A rib fracture is a
break
Break or Breaks or The Break may refer to:
Time off from duties
* Recess (break), time in which a group of people is temporarily dismissed from its duties
* Break (work), time off during a shift/recess
** Coffee break, a short mid-morning rest ...
in a
rib
In vertebrate anatomy, ribs ( la, costae) are the long curved bones which form the rib cage, part of the axial skeleton. In most tetrapods, ribs surround the chest, enabling the lungs to expand and thus facilitate breathing by expanding the ches ...
bone.
This typically results in chest pain that is worse with inspiration.
[ ]Bruising
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...
may occur at the site of the break. When several ribs are broken in several places a flail chest
Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath. ...
results. Potential complications include a pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve i ...
, pulmonary contusion
A pulmonary contusion, also known as lung contusion, is a bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, pot ...
, and pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...
.[
Rib fractures usually occur from a direct blow to the chest such as during a motor vehicle collision or from a ]crush injury
A crush injury is injury by an object that causes compression of the body. This form of injury is rare in normal civilian practice, but common following a natural disaster. Other causes include industrial accidents, road traffic collisions, bui ...
.[ Coughing or ]metastatic cancer
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...
may also result in a broken rib.[ The middle ribs are most commonly fractured.][ Fractures of the first or second ribs are more likely to be associated with complications. Diagnosis can be made based on symptoms and supported by ]medical imaging
Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to re ...
.[
]Pain control
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals pr ...
is an important part of treatment. This may include the use of paracetamol
Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferio ...
(acetaminophen), NSAIDs, or opioids
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid u ...
.[ A ]nerve block
Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block (sometimes referred to as simply "nerve block") is a short-term block, ...
may be another option.[ While fractured ribs can be wrapped, this may increase complications.][ In those with a flail chest, surgery may improve outcomes. They are a common injury following trauma.
]
Signs and symptoms
This typically results in chest pain that is worse with inspiration.[ ]Bruising
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...
may occur at the site of the break.[
]
Complications
When several ribs are broken in several places a flail chest
Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath. ...
results.[ Potential complications include a ]pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve i ...
, pulmonary contusion
A pulmonary contusion, also known as lung contusion, is a bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, pot ...
, and pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...
.[
]
Causes
Rib fractures can occur with or without direct trauma during recreational activity. Cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...
(CPR) has also been known to cause thoracic injury, including but not limited to rib and sternum fractures. They can also occur as a consequence of diseases such as cancer or rheumatoid arthritis. While for elderly individuals a fall can cause a rib fracture, in adults automobile accidents are a common event for such an injury.
Diagnosis
Signs of a broken rib may include:
* Pain on inhalation
* Swelling in chest area
* Bruise in chest area
* Increasing shortness of breath
* Coughing up blood (rib may have damaged lung)
Plain X-rays
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...
often pick up displaced fractures but often miss undisplaced fractures. CT scanning is generally able to pick up both types of fractures.[
Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe ]thoracic
The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
injuries such as pulmonary contusion
A pulmonary contusion, also known as lung contusion, is a bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, pot ...
.[ Rib fractures are also a sign of more serious injury in elderly people.
File:Rib fractures 2 -- Smart-Servier.png, Illustration showing rib fracture at 3rd, 4th and 5th rib.
File:X-ray of rib fractures and pneumothorax.jpg, Right sided pneumothorax and rib fractures
File:BrokenRidCTParaSag.png, Two broken ribs as seen on parasagittal CT
]
Treatment
There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air i ...
. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera
In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a f ...
(e.g., lung contusion
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...
) or remotely (e.g., cervical spine injury). Spontaneous fractures in athletes generally require a cessation of the cause, e.g., time off rowing, while maintaining cardiovascular fitness.
Nerve blocks
Nerve blocks that may be used to help with pain and reduce respiratory complications related to rib fractures. These include rhomboid intercostal block, epidural anesthesia, paravertebral block, erector spinae plane block and serratus anterior plane block. There is very little evidence to support the use of one nerve block over another on the basis of analgesia or safety.
Surgery
Treatment options for internal fixation/repair of rib fractures include:
* Judet and/or sanchez plates/struts are a metal plate with strips that bend around the rib and then is further secured with sutures.
* There are different specialist rib fixation systems on the market. They have two options: a precontoured metal plate that uses screws to secure the plate to the rib; and/or an intramedullary splint which is tunneled into the rib and secured with a set screw.
* Anterior locking plates are metal plates that have holes for screws throughout the plate. The plate is positioned over the rib and screwed into the bone at the desired position. The plates may be bent to match the contour of the section.
* U-plates can also be used as they clamp on to the superior aspect of the ribs using locking screws.
See also
* Pulmonary hygiene Pulmonary hygiene, formerly referred to as pulmonary toilet,
is a set of methods used to clear mucus and secretions from the airways. The word ''pulmonary'' refers to the lungs. The word ''toilet'', related to the French ''toilette'', refers to b ...
References
External links
{{Chest trauma
Chest trauma
Bone fractures
Injuries
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