Rib fracture: Difference between revisions
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==Background== | ==Background== | ||
[[File: | [[File:Gray530.png|thumb|Left pleura cavity (viewed from left) showing intercostal bundles (vein, artery, and nerve) under ribs.]] | ||
* | *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== | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
== | ==Evaluation== | ||
[[File:Ribs labeled.png|thumb|Ribs labled on [[CXR]].]] | |||
[[File:multipleribfractures.png|thumbnail|Multiple right-sided acute rib (and clavicle) fractures.]] | |||
[[File:Fracturedribsmarked.jpg|thumb|[[CXR]] with multiple old/healed fractured ribs of the person's left side (oval).]] | |||
[[File:X-ray of rib fractures and pneumothorax.jpg|thumb|Right sided [[pneumothorax]] with multiple rib fractures.]] | |||
[[File:BrokenRidCTParaSag.png|thumb|Two broken ribs as seen on parasagittal CT.]] | |||
[[File:PMC3259405 13244 2011 72 Fig22 HTML.png|thumb|Coronal CT image showing multiple contiguous left rib fractures (arrows).]] | |||
===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> | ||
** | *[[Ultrasound]] | ||
**Has been shown to detect rib fractures not seen on radiographs<ref>Turk F, Kurt AB, Saglam S. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 2010;17(6):473-477. doi:10.1007/s10140-010-0892-9</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== |
Latest revision as of 13:17, 10 April 2021
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
- CXR
- May only pick up 24% of fractures[1]
- CT chest
- Better sensitivity (63%) and specificity (97%)[2]
- Ultrasound
- Has been shown to detect rib fractures not seen on radiographs[3]
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[4]
- 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.
- ↑ Turk F, Kurt AB, Saglam S. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 2010;17(6):473-477. doi:10.1007/s10140-010-0892-9
- ↑ 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.