Rib fractures

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 or complications. 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, oxygen if indicated, respiratory physical therapy, and management of any underlying cause, concomitant injuries, and complications. Ventilatory support may be needed in patients who are unstable or have complications. Surgical stabilization is not required in most patients with simple rib fractures but may be considered in patients with multiple severely displaced fractures or those who fail to respond to nonoperative management.

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

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.