The most common injury sustained from blunt trauma to the chest is rib fractures and account for more than half of all thoracic injuries from non-penetrating trauma. Whereas in the elderly the most common cause of rib fractures is a fall and in youth the most common cause is recreational or athletic activities, in adults, motor vehicle accidents are the most common cause!
Fractures of the 1st and 2nd ribs are often associated with vascular injury and carry a much higher mortality rate. X-rays are often used to diagnose rib fractures, however, sensitivity can be as low as 50%. CT scan and MRI are much more sensitive in detecting rib fractures.
Pain control is of utmost importance in management of rib fractures in order to keep the patient breathing as deep as possible and clear pulmonary secretions (i.e., coughing). An intact chest wall, which includes the ribs, clavicles, sternum, and scapulae, is necessary for normal respiration. Due to the risk of pneumonia, binding the chest is no longer recommended. Kinesiology tape has proven quite successful in stabilizing a rib fracture and reducing severe pain.
Minor rib fractures can often be controlled with narcotic pain medications while in more severe cases intercostal nerve blocks are required. Surgery is generally only recommended when a broken rib has penetrated an internal organ or if there is a malunion of the rib when healing.
Fragments of fractured ribs can act as penetrating objects and can result in a hemothorax, which is a collection of blood in the space between the chest wall and the lung – also known as the pleural cavity or a pneumothorax, also known as a collapsed lung and occurs when air leaks into the space between the lung and the chest wall. This collection of air on the outside of the lung pushes on the outside of the lung causing it to collapse. Symptoms of a pneumothorax typically include sudden sharp one sided chest pain and shortness of breath. A hemopneumothorax is a combination of both conditions.
Ribs often fracture at the point of impact or the posterolateral bend, which is the weakest spot of the rib. In the case of first rib fractures, those which can be life threatening, the weakest point is at the groove for the subclavian artery.
In a car wreck, the mechanism for first rib injury seems to be the violent contraction of muscles caused by the sudden forward movement of the head and neck. The prevalence of reported rib fractures (with only approximately 70% of chest injury being reported annually) is higher in countries with a higher incidence of motor vehicle accidents. The incidence of rib fractures in children is low due to their more pliable, elastic ribs.
Rib fractures often take six weeks to heal and return to work or activities of daily living during that time depend on the activity involved and the level of pain. Generally, when pain is not present at rest, the patient can gradually begin to increase their activities. It is also recommended for patients to sleep in a recliner during this initial time as getting in and out of a flat bed can be extremely painful and continue to stress the fracture.
