Rib fracture: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
'' | ''Rib series typically <u>not</u> indicated'' | ||
*[[CXR]] | *[[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> | ||
| Line 30: | Line 30: | ||
==Management== | ==Management== | ||
*Adequate [[analgesia]] | *Adequate [[analgesia]] | ||
*Incentive spirometry | |||
===NOT Indicated=== | |||
*Rib belts or other chest wall wrapping has no place in treatment and should be discouraged | *Rib belts or other chest wall wrapping has no place in treatment and should be discouraged | ||
==Disposition== | ==Disposition== | ||
*Consider | ===Discharge=== | ||
*Consider for: | |||
**Isolated rib fractures | **Isolated rib fractures | ||
**Young, otherwise healthy patient | **Young, otherwise healthy patient | ||
**Good respiratory effort and cough (able to clear respiratory secretions) | **Good respiratory effort and cough (able to clear respiratory secretions) | ||
**Pain controlled with PO medications | **Pain controlled with PO medications | ||
*Consider | |||
===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> | **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 | **[[Flail chest]] | ||
**Significant associated injury | **Significant associated injury | ||
**Pre-existing pulmonary disease | **Pre-existing pulmonary disease | ||
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.