Causes

A sternum fracture often occurs in a car accident. The strong impact on the steering wheel and the pull of the seat belt are responsible for the trauma. A car accident causes severe violence to the bone tissue, which may be osteoporotic.

In addition, cardiac massage as part of resuscitation can also lead to a fracture of the sternum. In such a procedure, strong force is applied to the thorax so that the heart can be reached by the impulses. Older people naturally suffer from reduced bone density. In the widespread clinical picture of osteoporosis, the bony structures, such as the breastbone, are susceptible to fractures when force is applied.

Diagnosis

At the beginning there is always the anamnesis and the patient interview. The doctor asks questions about the accidental course of the sternum fracture in order to find indications of other injuries. Afterwards the patient is palpated, often a broken bone can already be palpated manually.

If there is a pressure pain over the sternum, it can also be a bruise. If nothing conspicuous is palpated, it may still be advisable to use imaging additionally: If there is indeed a fracture of the sternum (breastbone fracture), further injury must be sought. The lungs and heart are located under or near the sternum and must therefore always be examined as well.

In most cases, these organs are first listened to, the heart can be well examined by means of ECG and ultrasound, while the lungs are clearly visible on CT. If these organs are injured, however, this quickly manifests itself, for example, in breathing difficulties and pain. Vertebral fractures and rib fractures are also common with a fracture of the sternum and should also be examined. – Ultrasound,

X-ray or a
CT.

Therapy

Although the fracture of the sternum is very painful, it is fortunately only in the rarest of cases that surgery is required. This is only necessary if parts of the fractured sternum are displaced or breathing is severely impaired by the broken bone and drug therapy is not sufficient. Surgery is performed under general anaesthesia by opening the skin over the sternum and stabilising the sternum with plates and screws.

However, since the sternum cannot be plastered or splinted like a broken arm, the fracture is virtually impossible to immobilize. Therefore, it is important to combat especially the breath-related pain. Various painkillers are conceivable here, for example ibuprofen, Novalgin or opiates, i.e. painkillers that fall under the narcotics law.

Freedom from pain is also important for the patient because a relieving posture, which can lead to back pain, should be avoided at all costs. In addition, there is a risk, especially with older people, that the patient will not breathe deeply enough to ventilate the whole lung. This can then be the basis of pneumonia, which can also be very severe in old age.

In this case, painkillers are therefore not just “feel-good” drugs for the patient. The aim of the painkillers is to enable normal breathing without pain and to enable the patient to perform light activities early on with tolerable pain. Together with the pain therapy, breathing therapy can also be carried out, whereby the patient is instructed to breathe normally despite the fracture.

Respiratory therapy is particularly important for elderly people, as well as patients who have been injured several times and are therefore temporarily bedridden, and for people with respiratory diseases that already existed before the injury. The aim for all of them is to prevent pneumonia. This is mainly caused by secretions in the lower lung areas.

Physiotherapy can also be prescribed, but is not always necessary. A further important part of the treatment is also the protection of the fracture. Especially in the first two months after the injury there is an absolute ban on sports!

Even after two months the bone has not completely healed, but you can slowly start cycling or similar. Weight training or climbing should be suspended until about half a year after the injury. Overall, affected persons should listen to their body.

If pain occurs during exercise, they should stop exercising. Exaggerated ambition is out of place here. It is also important to treat the concomitant injuries that occurred during the fracture.

In about half of the sternum fractures, there are other relevant injuries (for example to the heart or lungs). Since the heart is located directly behind the sternum, a cardiac contusion (heart contusion) occasionally occurs, which can lead to cardiac arrhythmia. It is therefore common practice to monitor patients with a sternum fracture at least for one night in hospital.

In the case of an uncomplicated fracture of the sternum, surgery is generally not necessary. On the other hand, surgery should be performed especially in the case of displaced (dislocated) fractures or in the case of an impression fracture (part of the sternum is dented). Occasionally, a so-called false joint (pseudarthrosis) occurs even with initially uncomplicated fractures due to faulty healing.

In this case, the fracture gap is permanently mobile, allowing the sternum to move unnaturally. This can also make an operation necessary. Even severe, persistent pain can justify an operation.

During the operation, when a shift occurs, the bone is first brought into its original position, the surgeon speaks of a reduction. Then the fracture is fixed. This can essentially be achieved by two methods:

If the fracture is longitudinal and there are only two fragments, the surgeon can fix the fragments together with wire.

To do this, several opposite holes are drilled into the bone in the left and right fragment and then, similar to a shoelace, the holes are tied together with a wire. This is called a cerclage. – If there are several fragments, the fracture can also be fixed with a plate.

The individual fragments are screwed together with a metal plate and screws. This procedure has the advantage that even several small fragments are connected to each other in such a way that they do not move. The disadvantage is that a rather large foreign body is used. Under certain circumstances it may be necessary to remove the plate after months or years.