Rib Fracture

• Rib fracture causes:

  • most rib fractures are caused by blunt trauma to the chest wall
  • they are common in polytrauma with chest injuries being present in 25% of major trauma
  • spontaneous rib fractures can occur rarely following coughing or sneezing: usually there is a past medical history of osteoporosis, steroid use or chronic obstructive pulmonary disease
  • pathological rib fractures can also occur due to cancer metastases: most commonly prostate cancer in men and breast cancer in women
• Rib fracture clinical features:

  • severe, sharp chest wall pain which is more severe with deep breaths and coughing
  • significant chest wall tenderness with bruising over the trauma area
  • crackles or reduced breath sounds on auscultation if there is underlying injury
  • Drop in oxygen saturation
  • pneumothorax
• Flail chest:

  • this is a serious consequence of multiple rib fractures that can occur following trauma
  • it is caused by two or more rib fractures along three or more consecutive ribs, usually anteriorly
  • the flail segment moves paradoxically during respiration and impairs ventilation of the lung on the side of injury
  • the segment can cause serious contusional injury to the underlying lung if left untreated
  • often requires treatment with invasive ventilation and surgical fixation to prevent complications
• Rib fracture investigations:

  • CT scan - to assess fractures in 3D as well as search for metastases if present
  • chest x-rays: while these sometimes demonstrate anterior or posterior fractures, they provide suboptimal views and do not provide any information about the surrounding soft tissue injury
• Rib fracture management:

  • Conservative, with analgesia for pain
  • Surgical if pain is not managed or fractures have failed to heal following 12 weeks
  • flail chest segments are the only form of rib fractures which should be urgently discussed with cardiothoracic surgery as they can impair ventilation and result in significant lung trauma