Summary
Definition
History and exam
Key diagnostic factors
- história de trauma
- presença de fatores de risco
- dor
- dispneia
Other diagnostic factors
- sinais de oxigenação comprometida
- contratilidade paradoxal da parede torácica
Risk factors
- traumatismo torácico contuso
- ressuscitação cardiopulmonar (RCP)
- abuso físico em crianças
- osteoporose
- idade >65 anos
- participação em esportes
- tumores ósseos primários
- tumores ósseos metastáticos
- tosse intensa
Diagnostic investigations
1st investigations to order
- radiografia torácica
- radiografia pélvica
Investigations to consider
- tomografia computadorizada (TC) do tórax
- ultrassonografia do tórax
- angiografia
- TC do crânio, coluna cervical, tórax, abdome e pelve
- radiografia de esqueleto (crianças)
Treatment algorithm
todos os pacientes
Contributors
Authors
Garth H. Utter, MD, MSc
Professor of Surgery
University of California
Davis
California
CA
Disclosures
GHU has been paid as a consultant by the US Agency for Healthcare Research and Quality (AHRQ) for their Healthcare Cost and Utilization Project (HCUP) Tools Program. His organisation has received contract funding on his behalf from the US Centers for Medicare and Medicaid Services, and AHRQ for their Quality Indicators programs and AHRQ's Patient Safety Network program.
Acknowledgements
Dr Garth H. Utter would like to gratefully acknowledge Dr Peter Cundy, Dr Nicole Williams, Dr Paul Novakovich and Dr Brent Ponce, previous contributors to this topic.
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 and 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. NW’s hospital, the Women's and Children's Hospital, Adelaide, receives institutional research support from medical supply companies and BioMarin Pharmaceutical Inc. 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American College of Radiology. ACR appropriateness criteria: rib fractures. 2018 [internet publication].Full text
American College of Surgeons. ACS trauma quality programs: best practices guidelines for acute pain management in trauma patients. Nov 2020 [internet publication].Full text
Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Mar;82(3):618-26.Full text Abstract
Pieracci FM, Majercik S, Ali-Osman F, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury. 2017 Feb;48(2):307-21. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Contusão da parede torácica
More DifferentialsGuidelines
- ACS trauma quality programs best practices guidelines: acute pain management in trauma patients
- ACR appropriateness criteria: rib fractures
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