Treatment for Rib Fractures

There's no specific treatment for rib fractures ...

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Rib fractures can be excruciatingly painful and maddening ... maddening because there is no specific treatment for them other than pain medications and time to heal.

In a hospital setting, rib fractures are the most common type of injury caused by chest trauma. Moreover, rib fractures are closely associated with overall health and risk of dying. In other words, a person who sustains a severe injury and has several broken ribs is at a higher risk of death.

We all have 12 sets of ribs. The first three ribs are difficult to break and typically only break after high-energy trauma (think a car crash). The other nine ribs are easier to break and most people experience fractures in these ribs. Some more common causes of rib fractures are falls, sports-related injuries (think football or skiing), car accidents, assault and severe coughing (in the elderly).

Up to half of all rib fractures occur towards the front (anterior) and side (lateral) rib cage and are undetectable on x-ray. Furthermore, it's more difficult to spot radiographic changes secondary to rib fracture the first few days after injury. Finally, damage to cartilage may be impossible to spot on x-ray.

Although it's sometimes difficult to spot a rib fracture on x-ray, ultrasound is emerging as a potential diagnostic tool to visualize rib fractures, including fractures in cartilage

In and of itself, a rib fracture is painful but not deadly.

However, rib fractures are often closely linked to other types of more serious (deadly) injury. With rib fractures, physicians are more suspicious of the following:

  • air and blood in the lung cavity (hemopneumothorax)
  • vascular injury (think the thoracic great vessels including the subclavian artery and veins, innominate artery and veins and left common carotid artery)
  • intra-abdominal injury
  • pulmonary contustion
  • injury to the airway (bronchial tears)

If the physician expects pneumothorax, she will likely order upright or expiratory films, which are specific types of x-rays. Furthermore, in case of severe trauma or if ribs are displaced, the physician may order serial chest imaging.

In a hospital setting, the pain of a rib fracture makes it harder to breath and can contribute to atelectasis. Atelectasis is defined as partial or complete collapse of a lung. More specifically, when a patient experiences rib pain they breathe lightly thus hypoventilating the lungs; this hypoventilation results in atelactasis.Rib fractures also make it more difficult to wean somebody off ventilatory support. 

Hospitalized patients with severe pain caused by rib fractures can receive a nerve block with a long-acting anesthetic like bupivacaine. This long-acting anesthetic lasts 12 hours. Sometimes, an epidural can be given to stop the pain especially in the case of blunt chest trauma.

Most rib fractures, however, aren't treated with the direct application of anesthetics. Additionally, rib fractures aren't treated with immobilization of the chest wall and bindings (which can contribute to pneumonia or atelectasis).

Instead rib fractures are treated with a combination of benzodiazepines, opioids and NSAIDs (drugs like ibuprofen).

If you or a loved one suffers from an injury that results in rib fracture outside of a hospital setting, there's a good chance your physician may not be able to diagnose the fracture on x-ray. In other words, when your physician orders an x-ray and then looks at it, he may not see a fracture. Instead, pain over the affected ribs may be the only sign of injury.

Outpatient treatment of a rib fracture typically consists of the application of ice packs and prescription of pain medications as well as breathing exercises.

It's important to stay active while recovering from a rib fracture. Recovery can take up to six weeks.

Selected Sources

Brunett PH, Yarris LM, Cevik A. Chapter 258. Pulmonary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. Accessed September 24, 2015.





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