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Rib Fracture

(Broken Rib; Fracture, Rib)

Definition

A rib fracture is a break in a rib bone. Bruised muscles and ligaments often happen with a rib fracture. With a rib fracture, the lungs and other organs can be injured. More than one rib fracture after a trauma can indicate serious internal injury.
Multiple Rib Fractures with Damage to Lung
broken ribs resized
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Causes

Rib fractures are caused by:
  • A direct blow to the rib
  • Crushing of the chest, such as in contact sports or a car accident
  • Severe coughing incidents that can occur with lung problems or at high altitude
  • Rib fractures in young children are often a sign of abuse

Risk Factors

A risk factor is something that increases your chance of having an injury. Risk factors for breaking a rib include:
  • Age: 65 years and older
  • Difficulty doing activities of daily living
  • Playing contact sports
  • Having weak bones
  • Having a chronic cough
  • Extreme repetitive upper body activity (less common), such as in:
    • Throwing athletes
    • Basketball players
    • Golfers
    • Rowers
    • Weight lifters
  • Having an occupation involving a lot of overhead lifting
  • Having a history of rib or chest fracture

Symptoms

Symptoms include:
  • Pain in the ribs or upper chest area
  • Pain when coughing
  • Swelling and bruising in the fracture area
  • Severe local tenderness in the fracture area
  • Internal bleeding
  • Pain while breathing

Diagnosis

The doctor will ask about your symptoms and how the injury occurred. He will examine your chest, lungs, and back.
Tests may include:
  • Chest x-ray—an x-ray of the chest to check for fractures and any lung damage
  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the chest
  • MRI scan—a test that uses a strong magnetic field and radio waves to make pictures of structures inside the chest

Treatment

Treatment includes:

Rest

Rest and do not do physical activity until the pain has gone away.

Protection

Your doctor may suggest wearing a chest binder around your ribs to protect them. The binder will also help you breathe properly. It is very important to take some good breaths so that the lungs remain clear. Pneumonia can develop after rib fractures if you are not breathing deeply enough. If you play contact sports, you may need to wear a rib cage protector for 6-8 weeks when you return to playing.

Medication

Your doctor may recommend that you take one of the following drugs to help reduce inflammation and pain:
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve, Naprosyn)
  • Acetaminophen (Tylenol)
  • Aspirin

Physical Therapy

As your ribs heal, a physical therapist can teach you breathing exercises. The therapist can also help you maintain range of motion in arm and shoulder joints.

Intercostal Nerve Blocks

Special injections with local anesthetic can temporarily relieve pain.

Epidural Anesthesia

Sometimes a temporary epidural catheter is used to place anesthetic near the spinal cord and nerves. This can help severe cases. This is usually done for hospitalized patients.

Hospitalization

Hospitalization is usually only needed if there are complications such as damage to chest organs in the chest.

Prevention

Sometimes rib fractures cannot be prevented. To reduce your chance of fracturing a rib:
  • Wear protective equipment, such as rib pads, when playing contact sports.
  • Avoid over-training.
  • Learn the proper technique for exercise and sporting activities.
  • Maintain strong bones by:

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org

Trauma.org http://www.trauma.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Boden BP, Osbahr DC, et al. Low-risk stress fractures. Am J Sports Med. 2001;29:100-111.

Fractures. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00097. Updated October 2007. Accessed June 18, 2008.

Gregoretti C, et al. Regional anesthesia in trauma patients. Anesthesiol Clin. 2007;25(1):99-116.

Marx J, Hockberger R, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006.

O'Kane J. Delayed complication of a rib fracture. Phys Sportsmed. 1998;26:69.

Rib fractures. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?ss=15&doc%5Fid=7062&nbr=4251. Accessed October 14, 2005.

1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Barrett-Connor E, Nielson CM, Orwoll E, Bauer DC, Cauley JA; Osteoporotic Fractures in Men Study Group. Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study. BMJ. 2010;340:c1069.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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