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Rib fractures

Last reviewed: 28 Oct 2023
Last updated: 15 Oct 2019



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


all patients



Peter Cundy, MBBS, FRACS

Associate Professor

Discipline of Orthopaedics & Trauma

University of Adelaide

Paediatric Orthopaedic Surgeon

Women's and Children's Hospital




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




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


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



The Netherlands


GK declares that he has no competing interests.

James Puffer, MD

President and Chief Executive Officer

American Board of Family Medicine




JP declares that he has no competing interests.

  • Rib fractures images
  • Differentials

    • Chest wall contusion
    More Differentials
  • Guidelines

    • ACR Appropriateness Criteria: rib fractures
    • Western Trauma Association critical decisions in trauma: management of rib fractures
    More Guidelines
  • Videos

    Insertion of intercostal drain, open technique: animated demonstration

    More videos
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