Rib fracture: Difference between revisions
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==Background== | ==Background== | ||
[[File:multipleribfractures.png|thumbnail|Multiple Right sided rib fractures]] | [[File:multipleribfractures.png|thumbnail|Multiple Right sided rib fractures]] | ||
* | |||
* | *Most common injury in blunt chest trauma | ||
* | *9th, 10th, 11th rib fractures associated with intra-abdominal injury | ||
*Elderly patients have double the mortality of younger patients | |||
*<2 years old with >2 rib fractures → 50% mortality | |||
**Ribs more flexible in children, so fractures require extreme force | **Ribs more flexible in children, so fractures require extreme force | ||
** | **Consider [[non-accidental trauma]] | ||
==Clinical Features== | ==Clinical Features== | ||
* | *[[Chest wall pain]] | ||
* | *May have chest wall crepitus or ecchymosis | ||
*Pain on inspiration | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*[[CXR]] | ===Workup=== | ||
''Rib series typically <u>not</u> indicated'' | |||
*[[CXR]] | |||
**May only pick up 24% of fractures<ref>Rainer TH, Griffith JF, Lam E, et al. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma 2004:56;1211–13.</ref> | **May only pick up 24% of fractures<ref>Rainer TH, Griffith JF, Lam E, et al. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma 2004:56;1211–13.</ref> | ||
*CT chest | |||
*CT | **Better sensitivity (63%) and specificity (97%)<ref>Schulze C, Hoppe H, Schweitzer W, et al. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int. 2013; 233(1-3):90-98.</ref> | ||
** | |||
===Diagnosis=== | |||
*Typically made on imaging (see above) | |||
*Consider [[flail chest]], if multiple ribs are fractured in 2 or more places and paradoxical chest wall movement | |||
==Management== | ==Management== | ||
*Adequate [[analgesia]] | |||
* | |||
*Incentive spirometry | *Incentive spirometry | ||
===NOT Indicated=== | |||
*Rib belts or other chest wall wrapping has no place in treatment and should be discouraged | |||
==Disposition== | |||
===Discharge=== | ===Discharge=== | ||
* | *Consider for: | ||
* | **Isolated rib fractures | ||
* | **Young, otherwise healthy patient | ||
* | **Good respiratory effort and cough (able to clear respiratory secretions) | ||
**Pain controlled with PO medications | |||
== | ===Admission=== | ||
* | *Consider for: | ||
** | **Elderly patient with multiple rib fractures, hypotension, pulmonary contusion, hemothorax, pneumothorax, or age >85<ref>Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84.</ref> | ||
**[[Flail chest]] | |||
**Significant associated injury | |||
**Pre-existing pulmonary disease | |||
==See Also== | ==See Also== | ||
*[[Fracture (Main)]] | *[[Fracture (Main)]] | ||
*[[Flail chest]] | |||
==References== | ==References== |
Revision as of 18:40, 13 June 2020
Background
- Most common injury in blunt chest trauma
- 9th, 10th, 11th rib fractures associated with intra-abdominal injury
- Elderly patients have double the mortality of younger patients
- <2 years old with >2 rib fractures → 50% mortality
- Ribs more flexible in children, so fractures require extreme force
- Consider non-accidental trauma
Clinical Features
- Chest wall pain
- May have chest wall crepitus or ecchymosis
- Pain on inspiration
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Workup
Rib series typically not indicated
Diagnosis
- Typically made on imaging (see above)
- Consider flail chest, if multiple ribs are fractured in 2 or more places and paradoxical chest wall movement
Management
- Adequate analgesia
- Incentive spirometry
NOT Indicated
- Rib belts or other chest wall wrapping has no place in treatment and should be discouraged
Disposition
Discharge
- Consider for:
- Isolated rib fractures
- Young, otherwise healthy patient
- Good respiratory effort and cough (able to clear respiratory secretions)
- Pain controlled with PO medications
Admission
- Consider for:
- Elderly patient with multiple rib fractures, hypotension, pulmonary contusion, hemothorax, pneumothorax, or age >85[3]
- Flail chest
- Significant associated injury
- Pre-existing pulmonary disease
See Also
References
- ↑ Rainer TH, Griffith JF, Lam E, et al. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma 2004:56;1211–13.
- ↑ Schulze C, Hoppe H, Schweitzer W, et al. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int. 2013; 233(1-3):90-98.
- ↑ Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84.