The Symptoms, Treatment, and Prognosis for Broken Ribs

rib fracture
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Rib fractures are injuries that occur to the chest wall. The most common cause of a rib fracture is a traumatic injury to the chest from a fall, automobile crash, or other blunt force injury.  Much less common, is an overuse rib stress fracture, an injury that sometimes is the result of specific sports activities such as competitive rowing.

Rib fractures seldom require specific intervention or treatment, but they can be a sign of significant injury to the organs of the chest and abdomen.

Any trauma that has sufficient force to cause a rib fracture in someone with normal bone density, should alert your doctor to ensure there is no injury to the other structures of the chest and abdomen. 

There are situations where a rib fracture can occur without major overuse or trauma. These injuries are called pathologic fractures, and occur when the bone is weakened to the point where is can fracture with little or no trauma. The most common reason for a pathologic rib fracture is  in individuals with poor bone density, or osteoporosis. Other causes of weakened bone leading to a pathologic fracture can include infections, tumors, and other conditions that weaken bone.

Common Symptoms

The typical symptom of a broken rib is pain. The pain is almost always worse when taking a deep breath, or other sudden movements of chest such as sneezing or coughing. Patients will complain of focal pain directly over the broken rib bone, and in some patients the fracture can be felt as there is little soft-tissue between the skin and bone.

 

In more severe injuries, a deformity of the chest wall can be seen, and when there are multiple ribs fractured in multiple locations (a condition called 'flail chest'), chest wall movement may be abnormal with breathing (paradoxical chest motion).

Treatment of Rib Fractures

The most common treatment for a fracture rib is supportive care.

Because the chest wall needs to move for you to breathe, there is no way to immobilize the chest. Pain medications can help to alleviate some discomfort, but rest, shallow breathing, and time are the only methods to effectively treat a fractured rib.

As mentioned previously, injury to other structures in the chest and abdomen often take precedence over the broken rib. The fractured rib can also cause injury by leading to puncture of the lungs causing a hemothorax or pneumothorax. In addition, because people with a broken rib don't take deep breaths, they can develop pneumonia and atelectasis

Surgical Treatment

The good news, is that surgical treatment is very rarely considered in the treatment of rib fractures.  The two most common reasons for requiring surgery are a flail chest or a chest wall deformity. In these unusual situations, surgical repair of the broken rib may be considered. Typical implants used to treat broken ribs include metal plates, intramedullary rods, and bioabsorbable plates.

The challenge with surgery, is because there is no way to immobilize the ribs, there is a tendency for implants to loosen over time. Surgery is only considered in very specific and unusual circumstances.

Prognosis

Isolated rib fractures in younger patients have an excellent prognosis for complete healing.  In elderly patients, and patients with severe chest wall trauma, there is a higher chance of developing associated complications, specifically pulmonary complications. The focus of treatment of rib fractures is trying to minimize the chance of these complications from occurring.

Sources:

Fowler TT, et al. "Surgical Treatment of Flail Chest and Rib Fractures" J Am Acad Orthop Surg December 2014 vol. 22 no. 12 751-760

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