Fractures of the sternum, the bone that attaches to the first seven ribs and the clavicle, occurs most frequently from blunt trauma. Sternum fractures comprise less than 0.5 percent of all fractures, according to an article in a 2006 issue of "Asian Cardiovascular and Thoracic Annals." Sternal fractures can cause displacement of the sternum. Between 60 to 90 percent of sternal fractures occur during motor vehicle accidents; 20 percent of adults who undergo cardiopulmonary resuscitation may also have a broken sternum. Treatments depend on the severity of the break.
Rest
Rest and activity restriction may suffice for treating minor breaks or cracks in the sternum. Average recovery time for sternal fractures is 10.4 weeks, reports the Veterans-UK website. Lying flat for several days may be prescribed if it doesn't interfere with breathing, notes Primary Surgery, the website for the German Society for Tropical Surgery.
Pain Medications
Pain can limit respiratory efforts, including deep breathing and coughing, which increases the chance of developing pneumonia. Pain can also occur due to concurrent injuries such as broken ribs, pneumothorax, or collapsed lung, or heart contusions. Pain treatment should always include evaluation for additional sources of pain that might have been missed. For uncomplicated sternal fracture, anti-inflammatory medications such as ibuprofen are often sufficient for pain control. If narcotics are required, the smallest effective dose should be taken for the shortest amount of time possible, to avoid respiratory depression. Over 66 percent of patients require no more treatment than pain medication, and intercostal nerve blocks can help ease pain and promote deep breathing in some cases, MDGuidelines reports.
Surgical Repair
Surgical repair may be necessary if sternal displacement occurs. Visible deformity with poor respiratory effort and the need for continued ventilator support, along with intractable pain, indicate the need for surgery, states the 2006 article in "Asian Cardiovascular and Thoracic Annals." Surgical treatment consists of making a small incision and pulling the displaced sternum back into place with a hook. More severe fracture may require stabilization with an internal fixation device.
References
- Primary Surgery: Uncomplicated Fractures of the Ribs and Sternum
- "Asian Cardiovascular and Thoracic Annals": Operative Treatment of Sternal Fractures; Abdullah Al-Qudah, M.D.; 2006
- Veterans-UK: Sternal Fractures
- MDGuidelines: Fracture, Sternum (Closed)
- ModernMedicine: Trauma Nursing: Blunt Chest Injuries
