Rib fractures

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 23 Jun 2024

Last updated: 18 Apr 2024

Rib fractures may be due to blunt force injury, falls, nonaccidental trauma, aggressive CPR, or more rarely, severe coughing, athletic activities, or metastatic lesions and primary bone tumors.

Among infants younger than 12 months presenting with rib fractures, as many as 82% sustained these injuries non-accidentally (i.e., through physical abuse).

Assessment includes identification of the fracture itself and any concurrent injuries. These include pneumothorax, hemopneumothorax, pulmonary contusions, and a flail chest, as well as possible nonthoracic injuries.

Chest radiography is the first-line imaging modality in patients presenting with known or possible trauma, followed by a chest CT if needed.

Treatment includes pain control, lung volume expansion exercises and/or ventilatory support, physical therapy, mobilization, and treatment of concomitant injuries.

An increased number of ribs fractured correlates with increased morbidity and mortality.

Definition

A rib fracture is a break in one of the rib bones of the thoracic skeleton. Rib fractures are common injuries that most frequently are due to blunt force trauma (including falls and nonaccidental trauma), but can also occur as a result of aggressive cardiopulmonary resuscitation, severe coughing, athletic activities, or primary bone tumors and metastatic lesions (“pathologic fractures”). Rib fractures can be relatively benign, but often may be a marker of concomitant injuries such as pneumothorax, hemopneumothorax, and/or pulmonary contusions, flail chest, and possible nonthoracic injuries. An increased number of fractured ribs correlates with increased morbidity and mortality.

History and exam

Key diagnostic factors

history of trauma
presence of risk factors
pain
dyspnea

Full details

Other diagnostic factors

signs of impaired oxygenation
paradoxical chest wall motion

Full details

Risk factors

blunt chest trauma
cardiopulmonary resuscitation (CPR)
physical abuse in children
osteoporosis
age >65 years
participation in sport
primary bone tumors
metastatic bone tumors
severe cough

Full details

Diagnostic tests

1st tests to order

CXR
x-ray pelvis

Full details

Tests to consider

CT chest
ultrasound chest
angiography
CT of head, cervical spine, chest, abdomen, and pelvis
skeletal survey (children)

Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Garth H. Utter, MD, MSc

Professor of Surgery

University of California

Davis

California

Disclosures

GHU has been paid as a consultant by the US Agency for Healthcare Research and Quality (AHRQ) for their Healthcare Cost and Utilization Project (HCUP) Tools Program. His organization has received contract funding on his behalf from the US Centers for Medicare and Medicaid Services, and AHRQ for their Quality Indicators programs and AHRQ's Patient Safety Network program.

Acknowledgements

Dr Garth H. Utter would like to gratefully acknowledge Dr Peter Cundy, Dr Nicole Williams, Dr Paul Novakovich and Dr Brent Ponce, previous contributors to this topic.

Disclosures

PC is on the boards of MIGA (medical indemnity insurance) and Orthopaedics SA. He owns stock though a personal superannuation fund. PC’s hospital, the Women's and Children's Hospital, Adelaide, receives institutional support from medical supply companies for salary of research scientists. PC received payment from a medical supplier for two lectures on wound dressings in 2017. PC declares that none of the above are relevant to the Rib Fractures topic and that he receives no other money from suppliers. NW’s hospital, the Women's and Children's Hospital, Adelaide, receives institutional research support from medical supply companies and BioMarin Pharmaceutical Inc. PN and BP declare that they have no competing interests.

Peer reviewers

Gino Kerkhoffs, MD, PhD

Orthopaedic Surgeon

Department of Orthopaedic Surgery & Orthopaedic Research Center

Academic Medical Center

Meibergdreef

Amsterdam

The Netherlands

Disclosures

GK declares that he has no competing interests.

James Puffer, MD

President and Chief Executive Officer

American Board of Family Medicine

Lexington

Disclosures

JP declares that he has no competing interests.

$Rib fractures images$
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Rib fractures

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

all patients

Contributors

Authors

Garth H. Utter, MD, MSc

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Gino Kerkhoffs, MD, PhD

Disclosures

James Puffer, MD

Disclosures

Differentials

Guidelines

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice