Rib Fractures: Essentials of Management and Treatment Options

August 22, 2012

Rib fractures are the most common chest injury accounting for 10 to 15 percent of all traumatic injuries in the U.S. Nearly 300,000 people are seen each year for rib fractures and 7 percent of this population will require hospitalization for medical, pain, and/ or surgical management.

Rib fractures can cause serious complications including: bleeding in the chest (hemothorax), collapse of the lung (pneumothorax), or result in a fluid accumulation in the chest (pleural effusion), just to name a few. As well, rib fractures may contribute to the development of a lung infection or pneumonia. These problems are important to diagnose following chest trauma and even more importantly, when present, they need to be followed closely in the early post-traumatic period.

Pain is the most common symptom that people experience with rib fractures. It will often take the upwards of 6 weeks, sometimes 6 months for the fractures to heal and for patients to become entirely pain free. This pain results mostly from the movement of the broken ends and subsequently, with each motion or deep breath, the unstable ends move and pain ensues.

Pain control is a top priority in the care of patients with rib fractures. Poor pain control renders the patients unable to effectively breathe deeply, placing them at risk for collapse of the air sacs in their lungs (atelectasis) and at higher risk for infection in their lung (pneumonia). Additionally, when people are in pain they eat less, they cannot effectively sleep, and they are unable to move freely, or participate in their normal activities including work.

Rib fractures are most often uncomplicated which means that the fractured rib(s) are broken in one place. These uncomplicated fractures are usually not displaced allowing for realignment during the healing process and little movement with breathing and moving. These fractures can usually be managed conservatively with simple pain control and time.

However, at times, the fractures are considered complicated either because multiple breaks are present on each fractured rib causing the broken segments to be unstable, or when the broken ends are severely displaced. These complicated fractured ribs are often more unstable during activity and breathing and will likely take longer to heal; some may never heal normally.

3D reconstruction of fractured ribs before surgery

3D reconstruction of fractured ribs before surgery

Historically, good pain control and at times the use of a stabilizing elastic binder (to wrap around the chest) have been the only treatment options for most rib fractures. These treatment options continue to be utilized and are effective for many patients with uncomplicated rib fractures.

For the more complicated rib fractures we may also consider early surgical intervention to stabilize the unstable and/or displaced fractures. This is accomplished by screwing a small, customized, titanium plate across the fractured segment(s) of the rib thus achieving surgical fixation (stabilization); these plates realign the ribs and speed up the healing process.

After rib plating surgery

Images from after rib plating surgery

After rib plating surgery

 

Swedish Thoracic Surgery offers a specific clinic that is designed to care for patients with newly fractured ribs, both complicated and uncomplicated. We have a multidisciplinary team of care providers including thoracic surgeons, an interventional pulmonologist, and nurse practitioners who are available to evaluate the injury and make a clinical treatment plan that is individually tailored to each patient’s needs. This clinical plan would include consideration of the patient’s age, their underlying health, the severity of the fractures and the specific needs in their life. Our team is equipped to work closely with patients and caregivers to prevent potential and unnecessary post-traumatic complications and guide them to a quicker recovery and earlier return to productive and normal activities of daily living.

Learn more about the Swedish Rib Fracture Clinic.

Topics: Services, Surgery