Rib Fracture
Description
A rib fracture is a break in the continuity of one or more ribs. Like any bone fracture, it may be either open or closed. In a closed fracture, the skin over the fracture remains intact. In an open fracture, the skin is broken, creating a wound through which bone fragments may protrude. Open fractures carry a higher risk of infection because the wound is exposed to the external environment.
Affected Organ or Body Part
Humans have 12 pairs of ribs that, together with the spine, form the rib cage. Along with the intercostal and chest muscles, the rib cage plays an essential role in breathing. Because of their anatomical location, rib fractures may also injure the pleura and lungs, potentially resulting in life-threatening complications.
Most Commonly Affected Individuals
Rib fractures are most commonly associated with chest trauma, particularly following motor vehicle accidents. Chest trauma primarily affects younger adults and is a leading cause of trauma-related death during the first three decades of life. In the United States, chest trauma accounts for approximately 25% of all trauma-related deaths.
Causes and Risk Factors
Most rib fractures result from blunt chest trauma. They may also occur following penetrating chest injuries, including stab wounds and gunshot wounds. Approximately 70–80% of blunt chest injuries occur during motor vehicle accidents.
Symptoms
Because the chest moves continuously during breathing, pain is the most prominent symptom of a rib fracture. Rib fractures are frequently accompanied by injuries to the surrounding soft tissues or internal organs, which may cause shortness of breath, changes in heart rate, and general weakness.
Diagnosis
Diagnosis begins with a detailed medical history and physical examination. The physician identifies the area of greatest tenderness and may detect movement of bone fragments (crepitus) during palpation. The diagnosis is confirmed with two-view chest X-rays. In more complex cases, computed tomography (CT) of the chest may be performed to evaluate the extent of the injuries.
Treatment
Most rib fractures are treated conservatively with adequate pain control using analgesics. Chest binding or other methods that restrict chest movement are not recommended because they impair lung ventilation and hinder the clearance of respiratory secretions.
Surgical treatment, including rib osteosynthesis or internal/external fixation, may be required in the following situations:
- Bone fragments penetrate the chest wall or injure internal organs.
- Respiratory function does not improve within 12–24 hours despite mechanical ventilation because of an unstable chest wall.
- Severe chest wall deformity significantly reduces the volume of the pleural cavity.
If emergency thoracotomy is required, injuries to the internal organs are treated first, followed by rib stabilization. Depending on the clinical situation, fixation may be performed using plates or other osteosynthesis techniques.
Prevention
Prevention focuses primarily on injury prevention through safe behavior, responsible driving, and the proper use of safety equipment. Avoiding excessive alcohol consumption may also reduce the risk of traumatic injuries.
Key Points
- Rib fractures are breaks in the continuity of one or more ribs.
- Because of their anatomical location, rib fractures may injure the pleura and lungs, potentially causing life-threatening complications.
- Most rib fractures result from blunt chest trauma but may also occur following penetrating injuries such as stab wounds or gunshot wounds.
- Pain that worsens with breathing is the hallmark symptom of a rib fracture.
- Most rib fractures are managed conservatively with adequate pain relief, while surgery is reserved for unstable or complicated injuries.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology