The sternum, often called the breastbone, is a long, flat bone situated vertically in the center of the chest. It anchors the ribs and forms the front part of the rib cage, safeguarding the heart, lungs, and major blood vessels. While a fracture can be painful, most sternum fractures heal successfully without surgical intervention. Healing relies heavily on conservative treatment, primarily involving rest and careful management of symptoms.
Identifying the Injury: Causes and Symptoms
A fractured sternum almost always results from high-impact blunt force trauma applied directly to the anterior chest wall. The most frequent cause is a rapid deceleration event, commonly seen in motor vehicle collisions where the chest strikes the steering wheel or is constrained by a seatbelt. Falls from a height or direct impacts during high-velocity sports can also generate enough force to cause a break.
The immediate symptom is severe pain localized directly in the center of the chest. This pain is aggravated by any movement involving the chest wall, including deep breathing, coughing, or laughing. Visible signs include tenderness to the touch over the breastbone, along with rapid bruising and swelling at the fracture site. Due to the force required to break the sternum, medical evaluation is necessary to rule out associated internal injuries to the heart or lungs.
The Timeline: Expected Healing Duration
Full recovery for an uncomplicated sternum fracture typically takes between 6 and 12 weeks. Healing duration is influenced by the severity of the fracture, such as whether it is a simple hairline break or a complex, displaced fracture. Patient-specific factors, including advanced age, overall health, and conditions like diabetes or osteoporosis, can also slow the healing process.
Recovery involves two distinct phases: functional recovery and full bony union. Functional recovery, where severe pain subsides and daily activities become manageable, often occurs within the first 4 to 6 weeks. The goal during this period is effective pain management to allow for necessary movements like deep breathing, which prevents respiratory complications. Full bony union, where the bone has completely fused and is structurally sound, requires 8 to 12 weeks or sometimes longer.
Associated injuries, which are common given the force required to cause the fracture, can significantly extend the recovery timeline. If the trauma resulted in bruised lung tissue or multiple rib fractures, recovery centers on healing all injuries, making the process more complex. While functional improvement is relatively quick, patience is necessary for the bone to achieve complete structural integrity.
Managing Recovery and Promoting Healing
The standard treatment for an isolated sternum fracture is conservative management, focusing on rest and pain control. Adequate pain management is necessary, often involving prescribed medications initially, followed by over-the-counter anti-inflammatory drugs like NSAIDs. Controlling pain allows the patient to breathe deeply and cough forcefully, which prevents lung complications like pneumonia.
Patients are advised to use a technique called splinting the chest, which involves hugging a pillow tightly against the breastbone when coughing, sneezing, or moving. This external support stabilizes the chest wall and reduces the pain associated with these actions. Movement modification is essential during the initial 4 to 6 weeks while the body forms a soft callus at the fracture site.
Specific physical restrictions include avoiding lifting objects over ten pounds and refraining from activities involving excessive twisting, pushing, or pulling. These movements place strain on the sternum and can disrupt the healing bone fragments. Follow-up care involves monitoring the patient for persistent severe pain or difficulty breathing, which could signal complications like non-union. Gradual reintroduction of activity, including gentle range-of-motion and strengthening exercises, is introduced only after a physician confirms the fracture is stable and acute pain has resolved.