From the Guidelines
Shockwave therapy is not recommended as a primary treatment for sternal fractures due to limited evidence supporting its use in this specific context. The standard treatment for sternal fractures involves pain management with analgesics, rest, and gradual return to activities as tolerated. Most sternal fractures heal within 8-12 weeks with conservative management. While extracorporeal shockwave therapy (ESWT) has shown benefits in treating certain musculoskeletal conditions and non-union fractures in other parts of the body, its use in sternal fractures is not well-established.
Key Considerations
- The sternum's location near vital organs like the heart and lungs makes specialized treatments like shockwave therapy potentially risky without clear evidence of benefit.
- A recent study 1 found that the evidence to support the use of physical therapies, including extracorporeal shock wave therapy, for wound healing is weak and does not recommend their use.
- If a sternal fracture is not healing properly (non-union) after several months of conservative treatment, consultation with a thoracic surgeon would be more appropriate than shockwave therapy to discuss potential surgical interventions.
Treatment Approach
- Pain management with analgesics (such as acetaminophen, NSAIDs like ibuprofen 400-600mg every 6-8 hours, or in severe cases, opioids like hydrocodone/acetaminophen 5/325mg every 4-6 hours as needed)
- Rest and gradual return to activities as tolerated
- Physical therapy focusing on breathing exercises and gradual strengthening may be beneficial during recovery to maintain chest wall function and prevent complications.
From the Research
Effectiveness of Shockwave Therapy for Sternal Fracture
There are no research papers to assist in answering this question, as none of the provided studies mention the use of shockwave therapy for treating sternal fractures.
Alternative Treatment Options
- Sternal fixation has been shown to improve pain and upper extremity range of motion in patients with traumatic sternal fractures 2
- Periosteal infusion of local anesthetics and opioids can provide effective analgesia for patients with sternal fractures 3
- Subpectoral interfascial plane catheters can be used for analgesia in patients with sternal fractures 4
- Conservative treatment is commonly used for isolated sternal fractures, with surgical fixation indicated in cases of fracture instability, displacement, or non-union 5, 6
Treatment Outcomes
- Most patients with traumatic sternal fractures show sternal healing and report pain relief 5
- Treatment complications are relatively rare, occurring in approximately 2% of patients 5
- Surgical stabilization of sternal fractures can be feasible and safe, and should be considered in unstable fractures, severe displacement, symptomatic malunion, or non-union 6