Rib fracture

Rib fracture
Rib fracture
Other names	Broken rib, cracked rib
	An X ray showing multiple old fractured ribs of the person's left side as marked by the oval
Specialty	Emergency medicine
Symptoms	Chest pain that is worse with breathing in
Complications	Pulmonary contusion, pneumothorax, pneumonia
Causes	Chest trauma
Diagnostic method	Based on symptoms, medical imaging
Medication	Paracetamol (acetaminophen), NSAIDs, opioids
Prognosis	Pain improves over 6 weeks
Frequency	Common

A rib fracture is a break in a rib bone.^[1] This typically results in chest pain that is worse with inspiration.^[1] Bruising may occur at the site of the break.^[3] When several ribs are broken in several places a flail chest results.^[4] Potential complications include a pneumothorax, pulmonary contusion, and pneumonia.^[2]^[1]

Rib fractures usually occur from a direct blow to the chest such as during a motor vehicle collision or from a crush injury.^[2]^[1] Coughing or metastatic cancer may also result in a broken rib.^[1] The middle ribs are most commonly fractured.^[5]^[1] Fractures of the first or second ribs are more likely to be associated with complications.^[6] Diagnosis can be made based on symptoms and supported by medical imaging.^[3]

Pain control is an important part of treatment.^[7] This may include the use of paracetamol (acetaminophen), NSAIDs, or opioids.^[2] A nerve block may be another option.^[1] While fractured ribs can be wrapped, this may increase complications.^[1] In those with a flail chest, surgery may improve outcomes.^[8]^[9] They are a common injury following trauma.^[10]

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Mosby's Medical Dictionary (E-Book). Elsevier Health Sciences. 2013. p. 1567. ISBN 978-0323112581. Archived from the original on 2017-10-13.
^ ^a ^b ^c ^d ^e ^f ^g May, L; Hillermann, C; Patil, S (January 2016). "Rib fracture management". BJA Education. 16 (1): 26–32. doi:10.1093/bjaceaccp/mkv011.
^ ^a ^b ^c ^d Adams, James G. (2012). Emergency Medicine E-Book: Clinical Essentials (Expert Consult – Online). Elsevier Health Sciences. p. 682. ISBN 978-1455733941. Archived from the original on 2017-10-13.
^ Wanek, Sandra; Mayberry, John C (2004). "Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury". Critical Care Clinics. 20 (1): 71–81. doi:10.1016/S0749-0704(03)00098-8. PMID 14979330.
^ Nanni, Christina (2012). PET-CT: Rare Findings and Diseases. Springer. p. 257. ISBN 978-3-642-24698-2.
^ Murphy CE, 4th; Raja, AS; Baumann, BM; Medak, AJ; Langdorf, MI; Nishijima, DK; Hendey, GW; Mower, WR; Rodriguez, RM (27 May 2017). "Rib Fracture Diagnosis in the Panscan Era" (PDF). Annals of Emergency Medicine. 70 (6): 904–909. doi:10.1016/j.annemergmed.2017.04.011. PMID 28559032. S2CID 23442272.{{cite journal}}: CS1 maint: numeric names: authors list (link)
^ Brown, SD; Walters, MR (2012). "Patients with rib fractures: use of incentive spirometry volumes to guide care". Journal of Trauma Nursing. 19 (2): 89–91, quiz 92–03. doi:10.1097/JTN.0b013e31825629ee. PMID 22673074. S2CID 45547470.
^ Schuurmans, J; Goslings, JC; Schepers, T (April 2017). "Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review". European Journal of Trauma and Emergency Surgery. 43 (2): 163–68. doi:10.1007/s00068-016-0721-2. PMC 5378742. PMID 27572897.
^ Coughlin, TA; Ng, JW; Rollins, KE; Forward, DP; Ollivere, BJ (August 2016). "Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials". The Bone & Joint Journal. 98-B (8): 1119–25. doi:10.1302/0301-620X.98B8.37282. PMID 27482027.
^ Senekjian, L; Nirula, R (January 2017). "Rib Fracture Fixation: Indications and Outcomes". Critical Care Clinics. 33 (1): 153–65. doi:10.1016/j.ccc.2016.08.009. PMID 27894495.

[Mos2013-1] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Mosby's Medical Dictionary (E-Book). Elsevier Health Sciences. 2013. p. 1567. ISBN 978-0323112581. Archived from the original on 2017-10-13.

[May2015-2] ^ ^a ^b ^c ^d ^e ^f ^g May, L; Hillermann, C; Patil, S (January 2016). "Rib fracture management". BJA Education. 16 (1): 26–32. doi:10.1093/bjaceaccp/mkv011.

[Ad2012-3] Adams, James G. (2012). Emergency Medicine E-Book: Clinical Essentials (Expert Consult – Online). Elsevier Health Sciences. p. 682. ISBN 978-1455733941. Archived from the original on 2017-10-13.

[Wanek04-4] Wanek, Sandra; Mayberry, John C (2004). "Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury". Critical Care Clinics. 20 (1): 71–81. doi:10.1016/S0749-0704(03)00098-8. PMID 14979330.

[5] Nanni, Christina (2012). PET-CT: Rare Findings and Diseases. Springer. p. 257. ISBN 978-3-642-24698-2.

[6] Murphy CE, 4th; Raja, AS; Baumann, BM; Medak, AJ; Langdorf, MI; Nishijima, DK; Hendey, GW; Mower, WR; Rodriguez, RM (27 May 2017). "Rib Fracture Diagnosis in the Panscan Era" (PDF). Annals of Emergency Medicine. 70 (6): 904–909. doi:10.1016/j.annemergmed.2017.04.011. PMID 28559032. S2CID 23442272.{{cite journal}}: CS1 maint: numeric names: authors list (link)

[7] Brown, SD; Walters, MR (2012). "Patients with rib fractures: use of incentive spirometry volumes to guide care". Journal of Trauma Nursing. 19 (2): 89–91, quiz 92–03. doi:10.1097/JTN.0b013e31825629ee. PMID 22673074. S2CID 45547470.

[8] Schuurmans, J; Goslings, JC; Schepers, T (April 2017). "Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review". European Journal of Trauma and Emergency Surgery. 43 (2): 163–68. doi:10.1007/s00068-016-0721-2. PMC 5378742. PMID 27572897.

[9] Coughlin, TA; Ng, JW; Rollins, KE; Forward, DP; Ollivere, BJ (August 2016). "Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials". The Bone & Joint Journal. 98-B (8): 1119–25. doi:10.1302/0301-620X.98B8.37282. PMID 27482027.

[10] Senekjian, L; Nirula, R (January 2017). "Rib Fracture Fixation: Indications and Outcomes". Critical Care Clinics. 33 (1): 153–65. doi:10.1016/j.ccc.2016.08.009. PMID 27894495.

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