Long Island Sternal Fracture
Lawyer

Sternal Fractures from Car Accidents: Anatomy and Mechanism

The sternum — the breastbone — is a flat bone at the center of the anterior chest wall that protects the heart, great vessels, and mediastinal structures. It consists of three segments: the manubrium (the upper, broadest segment, which articulates with the clavicles at the sternoclavicular joints and with the first and second ribs at the sternocostal joints); the body (the longest segment, articulating with ribs 2 through 7 at the sternocostal joints); and the xiphoid process (the small cartilaginous inferior tip, which has limited structural function but can fracture and cause pain). The manubriosternal joint (angle of Louis) is a fibrocartilaginous joint between the manubrium and body that can be fractured or dislocated in chest trauma.

Sternal fractures occur in 3–8% of all motor vehicle collisions, with the overwhelming majority caused by direct anterior chest impact. The dominant mechanisms in car accidents are: steering wheel impact (the driver's chest impacts the steering wheel in a frontal collision, applying direct compressive force to the sternum); seatbelt compression (the diagonal shoulder belt restrains the occupant during a frontal or rear-end collision by concentrating force across the anterior chest and sternum — the classic "seatbelt fracture" mechanism); airbag deployment impact (airbag deployment at 150–200 mph can deliver substantial force to the anterior chest, particularly in short-stature drivers positioned close to the steering wheel); and dashboard crush in frontal crashes (intrusion of the dashboard into the passenger compartment can directly compress the anterior chest of front-seat occupants). Rear-end collisions cause sternal fractures through the rebound mechanism: the occupant is first thrown rearward into the seat, then thrown forward by the seatbelt restraint as the vehicle decelerates.

Fracture Classification: Types of Sternal Fractures

Unlike pelvic fractures, sternal fractures do not have a single universally adopted classification system, but clinical description focuses on fracture location, orientation, displacement, and comminution — each of which has implications for treatment and claim value.

Transverse fractures of the sternal body are the most common pattern (approximately 70–80% of sternal fractures), occurring at the level of the third or fourth intercostal space. The fracture line runs horizontally across the body, and the distal fragment may be displaced posteriorly (the most common displacement direction) or anteriorly. Transverse fractures are best visualized on the lateral chest X-ray or sagittal CT reconstruction. Comminuted fractures involve multiple fragments and represent higher-energy mechanisms; they are more likely to cause instability, paradoxical chest wall motion, and associated intrathoracic injuries. Comminuted fractures with three or more fragments are a strong indication for operative fixation with sternal plating. Manubrial fractures are less common and occur with direct impact to the upper chest; they are frequently associated with sternoclavicular joint disruption and first or second rib fractures — a pattern that requires careful evaluation for injury to the underlying great vessels (subclavian artery and vein, brachiocephalic artery). Xiphoid process fractures are clinically less significant from a structural standpoint but cause significant local pain, particularly with deep breathing and Valsalva maneuver.

Associated Injuries: Cardiac, Pulmonary, and Vascular Complications

Cardiac Contusion and Myocardial Injury

The heart lies directly posterior to the sternum, separated only by the pericardium and a thin layer of mediastinal fat. When the sternum fractures, the force transmission to the myocardium causes myocardial contusion — a bruise to the heart muscle causing local inflammation, edema, and, in severe cases, necrosis of myocardial fibers. The right ventricle, which lies most anteriorly, is the chamber most commonly affected. Clinically, myocardial contusion presents as: ECG changes (new right bundle branch block — the most specific finding — ST-segment changes, T-wave inversions, sinus tachycardia, or premature ventricular contractions); elevated cardiac troponin I or T (indicating myocardial cell death); and echocardiographic findings including right ventricular wall motion abnormality, reduced ejection fraction, or pericardial effusion. The standard of care per Eastern Association for the Surgery of Trauma (EAST) guidelines requires ECG and troponin on all patients with suspected cardiac contusion; admission for continuous cardiac monitoring is mandatory when either is abnormal. Hospital admission for cardiac monitoring — typically 24–48 hours in a step-down or telemetry unit — represents substantial recoverable medical expense damages.

Cardiac Arrhythmia Requiring Monitoring

Myocardial contusion from a sternal fracture can produce both acute and delayed cardiac arrhythmias. Acute arrhythmias — sinus tachycardia, premature ventricular contractions (PVCs), ventricular tachycardia — occur within the first 24–48 hours and are the primary indication for cardiac monitoring admission. Delayed arrhythmias can manifest weeks after the injury as the inflammatory response resolves and scar tissue forms at the contusion site; these include recurrent PVCs, new-onset atrial fibrillation, and, rarely, complete heart block. For personal injury claims, documentation of post-traumatic cardiac arrhythmia — through hospital telemetry records, Holter monitor results, and cardiologist notes — creates a compelling record of permanent cardiac consequences satisfying the permanent consequential limitation of use category under §5102(d) alongside the per se fracture category. A cardiologist's causation opinion linking the arrhythmia to the sternal fracture and underlying myocardial contusion is essential to preventing the insurer from arguing that the arrhythmia is idiopathic or pre-existing.

Blunt Thoracic Aortic Injury (BTAI)

Blunt thoracic aortic injury is a spectrum of aortic wall injuries — from Grade I intimal tear to Grade IV complete aortic rupture — caused by rapid deceleration. The aortic isthmus (just distal to the left subclavian artery at the attachment point of the ligamentum arteriosum) is the most common injury site because the descending aorta is relatively fixed here while the aortic arch remains mobile, creating shearing stress during deceleration. CT angiography of the chest is the diagnostic standard, obtained in any patient with high-energy anterior chest trauma, widened mediastinum on plain X-ray, or first/second rib fractures. From a legal perspective, the performance of CT angiography in a sternal fracture patient — even when the result excludes aortic injury — documents the severity of mechanism recognized by the treating emergency team. Grade I intimal tears are managed medically with blood pressure control; Grades II–IV may require endovascular thoracic aortic repair (TEVAR) — a major vascular procedure costing $80,000–$150,000 that represents substantial recoverable economic damages and creates a long-term follow-up requirement with imaging surveillance.

Pulmonary Contusion, Pneumothorax, and Hemothorax

Sternal fractures frequently co-occur with rib fractures and associated pulmonary injuries. Pulmonary contusion — bruising of the lung parenchyma — appears as consolidation on CT chest within 6 hours of injury and typically resolves over 5–7 days; in severe cases it causes acute respiratory failure requiring mechanical ventilation. Pneumothorax (air in the pleural space) results from rib fracture puncture of the visceral pleura or direct tracheal/bronchial injury; tension pneumothorax is a life-threatening emergency. Pneumothorax may require chest tube placement (tube thoracostomy) — the chest tube insertion site leaves a permanent scar at the lateral chest wall, constituting significant disfigurement under §5102(d). Hemothorax (blood in the pleural space) results from vascular injury to intercostal vessels, pulmonary vessels, or the aorta; it may require chest tube drainage or, if massive, video-assisted thoracoscopic surgery (VATS). Concurrent rib fractures are present in 50–60% of sternal fracture cases, and the combination of sternal fracture with three or more rib fractures (flail chest) represents a particularly severe pattern requiring ICU admission, aggressive pain control (often with epidural analgesia), and sometimes operative rib plating.

Tracheal and Bronchial Injury

Tracheobronchial injury — laceration or transection of the trachea or main bronchi — is a rare but serious associated injury in severe anterior chest trauma. It presents as massive air leak from a chest tube, subcutaneous emphysema extending to the neck and face, and respiratory distress. CT with thin slices and bronchoscopy are used for diagnosis; operative repair or endobronchial stenting is required. For personal injury claims, tracheobronchial injury represents one of the most severe associated injuries possible and dramatically increases claim value through surgical expense damages, ICU hospitalization, and potential long-term pulmonary complications.

Diagnosis: Imaging and Cardiac Monitoring

Treatment: Non-Operative Management and Sternal Plating Surgery

Complications: Non-Union, Costochondritis, and Chronic Chest Pain

Sternal fractures carry a clinically meaningful rate of long-term complications that affect claim value under multiple §5102(d) threshold categories.

Sternal non-union — failure of the fracture to heal with bony bridging by 3–6 months — is the most important long-term complication of sternal fractures from a legal standpoint. Non-union develops in an estimated 10–15% of sternal fractures managed non-operatively. The fibrous union that forms is mechanically unstable: the two fragments move relative to each other with every breath, cough, and trunk movement, causing severe mechanical chest pain that is activity-dependent and persistent. Non-union is confirmed on CT chest with bone windows showing a persistent fracture gap with fibrous rather than bony tissue filling the gap. From a legal perspective, sternal non-union is highly significant: it establishes permanent consequential limitation under §5102(d) through the chronic pain and physical limitation it causes, it creates clear surgical expense damages (sternal plating at $25,000–$60,000), and it creates a visible midsternal surgical scar constituting significant disfigurement — all three categories addressable simultaneously.

Post-traumatic costochondritis — inflammation of the sternocostal cartilages (the cartilaginous connections between the bony ribs and the sternum) — is a common complication of both direct sternal trauma and concurrent rib fractures. Patients report tenderness at multiple sternocostal junctions along the lateral border of the sternum, exacerbated by deep breathing, twisting, and arm movements. Costochondritis can persist for 12–24 months and, in some patients, becomes a permanent source of anterior chest pain. It is documented by clinical examination (direct sternocostal junction tenderness) and can be confirmed by local anesthetic injection providing temporary relief. Pain management records documenting ongoing sternocostal junction pain satisfy the permanent consequential limitation category.

Chronic chest wall pain from sternal non-union, costochondritis, or post-traumatic intercostal neuralgia is the most common long-term complaint following sternal fractures and rib fractures. Pain management specialists documenting chronic thoracic pain, prescribing intercostal nerve blocks, and opining on permanent pain and activity restriction provide the permanence foundation for §5102(d) claims. Cardiac arrhythmia sequelae — including recurrent premature ventricular contractions or new-onset atrial fibrillation persisting beyond hospitalization — require cardiology follow-up and Holter monitor documentation to establish permanent cardiac injury. PTSD from traumatic impact is a recognized psychological sequela of high-energy motor vehicle collisions with significant chest trauma; psychological evaluation documenting PTSD symptoms, and psychiatric or psychological treatment records, support a permanent consequential limitation claim for psychological injury alongside the physical injury categories.

New York Law: §5102(d) Threshold and Sternal Fracture Claims

Under New York Insurance Law §5102(d), a sternal fracture from a car accident satisfies the "fracture" category as a per se serious injury — no additional proof of limitation, duration of disability, or surgical intervention is required. The fracture diagnosis alone, confirmed by a lateral chest X-ray, CT of the chest, or bone scan, establishes the §5102(d) threshold. This is significant because the defense cannot argue that a confirmed sternal fracture is "not serious enough" under the no-fault threshold: the fracture category is satisfied the moment the fracture diagnosis is confirmed on imaging.

Beyond the per se fracture category, sternal fracture victims with persistent symptoms can also satisfy the permanent consequential limitation of use category (when chronic chest wall pain, exercise intolerance, or breathing limitation is documented by treating specialists as permanent) and the significant disfigurement category (when sternal plating surgery or chest tube insertion leaves permanent visible scars). Asserting multiple threshold categories simultaneously — as our firm routinely does — is strategically important because it forecloses the defense's ability to knock out any single threshold category on motion.

Sternal non-union requiring sternal plating is particularly valuable from a damages standpoint: the surgical procedure generates $25,000–$60,000 in recoverable surgical expense damages, the operative report and implant records establish indisputable medical necessity, and the post-operative permanence documentation directly supports the permanent consequential limitation category. Because the surgery is caused by the non-union — which in turn is caused by the original sternal fracture from the collision — the chain of causation is straightforward and difficult for the defense to challenge.

Cardiac arrhythmia documentation following sternal fractures with myocardial contusion requires careful coordination between the emergency physician, cardiologist, and plaintiff's attorney. Hospital telemetry records, Holter monitor reports, and cardiologist's opinions linking the arrhythmia to the traumatic myocardial contusion (rather than pre-existing cardiac disease) are essential. Insurers routinely challenge cardiac arrhythmia claims by arguing pre-existing cardiac disease — a causation dispute that requires a clear cardiologist opinion, negative cardiac history review, and, where available, pre-accident ECG comparison.

For seatbelt and airbag mechanism cases, there is no comparative fault argument: a plaintiff who was properly restrained and injured by the seatbelt or airbag — the safety equipment — was acting entirely reasonably. Defense counsel cannot argue that the plaintiff caused or contributed to their own sternal fracture by being properly belted. The seatbelt contusion mark across the anterior chest — photographed in the emergency department — is powerful corroborating evidence of the mechanism and the plaintiff's compliance with safety laws.

Victims injured in car accidents on Long Island involving sternal fractures should also consult a Long Island car accident lawyer to evaluate all aspects of their claim, including liability, no-fault benefits, and third-party damages.

Recovery Timeline and Lost Wage Documentation

Sternal fracture recovery timelines depend on fracture severity, associated injuries, and whether surgery is required. For non-operative management of isolated sternal fractures, patients are typically discharged from the hospital within 2–5 days (longer if cardiac monitoring admission is required). Activity restriction of 6–8 weeks is standard, during which heavy lifting, pushing, and pulling are prohibited. Return to sedentary desk work may be possible at 4–6 weeks if pain is controlled; return to physical labor is typically 8–12 weeks for uncomplicated fractures. For sternal non-union treated with plating surgery, the post-operative recovery requires an additional 6–8 weeks of activity restriction and physical therapy.

When concurrent rib fractures, pneumothorax, hemothorax, or cardiac contusion complicate the course, hospital stays of 7–14 days are common, with extended periods of restricted activity and pulmonary rehabilitation. For patients who develop chronic chest wall pain, ongoing pain management, intercostal nerve blocks, and activity limitation can persist indefinitely — representing continuing wage loss and medical expense damages that must be projected through a life care plan.

Under New York's no-fault system, lost wages up to $2,000 per month are covered by Personal Injury Protection (PIP) benefits for the first three years from the accident date. Lost wages exceeding PIP limits — and all future earning capacity loss — are recoverable as economic damages in the third-party liability claim. For construction workers, manual laborers, healthcare workers with patient lifting requirements, and other physically demanding occupations, sternal fractures can cause permanent occupational restrictions requiring vocational rehabilitation and earning capacity loss documentation by a forensic economist.

High-Value Factors in Long Island Sternal Fracture Car Accident Claims

Not all sternal fracture cases carry the same claim value. Several factors dramatically increase the value of a sternal fracture claim under New York law and should be identified and documented from the earliest stage of representation.

Seatbelt and airbag mechanism (no comparative fault): When a sternal fracture results from the seatbelt restraint system or airbag deployment in a frontal or rear-end collision, the plaintiff has zero comparative fault. The defendant cannot argue that the plaintiff was negligent by wearing a seatbelt — that is the law. The visible diagonal seatbelt contusion across the anterior chest, photographed in the emergency department, eliminates the comparative fault defense and ensures full recovery without any reduction for plaintiff's own negligence. This is in contrast to unrestrained occupant cases where defendants argue contributory negligence under New York's Spier v. Barker line of cases.

Cardiac monitoring hospitalization: Admission for cardiac monitoring following a sternal fracture — even when the monitoring result is normal — documents the treating emergency team's clinical assessment that the chest trauma was severe enough to warrant cardiac observation. The hospitalization record demonstrates that the injury was immediately recognized as serious, corroborates the plaintiff's subjective pain complaints, and generates substantial recoverable medical expense damages. When troponin is elevated or ECG is abnormal, the hospitalization expense increases further, and the cardiac injury documentation is directly usable as permanence evidence.

Potential BTAI workup: The performance of CT angiography of the chest to evaluate for blunt thoracic aortic injury is both a clinical necessity and a legal asset. Even when CT angiography excludes aortic injury, the radiologist's report and the emergency physician's decision to obtain the study document that the mechanism was recognized as high-energy, the chest trauma was severe, and the plaintiff required evaluation for a potentially fatal vascular injury. This objective clinical record powerfully corroborates the severity of the collision and the plaintiff's chest injury, making it significantly harder for the insurer's IME physician to minimize the mechanism at a later date.

Sternal non-union developing at 3–6 months: The development of sternal non-union — confirmed on CT chest — adds surgical expense damages, creates a second hospitalization record, generates a visible permanent scar, and establishes permanent consequential limitation through the pain and functional restriction associated with the non-union and the post-operative recovery. It also extends the duration of the plaintiff's disability and medical treatment, increasing lost wage damages. Because non-union is a delayed complication, it is critical to maintain a treating relationship with an orthopedic or thoracic surgeon during the months immediately following the initial injury — gaps in orthopedic follow-up can allow the insurer to argue that non-union was caused by the plaintiff's failure to follow up rather than the severity of the original fracture.

Concurrent rib fractures: Rib fractures occurring alongside a sternal fracture — a common combination given the shared anterior chest trauma mechanism — each independently satisfy the §5102(d) fracture category. Multiple fractures from the same collision are cumulative for threshold purposes: the plaintiff who fractured the sternum and three ribs has multiple independent fractures each individually satisfying the fracture threshold, and the cumulative injury pattern supports substantially higher pain and suffering damages. Rib fractures also increase the likelihood of associated pulmonary complications (pneumothorax, pulmonary contusion, flail chest) that add further hospitalization expense and permanence documentation.

Occupational impact on high-wage earners and physical workers: Sternal fracture victims who perform physically demanding work — construction, plumbing, electrical, healthcare, law enforcement, firefighting — face extended periods of work restriction and, in cases of sternal non-union or chronic chest wall pain, potential permanent occupational change. For these plaintiffs, the economic damages component — lost wages to date plus future earning capacity loss — can substantially exceed the non-economic damages. Retaining a vocational rehabilitation expert and forensic economist early in the case allows for comprehensive economic damages documentation that is properly disclosed in expert reports and incorporated into settlement demands at their full present value.

Evidence Preservation in Sternal Fracture Car Accident Cases

Evidence preservation is one of the most time-sensitive tasks in any sternal fracture car accident case. The most important categories of evidence — and the actions required to preserve them — are as follows.

Event Data Recorder (EDR / "black box") data: Modern vehicles record pre-crash speed, brake application, throttle position, airbag deployment trigger events, and delta-V (change in velocity during the crash). This data is stored in the EDR and can be downloaded using specialized equipment. However, EDR data is overwritten when the vehicle accumulates subsequent crash events or, in some vehicles, after a set number of ignition cycles. An evidence preservation letter must be sent to the defendant and, if the vehicle was repaired or transferred, to the body shop and new owner, within days of the collision. EDR data directly corroborates the severity of the crash mechanism — it is the objective measure of collision force that makes it extremely difficult for the defense to argue the crash was too minor to cause a sternal fracture.

Surveillance and traffic camera footage: Intersections on Long Island are increasingly equipped with traffic cameras (Nassau and Suffolk County traffic management systems), and private businesses near the accident scene often have exterior surveillance cameras capturing parking lots and adjacent roadways. This footage is typically overwritten within 30–72 hours. An immediate evidence preservation letter to the relevant government agencies and private businesses is essential. Surveillance footage captures the collision from an objective perspective — speed of approach, lane changes, signal compliance, and impact angle — that often cannot be replicated by any witness testimony.

Photographic evidence: Emergency department photographs of the seatbelt contusion pattern, anterior chest bruising, and any visible deformity are among the most compelling images in sternal fracture cases. Ensure that nursing notes document the seatbelt contusion, and request copies of all emergency department photographs from the medical records department. Photographs of vehicle damage — exterior crush, airbag deployment, steering wheel deformation, seatbelt deployment and pretensioner activation — corroborate mechanism.

Medical records and imaging: Request all emergency department records, imaging CDs (chest X-rays, CT scans, CT angiography), ECG tracings, telemetry strips, cardiac enzyme results, and operative records from Day 1 of representation. These records form the evidentiary foundation of the threshold claim, causation argument, and damages presentation. For sternal non-union cases, the follow-up CT chest at 3–6 months is a critical record that must be obtained and preserved as it directly establishes the surgical indication.

Choosing a Long Island Sternal Fracture Lawyer: What to Look For

Sternal fracture claims require a personal injury lawyer who understands the intersection of emergency medicine, cardiology, thoracic surgery, and New York no-fault law. Many general personal injury attorneys handle straightforward soft-tissue claims but lack the medical knowledge to identify and document the full spectrum of sternal fracture injuries and complications. The 24 years of experience at the Law Office of Jason Tenenbaum, P.C. include extensive handling of §5102(d) threshold cases, cardiac contusion documentation, and surgical expense damages from thoracic surgery.

When evaluating a Long Island sternal fracture lawyer, consider: Does the firm understand the difference between a transverse and comminuted sternal fracture, and how that affects surgical indication? Can the attorney explain to a jury why a sternal fracture with cardiac contusion requires hospital admission even when the ECG normalizes? Does the firm coordinate with thoracic surgeons to ensure sternal non-union is identified and surgically treated at the appropriate time? Does the firm assert the significant disfigurement category for sternal surgery scars as an independent threshold category?

These are the technical questions that determine whether a sternal fracture claim reaches its full value or is settled for a fraction of what it is worth. The Law Office of Jason Tenenbaum offers a free consultation and handles all sternal fracture cases on a pure contingency fee basis — no fee unless we recover compensation for you.