A fracture of the sternum after a road traffic collision is painful, frightening, and in the great majority of people heals without an operation. Two things reassure more than anything else. First, a broken breastbone by itself does not mean the heart has been injured — a normal ECG together with a normal troponin blood test effectively excludes that, and the fracture alone is not a reason for cardiac monitoring. Second, most of these fractures unite over six to twelve weeks with pain relief and time. The situations that need a thoracic surgical opinion are pain that has not settled by three months, a fracture that has not knitted, and a fracture that happened after very little force. Dr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon (GMC 6150382), assesses sternal injuries at London Bridge Hospital and The Lister Hospital Chelsea within 2–3 days. Self-referrals welcome.
Last reviewed: September 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
A normal ECG and a normal troponin together exclude significant blunt cardiac injury. A sternal fracture on its own does not predict it and is not by itself a reason for monitoring.
Six to twelve weeks to unite, with the worst pain in the first fortnight. Surgery is for displaced unstable fractures and for non-union, not for a fracture as such.
Pain that is no better at all at three months, with a sense of movement or a click, is the point to have the fracture reviewed rather than give it more time.
The seatbelt crosses the front of the chest diagonally and takes the whole force of a sudden deceleration through that strap. An airbag deploys explosively straight into the front of the chest. Both are designed to load the sternum and the chest wall because those structures can take force that the head and neck cannot. A sternal fracture from a restraint is not a sign that the restraint failed. It is a sign that it worked. Worth stating plainly, because people often feel that something must have gone wrong.
It also explains why these injuries so often follow collisions that did comparatively little visible damage. A modest impact is enough when the force is concentrated onto one bone through a narrow strap. People are frequently told that their accident was too minor to have broken anything, and that is simply not how the mechanics work.
Other mechanisms produce the same fracture. A fall onto the front of the chest, particularly in older people. A direct blow in sport. And cardiopulmonary resuscitation — sternal and rib fractures are common after effective chest compressions and are an accepted consequence of compressions deep enough to work.
One group deserves separate mention: a sternum that breaks after very little force at all. That raises the question of whether the bone was weakened beforehand, most often by osteoporosis, which is treatable and worth diagnosing. It is covered further below.
The breastbone sits directly in front of the heart, so the fear is entirely reasonable. The answer is that this question is settled by two simple tests rather than by the fracture.
Two further points about the immediate assessment, which belongs in an emergency department at the time rather than in a clinic weeks later. A sternal fracture can be accompanied by other injuries — most importantly to the thoracic spine — and those are looked for at the time. The often-quoted figures for associated spinal injury come from major trauma populations and do not describe the person who has broken a sternum in a low-speed collision, so they are worth treating with caution if you meet them online.
If the injury has just happened and you have not been assessed, the emergency department is the right place, not an outpatient appointment. New or worsening breathlessness, chest pain that is different in character from the injury pain, fainting, or an irregular heartbeat all warrant urgent attention.
By symptoms alone the two are not reliably distinguishable. Both give pain directly over the breastbone, worse on coughing, sneezing, laughing, taking a deep breath, rolling over in bed and getting up from lying flat. Both can produce a band of bruising across the line of the seatbelt, and that bruising is not itself evidence of a fracture.
A normal chest X-ray does not exclude a sternal fracture. The sternum lies directly in front of the spine and the heart, and on a standard front-facing film they are superimposed, so the fracture line is frequently invisible. A lateral view taken specifically to look at the sternum, or a CT scan, is what demonstrates it. People are often told their X-ray was clear and then spend weeks assuming their continuing pain has no explanation.
In practical terms, knowing the answer does not always change the early treatment, which is why imaging is not always repeated at the time. It matters more later: if pain persists, establishing whether there is a fracture and whether it has united is exactly what a CT scan is for. What each test shows is set out on the chest imaging page.
The bone generally unites over six to twelve weeks. The worst of the pain is in the first two to three weeks, after which there is steady improvement. Deep breaths, coughing, sneezing and getting out of bed remain uncomfortable longest, and progress is not a straight line — a worse day in week five is normal and does not mean something has gone wrong. By around three months most people are comfortable in ordinary activity, with some residual ache on heavy lifting or pushing through the arms.
Take the pain relief properly. The reason is not comfort. Chest wall pain makes people breathe shallowly and suppress coughs, and that is what causes chest infections after a chest injury. Regular simple analgesia taken on a schedule works considerably better than waiting until the pain is bad. Holding a folded towel or cushion firmly against the front of the chest when you cough helps a great deal and costs nothing.
Avoid heavy lifting and anything that pushes hard through the arms while it heals. Sleeping propped up is more comfortable for most people in the first weeks. If breathlessness worsens, or you develop a fever or a productive cough, that needs medical attention rather than being attributed to the fracture.
Most sternal fractures unite. A minority do not, and the result is a non-union: the two fragments remain separate, held only by scar tissue, and they move against each other. The description is consistent — a persistent ache over the fracture, a sense of movement, and often a click or a grinding sensation when pushing up out of a chair, lifting, or turning over in bed.
A CT scan confirms whether the bone has knitted, and it is the investigation that turns a vague complaint of ongoing pain into a specific diagnosis. Where a symptomatic non-union is confirmed, the sternum can be fixed with plates, which stabilises the fragments and reliably relieves the mechanical pain and the clicking.
Fixation is also considered early, rather than at three months, in a badly displaced fracture with an unstable segment that moves visibly on breathing. That is uncommon and is usually identified at the time of the injury.
The point worth taking from this section is that persistent pain months after a sternal fracture is not something to simply endure. It has a name, it is demonstrable on a scan, and where it is confirmed it is treatable. People are frequently told there is nothing to be done because the injury is old, and that is not right. The same principle applies to rib fractures that have not settled.
A sternum that breaks after a stumble, a minor bump, or in one case a heavy cough, raises a different question from one broken in a collision. The force does not explain the fracture, so the bone itself becomes the question.
The commonest explanation is osteoporosis, and the sternum is one of the sites where fragility fractures occur. Identifying it matters well beyond the chest, because it is treatable and because the next fragility fracture may be a hip. A fracture of this kind is a reason to have bone health assessed rather than simply to wait for the pain to settle.
Less commonly, a bone that is already abnormal fractures through the abnormal area, and the fracture is how the underlying problem first announces itself. That is uncommon, and it is one of the reasons a fracture after trivial trauma is reviewed differently rather than assumed to be bad luck. In someone previously treated for cancer, particularly breast cancer, a new sternal fracture or bony pain is assessed more urgently — that situation is covered on the breast cancer spread to the chest page.
Immediately after the injury, the emergency department. The cardiac assessment, the search for other injuries, and adequate pain relief all belong there and cannot be replaced by an outpatient appointment.
Afterwards, a thoracic surgeon is the specialty that owns the chest wall. That is worth naming because people with continuing pain months after a sternal fracture are frequently sent between general practice, orthopaedics and pain services without anyone taking responsibility for the front of the chest. If your pain has not improved at all by three months, if you can feel movement or a click at the fracture, or if the bone broke after very little force, that is the point to be assessed.
Dr Okiror assesses sternal and chest wall injuries at London Bridge Hospital and The Lister Hospital Chelsea, with outpatient consultations also available at the HCA clinics in Canary Wharf and the City of London. Private appointments are typically available within 2–3 working days. Self-referrals welcome. Bring the records and imaging from the time of the injury. Second opinions are available for patients already under another team’s care.
Questions most commonly asked after a seatbelt or airbag injury to the chest, a fall onto the front of the chest, or chest compressions.
Book an Assessment →Or call Jo Mitchelson:
020 7952 2882
Self-referrals welcome. Private appointments at London Bridge Hospital and The Lister Hospital Chelsea within 2–3 days. Dr Okiror reviews the imaging from the injury personally and establishes whether the fracture has united. If the injury has just happened, go to an emergency department first.
Jo Mitchelson, PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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