Sternal Fracture (Broken Breastbone)

How a sternal fracture happens

The sternum is a strong, flat bone made of three parts: the handle (manubrium), the body and the small tip (xiphoid process). It takes a large, direct force to break it. Most fractures run across the body of the sternum.

• Car crashes account for most cases: the shoulder belt or steering wheel strikes the chest during sudden deceleration. Seat belts and airbags have made sternal fractures more common in surviving drivers but have greatly reduced deaths overall.
• Direct blows in contact sports, from a fall onto an object, or assault.
• Insufficiency fractures in older adults with osteoporosis, long-term steroid use or a hunched spine, sometimes after minor strain.
• CPR chest compressions, which can crack the sternum or ribs.
• After heart surgery, where the sternum has been divided and wired (a separate problem called sternal dehiscence).

Symptoms

• Sharp pain in the center of the chest, worse with deep breaths, coughing, sneezing, laughing or twisting
• Tenderness when the breastbone is pressed
• Swelling and bruising, sometimes a seat belt-shaped bruise
• A crunching or clicking sensation, or a visible step if the bone ends are displaced
• Shallow breathing to avoid pain

Associated injuries doctors look for

An isolated sternal fracture is usually not dangerous. The concern is what else the force may have damaged, as in any chest trauma:

Diagnosis

• Examination of the chest wall, breathing and circulation
• Lateral (side-view) chest X-ray, which shows most sternal fractures; front-view X-rays often miss them
• CT scan of the chest, often done after significant trauma, which shows the fracture and other injuries
• Ultrasound in some emergency departments
• ECG in everyone with a sternal fracture
• Troponin blood test to screen for heart muscle injury; if the ECG and troponin are normal, significant heart injury is very unlikely
• Echocardiogram if the ECG or troponin is abnormal or blood pressure is low

People with an isolated, undisplaced sternal fracture, normal ECG and normal tests can usually go home with pain control. Older adults, those with other injuries or abnormal heart tests are admitted for monitoring.

Treatment

Pain control

Good pain relief is the main treatment, because it lets you breathe deeply and cough, which prevents pneumonia:

• Acetaminophen (paracetamol) taken regularly, following the label dose
• NSAIDs such as ibuprofen if safe for you, following the label dose; avoid with kidney problems, stomach ulcers or some heart conditions
• Short courses of stronger pain medicine for severe pain in the first days
• Ice packs wrapped in cloth for 15 to 20 minutes at a time in the first 48 hours

Breathing exercises

• Take 10 slow, deep breaths every hour while awake, holding each for a few seconds.
• Cough to clear mucus, hugging a pillow against your chest for support.
• An incentive spirometer, if given one, helps you keep the lungs expanded.

Do not strap or bind the chest; it restricts breathing and increases pneumonia risk.

Activity

• Avoid heavy lifting, pushing and pulling for at least 6 weeks.
• Sleeping propped up in a recliner or on pillows is often more comfortable at first.
• Return to contact sport only after the bone is healed and pain-free, usually 2 to 3 months, ideally with medical clearance.

Surgery

Surgery to fix the sternum with plates and screws is uncommon. It may be considered for badly displaced fractures, fractures that cause an unstable chest wall, fractures that fail to heal (nonunion) with persistent pain and clicking, or severe deformity.

Healing time

Most isolated sternal fractures are significantly less painful after 2 to 3 weeks and heal in 6 to 12 weeks. Some people have aching for several months, especially with heavy work or coughing. Non-union, where the bone does not knit, is uncommon but can cause ongoing pain and clicking that may need surgery.

Complications

• Pneumonia from shallow breathing
• Chronic pain or non-union
• Deformity of the chest wall
• Complications from associated heart or lung injuries

Frequently asked questions

How long does a broken sternum take to heal?

Most sternal fractures heal in 6 to 12 weeks. Pain usually eases a lot within 2 to 3 weeks, but you may feel aching with coughing, lifting or sleeping on your side for longer. Heavy lifting and contact sports are usually avoided for at least 6 weeks to 3 months.

Is a sternal fracture serious?

An isolated sternal fracture usually heals well without surgery. It can be serious when it comes with injuries to the heart, lungs, ribs or spine, which is why an ECG, blood tests and imaging are done. People over 65 or with multiple injuries are more likely to be admitted.

How do you sleep with a broken sternum?

Most people find sleeping on their back, propped up with pillows or in a recliner, most comfortable. Avoid sleeping on your front. Take pain medicine before bed, and keep a pillow handy to hug against your chest if you need to cough during the night.

Can a seat belt break your sternum?

Yes. In a crash, the shoulder belt holds the chest back with great force and can fracture the sternum. Even so, seat belts prevent far more serious injuries and deaths. A sternal fracture from a belt is a sign of a significant impact, so the heart and other organs are checked.

What does a fractured sternum feel like?

It causes sharp pain in the center of the chest that worsens with deep breaths, coughing, laughing or turning, along with tenderness and often bruising over the bone. Some people feel a click or grinding. Any chest pain after an injury needs medical assessment to rule out heart and lung damage.