Rib Fractures

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Rib fractures are breaks or cracks in one or more of the bones making up the rib cage. They are a common injury resulting from trauma to the chest.

Aetiology

Rib fractures are typically caused by:

• Blunt trauma, such as from a fall, car accident, or direct blow to the chest
• Severe coughing or sneezing, particularly in individuals with osteoporosis or other bone-weakening conditions
• High-impact sports injuries

Pathophysiology

The pathophysiology of rib fractures involves:

• Direct impact or stress to the rib cage, leading to a break or crack in the bone.
• Potential injury to surrounding tissues, such as muscles, blood vessels, and organs.
• Inflammation and pain at the site of the fracture, which can impair breathing and mobility.

Risk Factors

• Participation in high-impact sports
• Advanced age
• Osteoporosis or other conditions that weaken bones
• Chronic respiratory conditions that cause severe coughing
• History of previous rib fractures or chest trauma

Signs and Symptoms

The signs and symptoms of rib fractures include:

• Sharp pain at the site of the fracture, worsened by breathing, coughing, or movement
• Tenderness and swelling over the affected area
• Bruising of the chest wall
• Difficulty breathing or shortness of breath
• Crepitus (a crunching sound) when touching or moving the affected area

Investigations

Specific investigations to diagnose rib fractures include:

• Clinical examination: Physical inspection and palpation of the chest.
• Imaging studies:
  • Chest X-ray: To identify fractures and assess lung involvement.
  • CT scan: To provide a detailed view of the rib cage and detect complex fractures or associated injuries.
• Ultrasound: May be used to detect rib fractures and associated soft tissue injuries.

Management

Primary Care Management

• Pain management: Analgesics such as paracetamol or ibuprofen to relieve pain and inflammation.
• Rest: Limiting physical activity to allow healing.
• Breathing exercises: To prevent pneumonia and atelectasis, and to improve lung function.
• Ice application: To reduce swelling and pain.
• Avoiding tight bandages or chest binders: As they can restrict breathing and increase the risk of lung complications.

Specialist Management

• Hospitalisation: For severe cases, particularly if there are multiple rib fractures or complications such as pneumothorax or haemothorax.
• Surgical intervention: Rarely required but may be considered for unstable fractures or flail chest (a segment of the rib cage that moves independently).
• Intercostal nerve blocks: For severe pain management.
• Monitoring and follow-up: Regular check-ups to monitor healing and detect any complications.

References

1. NHS (2024) Rib Fractures. Available at: https://www.nhs.uk/conditions/broken-or-bruised-ribs/ (Accessed: 24 June 2024).
2. British Medical Journal (2024) Rib fractures: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h2041 (Accessed: 24 June 2024).
3. American College of Radiology (2024) ACR Appropriateness Criteria® Rib Fractures. Available at: https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria/Rib-Fractures (Accessed: 24 June 2024).
4. Shorr, R.M., et al. (1987) 'Blunt Thoracic Trauma: Analysis of 515 Patients', Annals of Surgery, 206(2), pp. 200-205.

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