Rib fracture

Background

• Diagnostic goal: detect commonly associated conditions: hemopneumothorax, pulmonary contusion, intra-abdominal injury, major vascular injury
• Pediatrics: <2 years old with >2 rib fractures = 50% mortality
  • Ribs more flexible in children, so fractures require extreme force
• Elderly: double the mortality of younger patients

Diagnosis

• Chest x-ray
  • 1st & 2nd rib fractures associated with severe chest trauma and underlying injury
  • 9th, 10th, 11th rib fractures associated with intra-abdominal injury

Disposition

• Strongly consider admission for more than one rib fracture in elderly patient or patient with preexisting pulmonary disease
  • Difficult for these patients to cough / clear secretions
• If discharged:
  • Teach how to splint and cough
  • Be liberal with pain medicine
  • Encourage incentive spirometer or tell to blow up balloons
  • Discourage rib belts or straps

See Also

• Pulmonary Contusion
• Traumatic Pneumothorax
• Sternum Fracture

Source

• Tintinanlli