Rib fracture

Rib fracture
An X ray showing multiple old fractured ribs of the person's left side as marked by the oval.
Classification and external resources
Specialty	emergency medicine
ICD-10	S22.3-S22.4
ICD-9-CM	807.0, 807.1
DiseasesDB	11553
eMedicine	emerg/204 radio/609
MeSH	D012253

A rib fracture is a break or fracture in one or more of the bones making up the rib cage.^[1] Fractures of the first and second ribs may be more likely to be associated with head and facial injuries than other rib fractures.^[2] The middle ribs are the ones most commonly fractured.^[3] Fractures usually occur from direct blows or from indirect crushing injuries. A rib fracture has the complication of potentially causing a pulmonary contusion.^[4] Rib fractures are usually quite painful because the ribs have to move to allow for breathing. When several ribs are broken in several places a flail chest results, and the detached bone sections will move separately from the rest of the chest.^[5]

Causes

Rib fractures can occur with or without direct trauma during recreational activity. Cardiopulmonary resuscitation, commonly known as CPR, has also been known to cause thoracic injury, including but not limited to rib and sternum fractures. They can also occur as a consequence of diseases such as cancer or rheumatoid arthritis. While for elderly individuals a fall can cause a rib fracture, in adults automobile accidents are a common event for such an injury.^[6]

Diagnosis

Two broken ribs as seen on parasagittal CT

Rt sided pneumothorax and rib fractures

Signs one may have a broken rib are:^[7]

• Pain on inhalation
• Swelling in chest area
• Bruise in chest area
• Increasing shortness of breath
• Coughing up blood (rib may have damaged lung)

Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic injuries such as pulmonary contusion.^[5] Rib fractures are also a sign of more serious injury in elderly people.^[8]

Treatment

There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection.^[9] Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation.^[10] Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera (e.g., lung contusion) or remotely (e.g., cervical spine injury). Spontaneous fractures in athletes generally require a cessation of the cause, e.g., time off rowing, while maintaining cardiovascular fitness.

Treatment options for internal fixation/repair of rib fractures include:

• Judet and/or sanchez plates/struts are a metal plate with strips that bend around the rib and then is further secured with sutures.^[11]
• Synthes matrixrib fixation system has two options: a precontoured metal plate that uses screws to secure the plate to the rib; and/or an intramedullary splint which is tunneled into the rib and secured with a set screw.^[12]
• Anterior locking plates are metal plates that have holes for screws throughout the plate. The plate is positioned over the rib and screwed into the bone at the desired position. The plates may be bent to match the contour of the section.^[13]
• U-plates can also be used as they clamp on to the superior aspect of the ribs using locking screws.^[14]

See also

• Pulmonary hygiene

References

Further reading

• Myers, Jeffrey (2002). Principles of Pathophysiology and Emergency Medical Care. Delmar Thomson Learning. p. 121. ISBN 0-7668-2548-5.