Rib fractures are a common consequence of trauma and can cause life-threatening complications.
The 4th-10th ribs are the most commonly fractured 1. Fractures of the 1st-3rd ribs are associated with high-energy trauma 3.
When the rib is fractured twice, the term floating rib is used to described the free fracture fragment, and when three or more contiguous floating ribs are present this is called a flail chest.
Buckle rib fractures can also occur.
- blunt and penetrating trauma: e.g. motor vehicle accidents, falls, assaults
- most common injury in blunt thoracic trauma, occurring in 50% of cases 3
- pathological fractures
- stress fractures: occur more commonly in high-level athletes
non-accidental injuries in children
- typically posterior fractures
- cardiopulmonary resuscitation (CPR): occurs in 1 in 3 5
- fetal rib fractures: caused by skeletal dysplasias
- radiation induced rib fractures 8-9
Rib fractures are often associated with other injuries and the greater the number of rib fractures the more likely are associated injuries 1, 3:
- brachial plexus or subclavian vessel injuries (1st-3rd rib fractures)
- pulmonary laceration
- lung herniation
- liver, kidney and spleen traumatic injuries (10-12th rib fractures)
- may miss up to 50% of rib fractures even with dedicated oblique rib projections 1
- more sensitive than plain radiography for the detection of rib fractures 1, 3
- demonstrates cortical discontinuity, linear edge shadow, and acoustic reverberation artefacts 6
- no more sensitive than x-ray with added disadvantage of patient discomfort and increased examination time 6
- Tc99m bone scan is sensitive but not specific for rib fractures and demonstrates focal areas of high-uptake, which need to be correlated with SPECT or radiographic imaging 1, 7
Treatment and prognosis
Rib fractures themselves are treated symptomatically and have a good prognostic outcome. Rarely, severe rib injuries (e.g. flail chest) may be treated with ORIF, often in the setting of other severe traumatic injuries and in the hope that respiratory function will improve facilitating a shorter ICU stay and quicker recovery.
Aside from immediate traumatic complications outlined above atelectasis and pneumonia may develop, mainly due to poor respiratory effort secondary to pain, and this increases the morbidity and mortality due to rib fractures 3.
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- 8. Asai K, Shioyama Y, Nakamura K et-al. Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy: risk factors and dose-volume relationship. Int. J. Radiat. Oncol. Biol. Phys. 2012;84 (3): 768-73. doi:10.1016/j.ijrobp.2012.01.027 - Pubmed citation
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