Rib fractures

Dr Henry Knipe et al.

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.

Aetiology
Associations

Rib fractures are often associated with other injuries and the greater the number of rib fractures the more likely are associated injuries 1, 3:

Plain radiograph
  • may miss up to 50% of rib fractures even with dedicated oblique rib projections 1
CT
  • more sensitive than plain radiography for the detection of rib fractures 1, 3
Ultrasound
  • 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
Nuclear medicine
  • 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

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.

Complications

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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Article Information

rID: 30713
Section: Gamuts
Synonyms or Alternate Spellings:
  • Rib fracture
  • Fractured ribs
  • Fractured rib

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Cases and Figures

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    Case 1
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    Case 2
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    Case 3: flail chest with pneumothorax
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    Case 3: post ORIF
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    Case 4: with pneumothorax
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    Case 5: on ultrasound
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    Case 6: bone scan
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    Case 7: pathological fracture due to multiple myeloma
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    Case 8: first rib (non-traumatic)
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    Pneumothorax due ...
    Case 9: with pneumothorax
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    Case 10
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    Case 11: with incidental ventricular assist devices
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    Case 12: ORIF of rib fractures
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    Case 13: ultrasound
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