or worsening shortness of breath
- Chest pain spreading to the arm, jaw, or back
- Palpitations, an irregular heartbeat, or faintness
- Coughing up blood or signs of shock
Frequently Asked Questions
How long does a fractured sternum take to heal?
Most sternal fractures heal over several weeks to a few months, with the pain easing gradually. Recovery depends on your age, bone health, and any associated injuries. Following your doctor's advice on activity and pain control speeds recovery.
Is a broken sternum dangerous?
The bone usually heals well, but the main concern is injury to the heart, lungs, or vessels that lie beneath it. Doctors check carefully for these. Severe breathlessness, palpitations, or faintness after the injury need emergency evaluation.
Do I need surgery for a sternal fracture?
Most sternal fractures heal without surgery, using rest and pain control. Surgery is only considered for fractures that are badly out of place, unstable, or fail to heal and continue to cause pain.
Why is pain control important with a sternal fracture?
Good pain relief lets you breathe deeply and cough, which keeps the lungs clear and lowers the risk of pneumonia. Avoiding deep breaths because of pain can lead to chest infections during recovery.
Can I exercise with a sternal fracture?
You should avoid heavy lifting, pushing, and strenuous upper-body activity until the bone heals and your doctor clears you. Gentle movement and breathing exercises are encouraged to keep the lungs healthy.
References
- American Academy of Orthopaedic Surgeons (AAOS). Chest and rib injuries.
- Mayo Clinic. Broken ribs and chest injuries.
- MedlinePlus, U.S. National Library of Medicine. Chest injuries.
- National Library of Medicine. StatPearls: Sternal Fracture.