Rib Fracture Clinical Presentation

  • Author: Laurie K Mahoney, MD, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 28, 2010
 

History

  • Description of the prehospital scene by paramedics can provide important clues to the possibility of rib fractures.
  • After motor vehicle collisions, deformation of the steering wheel and activation of seat belts and airbags have been associated with rib injuries.
  • Patients with rib fracture frequently complain of pain on inspiration and dyspnea.
  • Rib fractures have been reported after coughing spells without other significant trauma.
  • Athletes with high force, recurrent movements of the arms (eg, discus throwers) have had stress fractures of the upper and middle ribs.[13]
  • Consider nonaccidental trauma in pediatric cases and take an appropriate history for that diagnosis.
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Physical

  • Tenderness on palpation, crepitus, and chest wall deformity are common findings of rib fracture.
  • Paradoxical chest wall excursion with inspiration is seen with flail chest. A flail chest occurs when a large segment of ribs is not attached to the spine. These ribs are broken in at least 2 places on each rib. The paradoxical movement occurs because the middle section of the rib between the 2 fracture sites moves in response to intrathoracic pressure changes not intercostal muscle contractions.
  • Specific signs of ventilatory insufficiency include cyanosis, tachypnea, retractions, and use of accessory muscles for ventilation.
  • Less specific signs include anxiety and agitation.
  • Bruising near fracture site is uncommon in pediatric rib fractures, seen in 9.1% in one study.[11]
  • If fracture of the lower ribs is suspected, assess the patient for abdominal tenderness and costal margin tenderness, which could raise suspicion for injury to intra-abdominal organs.[14]
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Causes

  • Blunt trauma including motor vehicle crashes (most common mechanism[3] ) assault, falls, especially down staircases[12]
  • Motorcycle drivers are at greater risk for rib fractures compared with motorcycle passengers (57.1% vs 23.8%, p=0.05).[15]
  • Coughing spells
  • Nonaccidental trauma in pediatric cases[11]
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Contributor Information and Disclosures
Author

Laurie K Mahoney, MD, FAAEM  Attending Physician, Department of Emergency Medicine, Long Island College Hospital, Brooklyn

Laurie K Mahoney, MD, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM  Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Aortic injury is closely associated with a widening of greater than 8 cm measured at the widest points of the mediastinum on an upright anteroposterior chest radiograph.
 
 
 
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