Rib fracture

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 10, 2016
StartDiseasesRib fracture

Rib fractures or broken ribs are a common injury to the chest area. Rib fractures can occur at any age for a variety of reasons. The type and severity of the fracture can make it easier or more difficult to obtain an accurate diagnosis. Rib fractures or cracked ribs usually take six weeks to heal and are usually not life-threatening conditions among otherwise healthy people.

Contents

Definition & Facts

According to the American Association for the Surgery of Trauma, blunt trauma to the chest region is the leading cause of rib fractures. For individuals who have experienced chest trauma via blunt force, there is at least a 10 percent likelihood that one or more fractured ribs may be present. A rib fracture is different from a break in the rib in that the fracture is most typically a crack or break in the interior of the bone, rather than a break which severs the rib bone in one or more places. 

Symptoms & Complaints

The chief symptom physicians watch for when diagnosing a rib fracture is pain. The pain tends to be more severe when the individual is trying to breath deeply. Often, the pain is felt more intensely near the area where the rib fracture has occurred. Generally speaking, the most common set of symptoms individuals describe when suffering from a rib fracture include the following:

Causes

There are many possible ways that a rib could be fractured. Sometimes instead of the rib bone itself, it is the cartilage segment that attaches each rib to the breast bone (or sternum) that gets fractured. This is also considered a rib fracture medically. Here are some of the most commonly known causes for rib fractures:

  • Blunt trauma to the chest area. This could be from a car accident, from an attack, from a fall or severe coughing fits (such as in individuals suffering from emphysema).
  • Osteoporosis or osteopenia. This brittle bone condition is caused when the body leaches calcium from the bones, causing the bones to become more brittle and fragile. It is much easier for an individual suffering from osteoporosis or osteopenia to fall and suffer a rib fracture.
  • Rheumatoid arthritis. Some patients with serious rheumatoid arthritis can develop brittle bones, which can cause rib fractures.
  • Cancer. Serious diseases such as cancer can cause weakening of the bones and cartilage due to medications or growths that press on the rib cage. These individuals are at much greater risk of developing rib fractures.

Diagnosis & Tests

Diagnosis of a rib fracture begins when the doctor takes a medical history and continues with a thorough physical examination that focuses on the suspected injury site. The doctor may ask the individual to try to breath deeply, move their arms or bend. The doctor may also physically press on the site to see if there is any discomfort.

Following these simple exam tests, an X-ray is usually ordered. This is because it is not always possible to determine the cause of chest pain without being able to see exactly what is going on near the site. A chest X-ray can highlight where the rib fracture is, what type of fracture it is, how severe it is and if any other nearby structures or organs may be affected.

If it is seen that other structures or organs may be affected, the doctor may also order other tests relevant to those injuries. The X-ray will also determine what type of rib fracture is causing the discomfort and symptoms. The different types of rib fractures include:

  • Simple. When only one rib is fractured or there is only a hairline fracture (stress fracture) in multiple ribs.
  • Complex. When there is more than one break in a single rib or multiple ribs broken.
  • Flail chest. A very serious complicated fracture that separates one section of the rib cage from the rest, causing it to move freely.

CT scans may also be conducted to determine if there any damage to underlying organs like the lungs, liver and spleen. A CT scan may also assess if there is pneumothorax has occurred. Pneumothorax is a condition in which air escapes from the lungs and fills up the pleural cavity, potentially exerting pressure on the lung and causing it to collapse.

Treatment & Therapy

Treatment for a rib fracture will differ based on the severity. For a simple hairline fracture (the least severe kind), often rest and pain medication is all that is prescribed. Types of pain medications that may be prescribed include narcotic painkillers as well as over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen as well as paracetamol. Compression bandages and splints are typically not recommended, though applying ice packs is important to reduce swelling particularly in the first few days following the injury.

If the individual has three or more fractures of any kind, hospitalization and monitoring is often required, as is oxygen support to help with the function of the lungs while the fractures are healing. Hospitalization is also typically required for individuals over the age of 65 because there is an increased risk of atelectasis (a collapsed lung) and pneumonia.

For individuals who have compromised lung function, a medical device called an incentive spirometer is often prescribed. This device helps the patient improve lung function by learning how to take measured, slow, deep breaths. If the rib fracture has caused surrounding structures or organs to become compromised, this is viewed as a more serious issue and additional hospitalization and treatment may be required.

Prevention & Prophylaxis

Although there is no single way to achieve total prevention of rib fractures, preventing rib fractures is possible in some cases. Athletes are encouraged to wear the right kind of protective gear for the sport being played. Individuals of any age can improve the diet to keep bones strong by increasing intake of calcium and vitamin D

Quitting smoking or avoiding smoking can help reduce the risk of developing severe complications from a fractured rib. Smokers and those with a history of smoking have a higher risk of chronic obstructive pulmonary disease (COPD) and are more likely to develop infections after suffering a broken rib. Smoking also inhibits the healing process and should be avoided to facilitate a speedier recovery.

Another helpful way to reduce the likelihood of experiencing a rib fracture is to practice safe, defensive driving habits to avoid being in a car accident. Keeping the floor and hallways at home and at work free from clutter can also prevent falls, especially in older individuals.