Summary
Definition
History and exam
Key diagnostic factors
- history of trauma
- age >45 years
- pain
- dyspnea
Other diagnostic factors
- signs of impaired oxygenation
- paradoxical chest wall motion
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
Diagnostic investigations
1st investigations to order
- CXR
- x-ray pelvis
Investigations 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
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
KY
Disclosures
JP declares that he has no competing interests.
Differentials
- Chest wall contusion
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