Rib fractures

Last reviewed: 28 Oct 2023

Last updated: 15 Oct 2019

Rib fractures may be due to blunt force injury, falls, nonaccidental trauma, aggressive CPR, 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.

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

Treatment includes pain control, physical therapy, and 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 the rib bone of the thoracic skeleton. Rib fractures are common injuries that may be due to blunt force trauma, falls, nonaccidental trauma, aggressive cardiopulmonary resuscitation, severe coughing, athletic activities, or fractures due to primary bone tumors and metastatic lesions. Rib fractures can be relatively benign, but often may be a marker of concomitant injuries such as pneumothorax, hemopneumothorax, and/or pulmonary contusions. An increased number of fractured ribs correlates with increased morbidity and mortality.

History and exam

Key diagnostic factors

history of trauma
age >45 years
pain
dyspnea

More key diagnostic factors

Other diagnostic factors

signs of impaired oxygenation
paradoxical chest wall motion

Other diagnostic factors

Risk factors

blunt chest trauma
physical abuse in children
osteoporosis
age >45 years
athletics
primary bone tumors
metastatic bone tumors
cardiopulmonary resuscitation (CPR)
severe cough

More risk factors

Diagnostic investigations

1st investigations to order

CXR
x-ray pelvis

More 1st investigations to order

Investigations to consider

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

More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Peter Cundy, MBBS, FRACS

Associate Professor

Discipline of Orthopaedics & Trauma

University of Adelaide

Paediatric Orthopaedic Surgeon

Women's and Children's Hospital

Adelaide

Australia

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 & 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.

Nicole Williams, BMedSc (hons I), BMed, Grad Cert Sports Med, FRACS (Ortho)

Associate Professor

Orthopaedics and Trauma

University of Adelaide

Head of Orthopaedic Surgery and Major Trauma Service Co-Director

Women's and Children's Hospital

Adelaide

Australia

Disclosures

NW’s hospital, the Women's & Children's Hospital, Adelaide, receives institutional research support from medical supply companies and BioMarin Pharmaceutical Inc.

Acknowledgements

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

$Rib fractures images$
Differentials
- Chest wall contusion
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Guidelines
- ACR Appropriateness Criteria: rib fractures
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Rib fractures

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

Peter Cundy, MBBS, FRACS

Disclosures

Nicole Williams, BMedSc (hons I), BMed, Grad Cert Sports Med, FRACS (Ortho)

Disclosures

Acknowledgements

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

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