Rib fracture

Background
Multiple Right sided rib fractures
  • Most common injury in blunt chest trauma
  • 9th, 10th, 11th rib fractures associated with intra-abdominal injury
  • Elderly patients have double the mortality of younger patients
  • <2 years old with >2 rib fractures → 50% mortality

Clinical Features
  • Chest wall pain
  • May have chest wall crepitus or ecchymosis
  • Pain on inspiration
  • Flail segment (paradoxical chest wall movement) may be seen if multiple ribs are fractured in 2 or more places

Differential Diagnosis

Thoracic Trauma

Evaluation
  • CXR
    • May only pick up 24% of fractures[1]
  • CT chest has much better sensitivity (63%) and specificity (97%)[2]

Management
  • Adequate analgesia is paramount to management of rib fractures
  • Rib belts or other chest wall wrapping has no place in treatment and should be discouraged
  • Incentive spirometry
  • If flail segment is present, positive pressure ventilation may be required to allow for adequate ventilation

Disposition
  • Consider discharge for:
    • Isolated rib fractures
    • Young, otherwise healthy patient
    • Good respiratory effort and cough (able to clear respiratory secretions)
    • Pain controlled with PO medications
  • Consider admission for:
    • Elderly patient with multiple rib fractures, hypotension, pulmonary contusion, hemothorax, pneumothorax, or age >85[3]
    • Flail segment
    • Significant associated injury
    • Pre-existing pulmonary disease

See Also

References
  1. Rainer TH, Griffith JF, Lam E, et al. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma 2004:56;1211–13.
  2. Schulze C, Hoppe H, Schweitzer W, et al. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int. 2013; 233(1-3):90-98.
  3. Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84.
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