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What is a fractured breastbone?

A fractured breastbone refers to a break in the breastbone, which is the flat, long bone located in the centre of the chest. It is usually associated with direct, blunt trauma to the chest from the front. The breastbone is termed as sternum, and therefore these fractures are also called sternal fractures.

What are its main signs and symptoms?

Signs and symptoms include:

  • Pain on normal breathing which is worse on taking a deep breath, coughing or laughing
  • Discomfort on moving arms and lifting heavy objects
  • Swelling at the fracture site
  • Crepitus (abnormal sound when both fragments of bones rub together)
  • A step deformity is felt on palpation of the fracture site
  • The heart and lung may also have injuries in severe cases

What are the main causes?

The most common causes of breastbone fracture are:

  • Anterior, blunt chest trauma
  • Deceleration injuries like high impact sports like rugby, football or car accident

Moderately common causes include:

  • Athletic injuries
  • Falls
  • Assaults 
  • Cardiopulmonary resuscitation
  • Uncommon causes are:
  • Insufficiency fractures of the breastbone may occur in severe thoracic kyphosis, osteoporosis or osteopenia 
  • Post-menopausal women and elderly people are at higher risk of breastbone fractures
  • Stress fractures may occur in case of repetitive upper body work in sports like golf and weightlifting

How is it diagnosed and treated?

On physical examination, the doctor will palpate and assess the fracture site.

A lateral chest X-ray is very useful in diagnosing breastbone fractures.

Other investigations required include:

  • CT scan
  • Electrocardiogram
  • Ultrasonography
  • Cardiac monitoring and pulse oximetry are a must when patient is in for emergency care

Acute breastbone fractures are first managed by assessing, providing and maintaining airway breathing and circulation.

Vital signs are assessed and maintained.

Any life-threatening complication should be given immediate attention and care.

Analgesics are given to relieve pain associated with fractures.

The doctor will advise deep breathing in order to avoid complications.

Surgery is required to correct the fracture.

  1. Medicines for Fractured Breastbone

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References

  1. Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock. 2013 Apr-Jun;6(2):113-6. PMID: 23723620
  2. Yoldas B, Esme H, Calik M. Sternal fractures: “Operative treatment” should be kept in mind. J Res Med Sci. 2012 Aug;17(8):814-6. PMID: 23798954
  3. Zhao Y, Yang Y, Gao Z, Wu W, He W, Zhao T. Treatment of traumatic sternal fractures with titanium plate internal fixation: a retrospective study. J Cardiothorac Surg. 2017 Apr 4;12(1):22. PMID: 28376814
  4. Bentley TP, Journey JD. Sternal Fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan
  5. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Rib fracture: aftercare
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