Summary
Definition
History and exam
Key diagnostic factors
- history of trauma
- presence of risk factors
- pain
- dyspnea
Other diagnostic factors
- signs of impaired oxygenation
- paradoxical chest wall motion
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
Diagnostic tests
1st tests to order
- CXR
- x-ray pelvis
Tests to consider
- CT chest
- ultrasound chest
- angiography
- CT of head, cervical spine, chest, abdomen, and pelvis
- skeletal survey (children)
Treatment algorithm
all patients
Contributors
Authors
Garth H. Utter, MD, MSc
Professor of Surgery
University of California
Davis
California
CA
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
KY
Disclosures
JP declares that he has no competing interests.
Differentials
- Chest wall contusion
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- ACR Appropriateness Criteria: rib fractures
- Western Trauma Association critical decisions in trauma: management of rib fractures
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