Rib Fracture Treatment & Management

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

Prehospital Care

Prehospital care should focus on airway maintenance and supplemental oxygen.

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Emergency Department Care

Goal of initial ED care is stabilization of the trauma patient and multisystem trauma evaluation.

  • Primary focus of treatment for rib fractures is pain relief and adequate clearing of pulmonary secretions.
  • Isolated rib fractures, without associated injuries, may be managed on an outpatient basis with oral analgesics.
  • Lidocaine patch for pain control has been used, but one study suggests its efficacy is no greater than placebo.[22]
  • Other options include parenterally administered narcotics titrated to prevent respiratory depression.
  • Patient-controlled anesthesia allows adequate pain relief with minimal inhibition of respiratory drive.
  • Intercostal nerve blocks provide pain relief without affecting respiratory function, although risks of this procedure include intravascular injection and pneumothorax.
  • For hospitalized patients, consider epidural and intrapleural catheter placement for delivery of anesthetics. Patient-controlled analgesia pumps have also shown to be useful in these patients.
  • While rib belts or binders do control pain, they have been linked to hypoventilation, atelectasis, and pneumonia. As a result, their use is no longer recommended.
  • For patients with a significant mechanism of trauma, a CT of the chest and abdomen can be useful in scanning for significant related injury.
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Consultations

  • Because of the close association of rib fractures with injury to underlying structures, the ED physician may need to consult the trauma service.
  • Pain management specialists can be helpful for admitted patients.
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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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