Working Diagnosis:
Acute nondisplaced comminuted fracture of the sternal manubrium and right anterior 2nd rib fracture.

Treatment:
Her sternum pain improved with nonoperative management, focusing on relative rest, avoidance of painful and contact activities, and over-the-counter pain medications. Her pleuritic chest pain resolved three weeks after the initial injury.

Outcome:
The patient completed shoulder and chest wall physical therapy to assist return to outdoor cycling after 12 weeks(4). She had no remaining functional deficits or pain after the above treatment.

Author's Comments:
This case reminds clinicians to keep a wide differential for patients with SC joint pain or vague shoulder girdle pain, to do a thorough examination, and to pursue advanced imaging if there is any suspicion of an SC joint or sternal injury. <br> <br>Sternal injuries account for less than 1% of upper body injuries in athletes(1). Manubrium fractures account for only 15% of traumatic sternum fractures(2). The manubrium is important for the stability of the shoulder girdle and the thorax, with vital internal organs around this area, making a fracture of this region particularly significant(2). Stable, nondisplaced fractures can be managed nonoperatively, however, displaced and unstable fractures should be managed operatively(2,3). Typically, manubrium fractures present after blunt trauma to the chest wall but can result from a combination of indirect and direct forces(2). X-rays are typically normal, so advanced imaging is required if the suspicion is high.

Editor's Comments:
Patient who presents with unknown exact impact pattern injuries often present a wide differential diagnosis. With fracture patterns not always being acutely visible a negative XR is not always reassuring in the acute management period. Sternal fractures are rare but often associated with blunt force to the chest area. Often in the field or sports medicine we are piecing together the actual mechanism of injury as patients can present with a confusing description or pain pattern. This case reminds us to keep a wide differential and especially when follow up pain doesn’t quite fit advanced imaging can help confirm or rule out a diagnosis. When you look at the data the majority of these can be treated non operatively as was seen in this case.

References:
1. Enger M, Skjaker SA, Nordsletten L, et al. Sports-related acute shoulder injuries in an urban population. BMJ Open Sport Exerc Med. 2019;5(1):e000551. Published 2019 Aug 12. doi:10.1136/bmjsem-2019-000551 <br>2. Schulz-Drost S, Krinner S, Oppel P, et al. Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures. J Thorac Dis. 2018;10(3):1394-1405. doi:10.21037/jtd.2018.03.40 <br>3. Harston A, Roberts C. Fixation of sternal fractures: a systematic review. J Trauma. 2011;71(6):1875-1879. doi:10.1097/TA.0b013e31823c46e8 <br>4. Sternal fracture. (2021, November 19). Physiopedia. Retrieved 16:11, November 5, 2025 from https://www.physio-pedia.com/index.php?title=Sternal_fracture&oldid=286770.

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