What is a sternum fracture? In sternum fracture or sternum fracture, a fracture or a crack is created in the breast bone. The sternum is a long vertical bone located in the center of the chest and forms the anterior part of the chest along with 12 ribs. The sternum and ribs (to which it is attached) provide a safe enclosure for vital tissues and organs, including the lungs and heart. A direct blow to the chest can lead to a broken sternum or sternum. The most common cause of this is the steering wheel hitting the chest in motor vehicle accidents. Lighter blows may only bruise the sternum rather than break it. The diagnosis of sternum fracture can be confirmed by chest X-ray or CT scan. A sternum fracture usually heals on its own. But rest, cold compress and medicine are needed to speed up the healing process. Since it takes a lot of force or trauma to break the sternum, there is always a risk of damage to other organs and structures in the body, such as the vertebrae, ribs, lungs, heart, soft tissue, and nearby blood vessels. Damage to the heart and lungs are very serious and are more likely if there is a severe or displaced fracture. The main causes of sternum fractures Such fractures are often the result of a direct blow to the sternum. In this case, compound fractures that are accompanied by rib damage also occur, which will have various complications. Rib injuries often occur at the junction of the sternum and the sternum, and are usually caused by the chest hitting the steering wheel or seat belt in a motor vehicle accident. Sternal fracture is usually related to open heart surgery. It sometimes occurs due to a traumatic force to the upper back (often in a motor vehicle accident, without a direct blow to the sternum) that causes it to bend forward, or due to a collision with another player during contact sports such as football or rugby, or from being hit by a ball in sports such as hockey or cricket. Classification of sternum fractures The classification of these injuries, depending on their severity, is as follows: - Incomplete fracture (sternal fissure) - Complete fracture Depending on the damage to the skin, fractures are distinguished as follows: - Open fracture - Closed fracture The open type of fracture is the most dangerous due to the risk of infectious agents entering the wound surface and causing septic complications. Read more: Symptoms and treatment of clavicle fracture in Shiraz The classification based on the location of the broken parts of the bone is as follows: - Fracture without displacement of broken bone fragments - Fracture with displacement of broken bone fragments Displaced sternum fracture is characterized by the incorrect placement of bone parts in the anatomy of the body and causes the possibility of serious damage to nearby organs (pleura, lungs, heart, diaphragm) and the occurrence of related side effects. The classification based on the location of the bone fracture is as follows: - Fracture of sternum manubrium (sternum handle or upper part of the sternum bone) - Fracture of sternum - Dagger appendage fracture Symptoms and diagnosis of sternum fracture Patients with a sternum fracture usually experience sudden pain in the chest at the time of injury. The pain is often sharp and severe, and may increase with deep breathing, coughing, laughing, or sneezing. There is also the possibility of pain in the front of the chest, especially at night or early in the morning (especially in the first few days after the injury). The pain may increase when lying in certain positions (such as lying on the chest or side) and when the sternum is firmly touched at the site of the injury. Swelling and/or bruising is also sometimes evident. In severe sternum fractures where bone fragments have been displaced, an obvious deformity may be seen in that area. Patients with this condition also sometimes have pain when performing certain movements in the upper back and chest (such as turning, bending forward or sideways or arching backwards) and with certain movements in the upper limbs (such as pushing, pulling, lifting heavy objects, reaching the target, moving the arms in front of the body or above the head). The symptoms of sternum fracture are completely pathognomonic, that is, specific to this type of injury: - Severe pain in the sternum, which is aggravated by breathing and coughing. - In sternum fracture, breathing becomes shallow and frequent. - The patient sits bent over (to reduce pain) - Swelling and deformation at the site of injury - Occurrence of hematoma - In fractures where there is displacement of the bone, bone fragments are evident by touch. - X-rays of the side of the chest provide more complete information about the location and nature of the fracture. It should be noted that in cases of incomplete fracture (crack), the above symptoms may not appear. Therefore, after a serious chest injury, be sure to see a doctor on time. If there is a lot of displacement of the broken bone pieces, there is a possibility of damage to the lungs, pleura, or organs located in the mediastinum. Treatment of sternum fracture Treatment of a sternum fracture depends on the severity of the fracture and the type of limb involved (if any). If severe or dangerous injuries to the lungs, heart or blood vessels are observed, the necessary medical measures to save the patient are initiated. In the absence of these types of injuries or after stabilizing the condition of the injured person, other treatment measures will be performed. Supportive treatment for a sternum fracture includes rest for about 10-24 weeks and applying a cold compress to the injured area to reduce inflammation. In general, care should be taken not to put pressure on the chest. People who have suffered sternum fractures are advised to avoid doing things like lifting loads, carrying or pushing heavy objects, and moving the arms overhead until they heal. Some medicines can be used to reduce pain and inflammation. Although surgery is less necessary in cases of sternum fractures, it may be necessary for severe fractures or if lower organs are involved. Patients with fractures with separated and displaced bones usually require a short hospital stay for pain control, and most recover completely within 9-12 weeks, with an average of 10.4 weeks. Two-thirds of these patients only need painkillers, and the symptom of most of them is chest pain during this period. Treatment of sternum fracture without displacement This type of fracture responds better to conservative treatment. The first step in the treatment of such fractures is to apply 20 ml of a 1% solution of novocaine (a local anesthetic) to the affected area and to prescribe systemic analgesics to reduce pain. Due to difficulty in breathing in such cases, inhalation of moist oxygen is recommended. Next, it is necessary to stick a wide strip of a specialized adhesive along the sternum to keep the chest in place for two weeks. Read more: Respiratory and chest physiotherapy in Shiraz Treatment of displaced sternum fracture If there is still displacement, the sternum fragments can be manually held in place. Of course, this operation is performed after effective anesthesia. After transfer, the patient should lie on a bed with a chest protector for three weeks. A roller is placed between the patient's shoulder blades. Prolonged placement in a hyperextension position leads to gradual repair of broken bone fragments. Unfortunately, the structure of the sternum cannot always be repaired in this way. In some cases, doctors have to resort to surgical treatment of sternum fractures, osteosynthesis surgery with cross wires or plates. After the surgery, the person will regain the strength to work again within two months. Prognosis of future conditions in cases of sternum fractures It takes about 10 to 24 weeks for a broken sternum to heal completely. During this period, doctors check for chest pain. Cases of non-union of sternum fractures are rare. Prevent sternum fractures Most cases of sternum fractures occur in vehicle accidents. Wearing a seat belt will prevent the fracture of the sternum in such a situation. Using protective equipment during contact or high-impact sports and while working in tall buildings can prevent sternum fractures. Avoid lifting or pulling heavy objects at work without wearing proper protective equipment. Dr. Zohra Eshghi, a specialist in physical medicine and rehabilitation in Shiraz, providing treatment services for skeletal and muscular diseases in Shiraz, to receive an appointment for examination, diagnosis and treatment, contact us and the office using the information on the contact page.