What is Rib Fracture?
Rib fractures happen when a strong force hits the rib hard enough to cause it to break. We have 12 pairs of ribs in the chest area. The first seven ribs connect to the breastbone in the front and to the backbone at the back. Ribs numbered from 8 to 10 connect in a similar fashion but they connect to the rib cartilage of the breastbone in the front. The 11th and 12th ribs are often called ‘floating’ ribs as they only connect at the back and don’t connect at the front. An important thing to note is that each rib has a nerve, artery, and veins underneath it, which supply blood and send nerve signals. Ribs play a crucial role in protecting the organs and structures in the chest cavity. If a rib fracture happens, it is important to thoroughly check for any related injuries. This could include injuries to the lungs, heart, kidneys, spleen, liver, and the nerves and blood vessels.
What Causes Rib Fracture?
Rib fractures can happen from an injury or without any obvious cause. A lot of rib fractures are due to a forceful blow or sharp object hitting the chest. The ribs at the top, numbered 1 to 3, are the toughest to break, and having a fracture here indicates a severe injury. Ribs numbered 4 to 10 are the most prone to fractures while the last two rib segments, numbered 11 and 12, are more flexible and hence, less likely to get fractured.
In older people, falls are a common reason for rib fractures. These fractures are more serious in elderly people than in younger ones and can lead to further health complications.
Rib fractures can also occur because of diseases like cancer spreading from other organs. Athletes can get rib fractures due to repeated stress and small injuries over time. Also, people can spontaneously fracture their ribs due to severe coughing; this is more likely in people with osteoporosis or lung disease.
Children’s ribs are more bendy than adults’, so they are less likely to get rib fractures. However, if a child does have a rib fracture, this indicates a severe injury and may be a sign of potential child abuse.
Risk Factors and Frequency for Rib Fracture
The rate at which people experience rib fractures largely depends on how severe the injury or trauma they’ve suffered from is. Kids are less likely to get rib fractures than adults because their ribs are more flexible. Rib fractures are more common in older people than in younger ones, and sadly, they also have a higher risk of serious health problems or death as a result.
Signs and Symptoms of Rib Fracture
Rib fractures are typically diagnosed through a clinical exam. Usually, patients will mention a recent incident where they experienced a strong blow or puncture to the chest, and they will feel pain in that area. Their ability to take full breaths may be limited because of the discomfort. An examination can reveal bruising on the chest wall along with discomfort or a grating feeling when the area over the ribs is touched. In some cases, abnormal vital signs like low oxygen levels, rapid breathing, or severe breathing difficulty may require further investigation for other potential injuries such as a collapsed lung, blood in the chest, or injuries to the heart and lungs. If the lower section of ribs are injured, doctors need to check for damage to the kidney, liver, and spleen. Patients whose chest wall moves irregularly or who may have several rib fractures should be checked for a condition called flail chest, which requires specific management.
Testing for Rib Fracture
You can often diagnose broken ribs based on your symptoms and a physical examination, so you usually don’t need a special rib x-ray. If your doctor thinks you might have multiple broken ribs or internal injury due to a significant trauma, they might recommend an imaging test.
But regular chest x-rays don’t always catch every broken rib – they can only spot about half of the rib fractures. Point-of-care ultrasound exams, on the other hand, can reliably spot broken ribs and associated complications like a collapsed lung.
That being said, the best method for detecting broken ribs is a chest computed tomography (CT) scan. However, the scan might spotlight fractures that aren’t medically significant. So, the chest CT is mainly useful for checking for other injuries during a general trauma assessment.
Treatment Options for Rib Fracture
For basic and singular rib fractures, the usual treatment approach includes sufficient pain relief, rest, and the application of ice. Patients are also urged to use a device known as an incentive spirometer, which helps keep the lungs fully inflated and prevent complications like atelectasis (lung tissue collapse). Pain can also be managed using intercostal nerve blocks, a type of local anesthesia injected near the broken rib.
Wrapping the rib cage, known as rib taping, is no longer suggested as it can hinder proper breathing. When the usual conservative treatment methods don’t work or if the rib fractures are severe, surgery might be considered. Reasons to choose surgery could include non-healing fractures, chest wall abnormalities, intense rib fracture pain causing breathing failure or conditions like flail chest, which is when a segment of the rib cage breaks and becomes detached from the rest of the chest wall.
If surgery is pursued, the sooner it’s carried out, the better the patient outcomes tend to be, as it can also decrease or eliminate the need for mechanical ventilation —a machine that helps patients breathe.
Additionally, other related injuries such as pneumothorax (air leak into the space between the lung and chest wall) or hemothorax (blood accumulation in the space between the chest wall and the lung) should be addressed as well. A chest tube may need to be inserted if determined necessary by the doctors.
What else can Rib Fracture be?
When a person has chest pain, doctors need to consider many different causes. These might include:
- An injury or bruise to the ribs or chest wall
- An injury to the diaphragm (the muscle that helps us breathe)
- A hemothorax, which is when blood fills the space between the chest wall and the lung
- A pneumothorax, also known as a collapsed lung
- A fracture or break in the breastbone, or sternum
- A bruise to the lung
- A bruise to the heart
- A fracture or break in the collarbone, or clavicle
- Flail chest, a condition that occurs when a segment of the rib cage breaks and becomes detached from the rest of the chest wall
- A fracture or break in the shoulder blade, or scapula
- A pneumomediastinum, which is air in the center of the chest around the heart and major blood vessels
Because all of these can cause similar symptoms, careful examination by a doctor is important to make sure the right diagnosis is made.
What to expect with Rib Fracture
The treatment for rib fractures can vary depending on how severe the injury is and how much pain the patient is in. It might be possible for the patient to be treated at home or they might need to stay in the hospital. If it’s just a single rib that’s broken, it usually heals quite well with pain management, rest, and ice. However, if multiple ribs are broken, moved out of place, or there are other injuries as well, the patient may need to stay in hospital for monitoring because there’s a risk of breathing problems. In some cases, surgery might be needed.
Older people who fracture their ribs tend to face a greater risk of death than younger people, so they often require closer monitoring.
Possible Complications When Diagnosed with Rib Fracture
The most serious complications from broken ribs include a condition called flail chest and damage to internal organs or structures. These solid organ injuries could include harm to the liver or spleen. The higher the broken rib is within the chest cage, the more likely it is that the liver or spleen will be injured. Additionally, it’s vital to monitor the patient’s breathing, as broken ribs can lead to acute respiratory failure due to difficulty breathing, possibly requiring mechanical help with breathing and surgical stabilization.
Common Complications:
- Flail chest
- Damage to internal structures
- Liver injuries
- Splenic injuries
- Acute respiratory failure
- Need for mechanical ventilation
- Need for surgical stabilization
Preventing Rib Fracture
Rib fractures in older adults can lead to serious health issues and even death. This is why it’s crucial to focus and invest resources on preventing falls that may cause these fractures. Research confirms that a team comprising various health professionals can greatly decrease the number of falls among the elderly. As such, it is important for doctors, nurses, and hospital staff to gain training on how to provide the required tools and resources that can help prevent falls. This type of training will help to reduce the instances of dangerous falls, thus preventing rib fractures among older adults.
