eMedicine Specialties > Radiology > Musculoskeletal

Rib, Fractures: Follow-up

Author: Lennard A Nadalo, MD, Clinical Professor, Department of Radiology, University of Texas Southwestern Medical School; Consulting Staff, Envision Imaging of Allen and Radiological Consultants Association
Coauthor(s): Kory Jones, MD, Staff Physician, Department of General Surgery, Methodist Mansfield Medical Center, Arlington Memorial Hospital
Contributor Information and Disclosures

Updated: Jan 16, 2009

Intervention

Radiologic intervention

Radiologic intervention in cases of rib trauma generally represents emergency treatment of the complications of chest-wall injuries (pneumothoraces) or the control of hemorrhage. Angiography may be used as a diagnostic technique in cases in which findings in the aortic arch and anterior mediastinum remain in doubt.

Treatment

Bansidhar et al found that 93% of patients with clinical rib fractures are able to resume their daily activities without disability.39 As a result, the authors did not recommend routine chest radiographic follow-up in addition to physical examination except in the presence of clinical deterioration.

Adequate pain control, rapid mobilization, and meticulous respiratory care can prevent respiratory complications in patients with rib fractures. An adequate oral analgesic or an intercostal nerve block plus an oral analgesic should provide reasonable pain relief. Epidural analgesia is becoming the standard of care for pain management in patients with multiple rib fractures.

In a study in which morphine patient-controlled analgesia (PCA) was compared with thoracic epidural analgesia involving bupivacaine and fentanyl, the latter provided more adequate pain control.16 In another study regarding the effectiveness of intrapleural analgesia for blunt trauma of the chest wall, this treatment did not significantly differ from placebo.15 Furthermore, the investigators did not recommend intrapleural analgesia for pain management in patients with rib fractures.

Rapid mobilization can include oscillation therapy or body positioning in patients that are on bed rest or who are intubated. This mobilization can involve the patient's ambulating, sitting up in bed, or getting out of bed to move into a chair. Respiratory care entails incentive spirometry, pulmonary toilet, and even mechanical ventilation, when indicated. In splinting the rib fractures, adhesive strapping or chest binders should be avoided in all patients except the very young.

Medicolegal Pitfalls

  • Multiple injuries often occur in people who are involved in traffic accidents, and rib fractures are among the most common of these injuries, with an occurrence as high as 60%. Radiography of the chest should be a routine part of autopsies of patients who die of injuries that result from traffic accidents.43
  • Although CPR can be life saving, forceful compressions of the chest can result in rib and sternal fractures. Repeated compressions after iatrogenic rib trauma have been reported to cause pneumothorax, hemothorax, and laceration of the right ventricle.
  • Rib fractures have been reported among infants after chest physiotherapy. In one report, the indications for chest physiotherapy included bronchiolitis and pneumonia.11 Among those infants with iatrogenic rib fractures, an average of 4 ribs was broken. The incidence of rib fractures after chest physiotherapy is estimated to be 1 case per 1000 infants with serious chest disease.11

Related eMedicine topics:
Bronchiolitis
Pediatrics, Bronchiolitis
Pediatrics, Pneumonia

 
Acknowledgments

I would like to recognize the support provided by Ms. Dot Howard, RN, MSN, CEN, Trauma Manager, and the other members of the Trauma Program Staff of Methodist Dallas Medical Center, Dallas, Texas.



More on Rib, Fractures

Overview: Rib, Fractures
Imaging: Rib, Fractures
Follow-up: Rib, Fractures
Multimedia: Rib, Fractures
References
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References

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Further Reading

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Keywords

rib fractures, cracked ribs, broken ribs, chest wall trauma, chest-wall trauma, crushed chest injury, chest trauma, thoracic trauma, blunt chest trauma, flail chest, pneumothorax, hemothorax, hemopneumothorax

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Contributor Information and Disclosures

Author

Lennard A Nadalo, MD, Clinical Professor, Department of Radiology, University of Texas Southwestern Medical School; Consulting Staff, Envision Imaging of Allen and Radiological Consultants Association
Lennard A Nadalo, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Radiological Society of North America, and Texas Radiological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Kory Jones, MD, Staff Physician, Department of General Surgery, Methodist Mansfield Medical Center, Arlington Memorial Hospital
Disclosure: Nothing to disclose.

Medical Editor

Leon Lenchik, MD, Director, Densitometry Minifellowship, Assistant Professor, Department of Radiology, Wake Forest University Medical Center
Leon Lenchik, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Theodore E Keats, MD, Professor, Departments of Radiology and Orthopedics, University of Virginia School of Medicine
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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