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BROKEN STERNUM

A broken sternum, also called a sternal fracture, occurs when the breastbone, the flat bone in the center of your chest, breaks. This bone connects your ribs and collarbone, and protects vital organs like your heart and lungs. A broken sternum is usually caused by a strong impact to the chest, such as a car accident, fall, or CPR. Symptoms include sharp pain in the chest, especially when breathing deeply, coughing, or laughing. You might also experience swelling, bruising, or a feeling of the bone grinding together (crepitus) when you touch the area. If you think you have a broken sternum, it’s important to see a doctor for proper diagnosis and treatment.

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If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Sternum Fractures in Children and Adolescents

Sternum fractures, though relatively uncommon in children and adolescents compared to adults, present unique challenges in diagnosis and management due to the anatomical and physiological differences in this age group. Understanding the causes, symptoms, diagnosis, treatment options, rehabilitation, and return to sports is crucial for effective management. Medical City Children’s Orthopedics and Spine Specialists offer specialized care that addresses these needs.

Causes

Sternum fractures in children and adolescents typically result from direct trauma to the chest. Common causes include:

Motor Vehicle Accidents: This is the most frequent cause, where the chest hits the steering wheel, dashboard, or seatbelt during a collision.
Sports Injuries: High-impact sports such as football, hockey, and gymnastics can lead to sternum fractures due to falls or direct blows to the chest.
Falls: Accidental falls from significant heights or during activities like biking or skateboarding.
Blunt Trauma: Incidents such as being hit by a heavy object or involvement in physical altercations.

What Increases the Risk of a Broken Sternum?

A broken sternum can be uncomfortable and worrisome. Several factors can elevate the likelihood of this injury:

Bone Health Conditions: Conditions like thoracic kyphosis and osteoporosis can weaken bones, making them more susceptible to fractures.
Age: As we age, bone density can decrease, particularly in older adults, increasing the risk.
Hormonal Changes: Postmenopausal women experience a drop in estrogen levels, which can lead to reduced bone strength.
Prolonged Steroid Use: Extended use of steroids can impact bone density, heightening the risk of a sternum fracture.

Understanding these factors can help in preventing injury by taking proactive steps such as strengthening bones through diet and exercise or consulting with a healthcare provider for personalized advice.

QUESTIONS AND ANSWERS

How Serious is My Child's Injury?

Doctors explain the type of sternum fracture, whether it’s a simple fracture, a more complex one, or if there are any associated injuries. They might use imaging studies such as X-rays, CT scans, or MRIs to provide a detailed explanation of the fracture’s location and extent.

What is the Treatment Plan and Recovery Process?

Doctors outline the treatment options, starting with non-surgical methods like rest, pain management, and physical therapy. If surgery is needed, they explain the procedure, potential risks, and benefits. They also provide a timeline for recovery, which typically ranges from a few weeks for minor fractures to several months for more severe cases. Information about follow-up appointments and the role of physical therapy in the recovery process is also provided.

When Can My Child Return to Normal Activities and Sports?

Doctors provide guidance on a gradual return to activities. They emphasize the importance of full recovery before resuming high-impact sports. The timeline for returning to normal activities depends on the healing progress and the type of activity. Generally, light activities can be resumed in a few weeks, while full participation in sports may take several months. Doctors also highlight the importance of protective gear and gradual reintroduction to prevent further injury.

When children break bones, parents need to take them to the very best doctors. At the Medical City Children’s Orthopedics and Spine Specialists, we are the best. We specialize in children and their bones.

Broken Sternum Symptoms

The clinical presentation of a sternum fracture in children and adolescents can vary but commonly includes:

Pain: Acute, sharp pain in the chest area, particularly worsened by breathing, coughing, or movement.
Swelling and Bruising: Visible swelling or bruising over the sternum.
Tenderness: Pain on palpation of the sternum.
Respiratory Distress: Difficulty breathing, shallow breathing, or pain during respiration.
Visible Deformity: In severe cases, an indentation or protrusion of the sternum.

Diagnosis of a Sternum Fracture

Diagnosis of sternum fractures typically involves a combination of clinical evaluation and imaging studies:

Clinical Examination: Physical examination to assess tenderness, swelling, and pain on palpation.
Radiographs (X-rays): The primary imaging modality to identify fractures. However, sternal fractures may be subtle and sometimes missed.
CT Scan: Provides a detailed view of the sternum and is more sensitive than X-rays, especially for complex or subtle fractures.
Ultrasound: A tool used at the bedside to detect sternal fractures, particularly useful in children to avoid radiation exposure.

Potential Complications from a Broken Sternum

A fractured sternum can lead to several complications, both in the short and long term. Here’s what you need to be aware of:

Short-Term Issues

Pain and Discomfort: One immediate outcome is persistent chest pain, typically lasting 8 to 12 weeks. This discomfort can hinder your ability to cough effectively, heightening the risk of developing infections due to uncleared lung secretions.
Adjacent Tissue Damage: In cases where trauma is involved, bruising of nearby lung tissue or the heart can occur, adding complexity to the recovery process.

Long-Term Concerns

Improper Healing: Should the sternum not heal adequately, it could lead to the formation of pseudarthrosis, a condition where a false joint develops. This not only causes pain but may also necessitate surgical intervention.
Vulnerable Populations: Certain groups, including older adults, individuals with osteoporosis or diabetes, and those on long-term steroid medications, face a heightened risk of improper healing.
Limited Mobility Residuals: Due to restricted arm movement during recovery, patients might experience shoulder and spine stiffness or pain, further complicating the rehabilitation journey.

By understanding these potential complications, you can better manage expectations and strategies during the healing period.

Non-Surgical Treatment

Surgery is not needed for most sternal fractures in children and adolescents:

Rest and Immobilization: Avoiding activities that could exacerbate the injury. The use of chest binders or wraps can provide support and reduce pain.
Pain Management: Over-the-counter pain relievers like acetaminophen or ibuprofen. In some cases, doctors may prescribe a stronger pain medication.
Ice Application: Ice packs are applied to reduce swelling and pain in the initial stages post-injury.
Physical Therapy: Gentle exercises to maintain chest wall mobility and prevent stiffness once the initial pain subsides.

Surgical Treatment for a Broken Sternum

Surgical intervention is rarely needed but in cases of severe displacement, non-union, or associated injuries, doctors may recommend it:

Open Reduction and Internal Fixation (ORIF): Realigning the fractured sternum and stabilizing it with plates and screws. This is typically done under general anesthesia.
Minimally Invasive Techniques: Doctors may use thoracoscopy in some cases to minimize surgical trauma and enhance recovery.

Rehabilitation For Sternum Fractures

Rehabilitation focuses on gradually restoring function and strength:

Breathing Exercises: To improve lung function and prevent complications such as pneumonia.

To further avoid developing a chest infection during recovery from a broken sternum, consider the following steps:

Regular Deep Breaths: Engage in deep breathing exercises regularly throughout the day to keep your lungs active and healthy.
Do Not Suppress Coughing: Allow yourself to cough naturally, as this helps clear mucus from the lungs, reducing the risk of infection.
Avoid Cough Medicine: Refrain from using cough suppressants, as they can inhibit necessary coughing that clears your airways.
Chest Support While Coughing: Use a pillow or your hands to gently support your chest wall when you cough. This can help mitigate discomfort and protect the healing area.

By integrating these practices into your recovery routine, you can effectively support your respiratory health and enhance the healing process.

Time to Heal

The healing time for a sternum fracture can vary depending on the severity of the fracture and the individual’s age and health:

Typical Healing Time: Most children and adolescents can expect a healing period of 6-8 weeks.
Severe Cases: In cases requiring surgery, the healing process may extend to 12 weeks or more.
Follow-up: Regular follow-up appointments are crucial to monitor healing progress and adjust treatment plans as necessary.

Outlook for a Broken Sternum

Recovering from a broken sternum generally involves a straightforward path, with symptoms subsiding over a few weeks. Most individuals can expect to heal completely, given that they follow appropriate care and recommendations.

Key Points for Recovery:

Pain and Symptoms: Typically, pain should decrease gradually, and other symptoms should lessen as the healing process progresses.
Follow-Up: Schedule follow-up appointments to monitor healing. If symptoms persist or worsen, it’s crucial to consult your healthcare provider.
Infection Prevention: Take precautions to prevent lung infections, such as maintaining good respiratory hygiene and following medical advice.

Factors Influencing Recovery:

Complications: Recovery can be impacted by additional complications, so it’s essential to be vigilant about any new or worsening symptoms.
Individual Health: General health, age, and any underlying conditions can affect recovery time and outcomes.

In conclusion, with proper medical attention and adherence to recovery guidelines, a full recovery from a fractured sternum is achievable for most patients. Remember to consult with your healthcare provider for personalized advice and recommendations.

Returning to Sports

Returning to sports is a gradual process and parents should seek guidance from their doctors:

Initial Rest: Complete rest from sports for at least 4-6 weeks.
Gradual Resumption: Light activities can be resumed once pain decreases, and a full range of motion is restored.
Full Return: Only after complete healing is confirmed through imaging and physical examination, typically around 3 months post-injury.
Protective Gear: Using appropriate protective gear when returning to high-impact sports to prevent re-injury.

Why Choose Medical City Children’s Orthopedics and Spine Specialists

Choosing the right healthcare provider for managing sternum fractures in children and adolescents is crucial. Medical City Children’s Orthopedics and Spine Specialists offer several advantages:

Expertise in Pediatric Orthopedics: The specialists are trained to handle the unique needs of growing children and adolescents, ensuring age-appropriate care.
Comprehensive Care: From diagnosis to rehabilitation, they provide a full spectrum of services tailored to the individual needs of each patient.
Advanced Imaging and Diagnostic Tools: State-of-the-art imaging technologies ensure accurate diagnosis and monitoring.
Minimally Invasive Techniques: Whenever possible, they employ minimally invasive surgical techniques to reduce recovery time and improve outcomes.
Multidisciplinary Team: A team approach that includes orthopedic surgeons, physical therapists, and pain management specialists to provide holistic care.
Family-Centered Care: Emphasis on involving the family in the care process, ensuring that parents and guardians are well-informed and involved in decision-making.
Rehabilitation Programs: Comprehensive rehabilitation programs designed to aid in faster and more effective recovery, tailored to the needs of young athletes and active children.
Focus on Return to Activity: Specialized programs to safely return children to their normal activities and sports, emphasizing the prevention of future injuries.

In conclusion, sternum fractures in children and adolescents, while less common than in adults, require careful management to ensure proper healing and return to normal activities. Medical City Children’s Orthopedics and Spine Specialists provide expert, comprehensive care that addresses the unique needs of this population, ensuring the best possible outcomes.

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WebMD: What is a Sternum Fracture

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