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.
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
Other diagnostic factors
- signs of impaired oxygenation
- paradoxical chest wall motion
- blunt chest trauma
- physical abuse in children
- age >45 years
- primary bone tumors
- metastatic bone tumors
- cardiopulmonary resuscitation (CPR)
- severe cough
1st investigations to order
- x-ray pelvis
Investigations to consider
- CT chest
- ultrasound chest
- CT of head, cervical spine, chest, abdomen, and pelvis
- skeletal survey (children)
- Chest wall contusion
- ACR Appropriateness Criteria: rib fractures
- Western Trauma Association critical decisions in trauma: management of rib fractures
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