Dealing With Rib Fractures

There is no specific treatment other than time and pain meds

Mature pain clutching his ribs in pain

 Colin Hawkins / Getty Images

Rib fractures can be excruciatingly painful, as well as frustrating, because there is no specific treatment for them other than pain medications and time to heal. With rib fracture, rib pain can be aggravated by the smallest movements: breathing, coughing, and movement of the upper body.

In a hospital setting, rib fractures are the most common type of injury caused by chest trauma. Moreover, rib fractures are closely associated with overall health and risk of dying. In other words, a person who sustains a severe injury and has several broken ribs is at a higher risk of death.

Some Ribs Are Harder to Break Than Others

We all have 12 sets of ribs. The first three ribs are difficult to break and typically fracture only after high-energy trauma (e.g., a car crash).

The other nine ribs are easier to break and account for more fractures, with the middle ribs most often broken. Some more common causes of rib fractures are falls, sports-related injuries (e.g., football or skiing), car accidents, assault and severe coughing (in the elderly).

Why Secondary Injuries Are Hard to Spot

Up to 25% of all rib fractures occur towards the front (anterior) and side (lateral) rib cage and are undetectable on X-ray. Furthermore, it's more difficult to spot X-ray changes secondary to rib fracture for the first few days after injury.

Finally, damage to cartilage may be impossible to spot on an X-ray. Ultrasound is emerging as a potential diagnostic tool to visualize rib fractures, including fractures in cartilage.

Rib Fractures Are Often Linked to Other More Serious Injuries

In and of itself, a rib fracture is painful but not life-threatening. However, rib fractures are often closely linked to other more serious injuries.

With rib fractures, physicians are more suspicious of the following:

  • Air and blood in the lung cavity (i.e., hemopneumothorax)
  • Vascular injury (the thoracic great vessels including the subclavian artery and veins, innominate artery, and veins, and left common carotid artery)
  • Intra-abdominal injury
  • Pulmonary contusion
  • Injury to the airway (bronchial tears)

If the physician expects pneumothorax, upright or expiratory films will likely be ordered, which are specific types of X-rays. Furthermore, in the case of severe trauma or if ribs are displaced, the physician may order serial chest imaging.

Atelectasis

The pain of a rib fracture makes it harder to breathe and can contribute to atelectasis. Atelectasis is defined as the partial or complete collapse of a lung. More specifically, when a patient experiences rib pain, she breathes lightly, thus hypoventilating the lungs; this hypoventilation results in atelectasis. Rib fractures also make it more difficult to wean somebody off ventilatory support.

Treatment Options

Hospitalized patients with severe pain caused by rib fractures can receive a nerve block with a long-acting anesthetic like bupivacaine. Sometimes, an epidural can be given to stop the pain, especially in the case of blunt chest trauma.

Instead, rib fractures are treated with a combination of benzodiazepines, opioids, and NSAIDs (drugs like Advil). Notably, benzodiazepines and opioids have abuse potential, and their use should be used as prescribed for no longer than the duration of the illness or injury.

If you or a loved one suffers from an injury that results in rib fracture outside of a hospital setting, there's a good chance your physician may not be able to diagnose the fracture on X-ray. Instead, pain over the affected ribs may be the only sign of injury.

Outpatient treatment of a rib fracture typically consists of the application of ice packs and prescription of pain medications as well as breathing exercises.

It's important to stay active while recovering from a rib fracture. Recovery can take up to six weeks or more.

Even though there's no specific treatment for a rib fracture, if you suspect that you've sustained one, it's a good idea to see a physician. A physician can help with the pain and examine you for other trauma or injury.

Moreover, a physician may prescribe you pain medications for your injury. Please remember that when prescribed medication, please take it exactly as prescribed. Certain medications prescribed for rib fracture—opioids and benzodiazepines—have abuse potential when taken incorrectly or in excess.

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Article Sources

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Additional Reading

  • Brunett PH, Yarris LM, Cevik A. Chapter 258. Pulmonary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011.