Stress fractures of the sternum and ribs related to sports in adolescents and adults: literature review

Stress (overuse, fatigue) fractures are among the most common injuries in athletes. Due to their gradual onset, often subtle clinical presentation, and sometimes absent imaging findings, this pathology is frequently overlooked. A search of published data was conducted in the PubMed, ResearchGate, and CyberLeninka databases, covering publications from January 1, 1996, to June 1, 2026. The search utilized combinations of AND/OR operators and the following keywords: “stress fractures” / “стрессовые переломы,” “overuse fractures” / “нагрузочные переломы,” “усталостные переломы,” “ribs” /“рёбра,” “sternum” / “грудина,” “sports” / “спорт,” “athletes” / “спортсмены.” A total of 74 sources were selected, of which 30 were published within the last 10 years. According to published data, the incidence of rib stress fractures accounts for 5.6%, while sternal fractures account for less than 1% of all skeletal stress injuries. The occurrence of these fractures is associated with repetitive loading on the musculoskeletal system, causing constant microvascular trauma combined with overexertion of the muscles surrounding the bone. Rib stress fractures occur most frequently in baseball players (38%) and rowers (24.5%), as well as swimmers (5%) and dancers (5%). This injury is more typical for adolescents than for adult athletes. Sternal stress fractures are typical for disciplines requiring pushing, throwing, or pressing movements (weightlifting, golf, rowing, gymnastics). Instrumental confirmation of the diagnosis occurs from 2 to 6 weeks from the onset of pain. Magnetic resonance imaging is the primary diagnostic method. Most stress fractures consolidate spontaneously within 4–6 weeks provided physical activity is limited. However, the nonunion rate for first-rib fractures reaches 29%. Complications of pseudarthrosis of the first rib include thoracic outlet syndrome, Horner syndrome, and brachial plexus palsy (43% of cases). Indications for surgical treatment include: a first-rib fracture accompanied by symptoms of brachial plexus compression; displacement of sternal fragments; formation of sternal pseudarthrosis; persistent severe pain.