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Rib Fracture Differential Diagnoses

  • Author: Sarah L Melendez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: May 11, 2016
 
 
 
Contributor Information and Disclosures
Author

Sarah L Melendez, MD Fellow in Pediatric Emergency Medicine, Department of Emergency Medicine, Arnold Palmer Hospital for Children

Sarah L Melendez, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FAAEM, FACEP Associate Professor of Emergency Medicine, Residency Program Director, Vice-Chair for Education, Department of Emergency Medicine, University of Kentucky-Chandler Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

References
  1. Ochi K, Furuya T, Ikari K, Taniguchi A, Yamanaka H, Momohara S. Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan. Arch Osteoporos. 2013. 8(1-2):130. [Medline].

  2. Colosimo AJ, Byrne E, Heidt RS Jr, Carlonas RL, Wyatt H. Acute traumatic first-rib fracture in the contact athlete: a case report. Am J Sports Med. 2004 Jul-Aug. 32(5):1310-2. [Medline].

  3. Lee SJ, Chu SJ, Tsai SH. Isolated Bilateral First-rib Fractures. J Emerg Med. 2008 Jul 21. [Medline].

  4. Recinos G, Inaba K, Dubose J, et al. Epidemiology of sternal fractures. Am Surg. 2009 May. 75(5):401-4. [Medline].

  5. Peters ML, Starling SP, Barnes-Eley ML, Heisler KW. The presence of bruising associated with fractures. Arch Pediatr Adolesc Med. 2008 Sep. 162(9):877-81. [Medline].

  6. Boele van Hensbroek P, Mulder S, Luitse JS, van Ooijen MR, Goslings JC. Staircase falls: high-risk groups and injury characteristics in 464 patients. Injury. 2009 Aug. 40(8):884-9. [Medline].

  7. Maxwell CA, Mion LC, Dietrich MS. Hospitalized injured older adults: clinical utility of a rib fracture scoring system. J Trauma Nurs. 2012 Jul. 19(3):168-74. [Medline].

  8. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994 Dec. 37(6):975-9. [Medline].

  9. Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84. [Medline].

  10. Rosenberg G, Bryant AK, Davis KA, Schuster KM. No breakpoint for mortality in pediatric rib fractures. J Trauma Acute Care Surg. 2016 Mar. 80 (3):427-32. [Medline].

  11. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000 Jun. 48(6):1040-6; discussion 1046-7. [Medline].

  12. Shorr RM, Rodriguez A, Indeck MC, Crittenden MD, Hartunian S, Cowley RA. Blunt chest trauma in the elderly. J Trauma. 1989 Feb. 29(2):234-7. [Medline].

  13. Wang HW, Xiang Q, Li CQ, Zhou Y. Traumatic vertebral fractures with concomitant fractures of the first rib. Orthop Surg. 2013 May. 5(2):100-4. [Medline].

  14. Richardson JD, McElvein RB, Trinkle JK. First rib fracture: a hallmark of severe trauma. Ann Surg. 1975 Mar. 181(3):251-4. [Medline].

  15. Logan PM. Is there an association between fractures of the cervical spine and first- and second-rib fractures?. Can Assoc Radiol J. 1999 Feb. 50(1):41-3. [Medline].

  16. Hassan AN, Ballester J, Slater N. Bilateral first rib fractures associated with Horner's syndrome. Injury. 2000 May. 31(4):273-4. [Medline].

  17. Al-Hassani A, Afifi I, Abdelrahman H, El-Menyar A, Almadani A, Recicar J, et al. Concurrent rib and pelvic fractures as an indicator of solid abdominal organ injury. Int J Surg. 2013. 11(6):483-6. [Medline].

  18. Kristine A Karlson, MD, Section EditorsPatrice Eiff, MD & John A Marx, MDDeputy Editor Jonathan Grayzel, MD, et al. Rib fractures. UpToDate. Available at http://www.uptodate.com/ribfractures. Accessed: April 3, 2012.

  19. Coris EE, Higgins HW 2nd. First rib stress fractures in throwing athletes. Am J Sports Med. 2005 Sep. 33(9):1400-4. [Medline].

  20. Holmes JF, Wisner DH, McGahan JP, Mower WR, Kuppermann N. Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2009 Oct. 54(4):575-84. [Medline].

  21. Park S. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture. Korean J Thorac Cardiovasc Surg. 2012 Aug. 45(4):246-50. [Medline]. [Full Text].

  22. Leport T, Baudrit P, Potier P, Trosseille X, Lecuyer E, Vallancien G. Study of rib fracture mechanisms based on the rib strain profiles in side and forward oblique impact. Stapp Car Crash J. 2011 Nov. 55:199-250. [Medline].

  23. Murphy J, Nyland J, Lantry J, Roberts C. Motorcyclist "biker couples": a descriptive analysis of orthopaedic and non-orthopaedic injuries. Injury. 2009 Nov. 40(11):1195-9. [Medline].

  24. Connolly LP, Connolly SA. Rib stress fractures. Clin Nucl Med. 2004.

  25. Chan SS. Emergency bedside ultrasound for the diagnosis of rib fractures. Am J Emerg Med. 2009 Jun. 27(5):617-20. [Medline].

  26. Griffith JF, Rainer TH, Ching AS, Law KL, Cocks RA, Metreweli C. Sonography compared with radiography in revealing acute rib fracture. AJR Am J Roentgenol. 1999 Dec. 173(6):1603-9. [Medline].

  27. Kara M, Dikmen E, Erdal HH, Simsir I, Kara SA. Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma. Eur J Cardiothorac Surg. 2003 Oct. 24(4):608-13. [Medline].

  28. Rainer TH, Griffith JF, Lam E, Lam PK, Metreweli C. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma. 2004 Jun. 56(6):1211-3. [Medline].

  29. Hurley ME, Keye GD, Hamilton S. Is ultrasound really helpful in the detection of rib fractures?. Injury. 2004 Jun. 35(6):562-6. [Medline].

  30. Magu S, Yadav A, Agarwal S. Computed tomography in blunt chest trauma. Indian J Chest Dis Allied Sci. 2009 Apr-Jun. 51(2):75-81. [Medline].

  31. Sanchez TR, Grasparil AD, Chaudhari R, Coulter KP, Wootton-Gorges SL. Characteristics of Rib Fractures in Child Abuse-The Role of Low-Dose Chest Computed Tomography. Pediatr Emerg Care. 2016 Jan 12. [Medline].

  32. Ingalls NK, Horton ZA, Bettendorf M, Frye I, Rodriguez C. Randomized, double-blind, placebo-controlled trial using lidocaine patch 5% in traumatic rib fractures. J Am Coll Surg. 2010 Feb. 210(2):205-9. [Medline].

  33. Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001.

  34. Shields JF, Emond M, Guimont C, Pigeon D. Acute minor thoracic injuries: evaluation of practice and follow-up in the emergency department. Can Fam Physician. 2010 Mar. 56(3):e117-24. [Medline]. [Full Text].

  35. Misthos P, Kakaris S, Sepsas E, Athanassiadi K, Skottis I. A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma. Eur J Cardiothorac Surg. 2004 May. 25(5):859-64. [Medline].

  36. Bansidhar BJ, Lagares-Garcia JA, Miller SL. Clinical rib fractures: are follow-up chest X-rays a waste of resources?. Am Surg. 2002.

  37. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003 Mar. 54(3):615-25. [Medline].

  38. Mohta M, Verma P, Saxena AK, Sethi AK, Tyagi A, Girotra G. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study. Journal of Trauma. 2009.

  39. Hwang EG, Lee Y. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 2014 Aug. 10 (4):241-4. [Medline].

  40. Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009 Mar. 56(3):230-42. [Medline].

  41. Short K, Scheeres D, Mlakar J, Dean R. Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial. Am Surgery. 1996.

  42. [Guideline] Brasel KJ, Guse CE, Layde P, Weigelt JA. Rib fractures: relationship with pneumonia and mortality. Crit Care Med 2006. 2006. 34(6):1642:[Full Text].

  43. Karmy-Jones R, Holevar M, Sullivan RJ, et al. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Respir J. 2008.

  44. Bruno VD, Batchelor TJ. Late aortic injury: a rare complication of a posterior rib fracture. Ann Thorac Surg. 2009 Jan. 87(1):301-3. [Medline].

  45. Carver TW, Milia DJ, Somberg C, Brasel K, Paul J. Vital capacity helps predict pulmonary complications after rib fractures. J Trauma Acute Care Surg. 2015 Sep. 79 (3):413-6. [Medline].

  46. Henry TS, Kirsch J, Kanne JP, et al. ACR Appropriateness Criteria rib fractures. National Guideline Clearinghouse. Available at http://www.guideline.gov/content.aspx?id=48290&search=rib+fracture. 2014; Accessed: May 11, 2016.

  47. Albers JE, Rath RK, Glaser RS, Poddar PK. Severity of intrathoracic injuries associated with first rib fractures. Ann Thorac Surg. 1982 Jun. 33(6):614-8. [Medline].

  48. Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD. Epidemiology of trauma deaths. Am J Surg. 1980 Jul. 140(1):144-50. [Medline].

  49. Carrier FM, Turgeon AF, Nicole PC, Trépanier CA, Fergusson DA, Thauvette D, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009.

  50. Colosimo AJ, Byrne E, Heidt RS Jr, Carlonas RL, Wyatt H. Acute traumatic first-rib fracture in the contact athlete: a case report. Am J Sports Med. 2004 Jul-Aug. 32(5):1310-2. [Medline].

  51. Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005 Oct. 138(4):717-23; discussion 723-5. [Medline].

  52. Fulda GJ, Giberson F, Fagraeus L. A prospective randomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the management of acute thoracic pain. J Trauma. 2005 Aug. 59(2):383-8; discussion 389-90. [Medline].

  53. Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. J Trauma. 1990 Jun. 30(6):695-700. [Medline].

  54. Hurley ME, Keye GD, Hamilton S. Is ultrasound really helpful in the detection of rib fractures?. Injury. 2004 Jun. 35(6):562-6. [Medline].

  55. Lee RB, Bass SM, Morris JA Jr, MacKenzie EJ. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma. 1990 Jun. 30(6):689-94. [Medline].

  56. LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989 Feb. 69(1):15-9. [Medline].

  57. Love JC, Symes SA. Understanding rib fracture patterns: incomplete and buckle fractures. J Forensic Sci. 2004 Nov. 49(6):1153-8. [Medline].

  58. Newman RJ, Jones IS. A prospective study of 413 consecutive car occupants with chest injuries. J Trauma. 1984 Feb. 24(2):129-35. [Medline].

  59. Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982 Oct. 196(4):481-7. [Medline]. [Full Text].

  60. Ruddy RM. Trauma and the paediatric lung. Paediatr Respir Rev. 2005 Mar. 6(1):61-7. [Medline].

  61. Stawicki SP, Grossman MD, Hoey BA, Miller DL, Reed JF 3rd. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 2004 May. 52(5):805-8. [Medline].

  62. Trinkle JK, Richardson JD, Franz JL, Grover FL, Arom KV, Holmstrom FM. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975 Apr. 19(4):355-63. [Medline].

  63. Wilson JM, Thomas AN, Goodman PC, Lewis FR. Severe chest trauma. Morbidity implication. Arch Surg. 1978 Jul. 113(7):846-9. [Medline].

  64. Woodring JH, Fried AM, Hatfield DR, Stevens RK, Todd EP. Fractures of first and second ribs: predictive value for arterial and bronchial injury. AJR Am J Roentgenol. 1982 Feb. 138(2):211-5. [Medline].

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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.
Anteroposterior (AP) radiograph of an elderly female patient with severe left chest wall pain after a minor fall. This image demonstrates a left lateral rib fracture (arrow) that is not seen on the standard AP chest radiograph.
Axial computed tomography image of the chest in a patient with both anterior and posterior thoracic injuries. A fracture of the sternum (white arrow) and a posterior left rib fracture (yellow arrow) are present.
Right rib radiograph in a 48-year-old male who presented with severe right posterior chest wall pain following a fall. This image demonstrates 2 fractures of the right chest wall (white arrows).
 
 
 
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