Case report: Pathological fracture of the manubrium sternum of unknown aetiology

A 26-year-old male professional football player presented with sternal discomfort after performing upper limb exercises. X-rays and a computed tomography (CT) scan of the manubrium sternum indicated an area of lysis with a fracture line. An MRI showed bone marrow oedema as well as presternal and retrosternal soft tissue mass. An incision biopsy of the site and the soft tissue were performed under general anaesthesia. Additional investigations included a bone marrow biopsy from the left iliac crest, a full blood count and C-reactive protein test, all of which were normal. The morphological features were mostly in keeping with a healing fracture site, and the investigations revealed no evidence of a tumour or structural abnormality. In bone injuries, where the level of force is not commensurate with the degree of injury or where the anatomical area and other factors in the presentation are unusual, they require careful investigation. Treating physicians should actively exclude the multitude of potential causes when investigating pathological fractures.