Rib Fracture

Question 1

General Considerations:

• Are the most common injury sustained in blunt thoracic trauma.
• They are usually sustained in motor vehicle accidents.
• Fractures of first rib usually indicate severe trauma because of the necessary force to produce such an injury.

Answer 1

Rib Fracture

Question 2

Physical Findings:

• Fractures may cause localized pain, crepitus, pain with inspiration, and dyspnea.
• May cause pneumothorax or hemothorax.
• Mortality increases with number of ribs involved.
• Pain associated with this may lead to hypoventilation, atelectasis, retained secretions, pneumonia.

Answer 2

Rib Fracture

Question 3

Lab/Imaging Findings:

• CXR is screening tool for detection of rib fractures, although up to 50% cannot be detected on CXR.
• X-ray not routinely ordered unless complications are suspected.
• May also be identified by specific rib X-rays and CT scan.

Answer 3

Rib Fracture

Question 4

Treatment:

• Rapid mobilization, respiratory support, and pain management are the mainstays of treatment for the patient with multiple Dx.
• Continuous body positioning and oscillation therapy prevent hypoventilation and atelectasis
• Mechanical ventilation allows for healing of the ribs and prevention of complications in the patient with respiratory failure.
• Incentive spirometry is excellent supportive therapy in stable patients.
• Pain control is paramount in facilitating adequate ventilation.

Answer 4

Rib Fracture

Question 5

Disposition:

Young, healthy patient with isolated rib fractures without evidence of other serious underlying injury
* Pain medications
* Deep breathing exercises with incentive spirometry.
* Incentive spirometry

They do not require routine admittance or serial radiographic studies

Admission should be considered for elderly or other patients with serious underlying lung disease and isolated rib fractures.

Answer 5

Rib Fracture

Question 6

Complications:

Pneumonia
PTX - Pneumothorax
Hemothorax
Hypoxia

Answer 6

Rib Fracture