A rib fracture is a bone fracture in a rib bone.[ Bruising may occur at the site of the break.][
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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.][
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Pain control is an important part of treatment.[ A nerve block may be another option.][ While fractured ribs can be wrapped, this may increase complications.][ In those with a flail chest, surgery may improve outcomes.]
Causes
Rib fractures can occur with or without direct trauma during recreational activity. Cardiopulmonary resuscitation (CPR) has also been known to cause thoracic injury, including but not limited to rib and Sternal fracture. They can also occur as a consequence of diseases such as cancer or rheumatoid arthritis. An exceptionally powerful cough, such as that which can occur in whooping cough, may also result in a broken rib. While for elderly individuals a fall can cause a rib fracture, in adults automobile accidents are a common event for such an injury.
Diagnosis
Signs of a broken rib may include:
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Pain on inhalation
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Swelling in chest area
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Bruise in chest area
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Increasing shortness of breath
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Coughing up blood (rib may have damaged lung)
Plain X-rays often pick up displaced fractures but often miss undisplaced fractures.[
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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 thorax 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.
Nerve blocks
Nerve blocks may be used to help with pain and reduce respiratory complications related to rib fractures.
Surgery
Treatment options for internal fixation/repair of rib fractures include:
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Judet and/or sanchez plates/struts are a metal plate with strips that bend around the rib and then is further secured with sutures.
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There are different specialist rib fixation systems on the market. They have 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.
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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.
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U-plates can also be used as they clamp on to the superior aspect of the ribs using locking screws.
See also
External links
