A rib fracture is a break in a rib bone. This typically results in chest pain that is worse with breathing in. Bruising may occur at the site of the break. When several ribs are broken in several places a flail chest results. Potential complications include a pneumothorax, pulmonary contusion, and pneumonia. Rib fractures usually occur from a direct blow to the chest such as during a motor vehicle collision or from a crush injury. Coughing or metastatic cancer may also result in a broken rib. The middle ribs are most commonly fractured. Fractures of the first or second ribs are more likely to be associated with complications. Diagnosis can be made based on symptoms and supported by medical imaging. Pain control is an important part of treatment. This may include the use of paracetamol, NSAIDs, or opioids. A nerve block may be another option. While fractured ribs have been wrapped, this may increase complications. In those with a flail chest, surgery may improve outcomes. They are a common injury following trauma.
Signs and symptoms
This typically results in chest pain that is worse with breathing in. Bruising may occur at the site of the break.
Complications
When several ribs are broken in several places a flail chest results. Potential complications include a pneumothorax, pulmonary contusion, and pneumonia.
Plain X-rays often pick up displaced fractures but often miss undisplaced fractures. CT scanning is generally able to pick up both types of fractures. Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic injuries such as pulmonary contusion. Rib fractures are also a sign of more serious injury in elderly people.
Treatment
There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera or remotely. Spontaneous fractures in athletes generally require a cessation of the cause, e.g., time off rowing, while maintaining cardiovascular fitness.
Treatment options for internal fixation/repair of rib fractures include:
Judet and/or sanchez plates/struts are a metal plate with strips that bend around the rib and then is further secured with sutures.
Synthes matrixrib fixation system has two options: a precontoured metal plate that uses screws to secure the plate to the rib; and/or an intramedullary splint which is tunneled into the rib and secured with a set screw.
Anterior locking plates are metal plates that have holes for screws throughout the plate. The plate is positioned over the rib and screwed into the bone at the desired position. The plates may be bent to match the contour of the section.
U-plates can also be used as they clamp on to the superior aspect of the ribs using locking screws.
