Rib fracture
Encyclopedia
A rib fracture is a break or fracture
in one or more of the bone
s making up the rib cage
.
The first rib
is rarely fractured because of its protected position behind the clavicle
(collarbone). However, if it is broken serious damage can occur to the brachial plexus
of nerve
s and the subclavian
vessels. Fractures of the first and second ribs may be more likely to be associated with head
and facial injuries than other rib fractures.
The middle ribs are the ones most commonly fractured. Fractures usually occur from direct blows or from indirect crushing injuries. The weakest part of a rib is just anterior to its angle, but a fracture can occur anywhere. The most commonly fractured ribs are the 7th and 10th.
A lower rib fracture has the complication of potentially injuring the diaphragm, which could result in a diaphragmatic hernia
.
Rib fractures are usually quite painful because the ribs have to move to allow for breathing. Even a small crack can inflame a tendon and cripple an arm.
When several ribs are broken in several places a flail chest
results, and the detached bone sections will move separately from the rest of the chest.
ing and in various sport
s – for example, rowing
and golf
– often in elite athletes. They can also occur as a consequence of diseases such as cancer or infections (pathological fracture).
Fragility fractures of ribs can occur due to diseased bone structure, e.g. osteoporosis
and metastatic
deposits.
s:
Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic
injuries such as pulmonary contusion
. Rib fractures are also a sign of more serious injury in elderly people.
can avoid this.
Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation
. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera
(e.g., lung contusion
) or remotely (e.g., cervical spine injury).
Spontaneous fractures in athletes generally requires a cessation of the cause, e.g., time off rowing, whilst maintaining cardiovascular fitness.
Treatment options for internal fixation/repair of rib fractures include:
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
in one or more of the bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
s making up the rib cage
Rib cage
The rib cage is an arrangement of bones in the thorax of animals. It is formed by the vertebral column, ribs and sternum and encloses the heart and lungs....
.
The first rib
First rib
The first rib is the most curved and usually the shortest of all the ribs; it is broad and flat, its surfaces looking upward and downward, and its borders inward and outward....
is rarely fractured because of its protected position behind the clavicle
Clavicle
In human anatomy, the clavicle or collar bone is a long bone of short length that serves as a strut between the scapula and the sternum. It is the only long bone in body that lies horizontally...
(collarbone). However, if it is broken serious damage can occur to the brachial plexus
Brachial plexus
The brachial plexus is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four cervical and first thoracic nerve roots...
of nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
s and the subclavian
Subclavian
In general, Subclavian means beneath the clavicle, and it can refer to:* Subclavian vein* Subclavian artery* Subclavian nerve...
vessels. Fractures of the first and second ribs may be more likely to be associated with head
Head injury
Head injury refers to trauma of the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature....
and facial injuries than other rib fractures.
The middle ribs are the ones most commonly fractured. Fractures usually occur from direct blows or from indirect crushing injuries. The weakest part of a rib is just anterior to its angle, but a fracture can occur anywhere. The most commonly fractured ribs are the 7th and 10th.
A lower rib fracture has the complication of potentially injuring the diaphragm, which could result in a diaphragmatic hernia
Diaphragmatic hernia
Diaphragmatic hernia is a defect or hole in the diaphragm that allows the abdominal contents to move into the chest cavity. Treatment is usually surgical.The following types of diaphragmatic hernia exist:* Congenital diaphragmatic hernia** Morgagni's hernia...
.
Rib fractures are usually quite painful because the ribs have to move to allow for breathing. Even a small crack can inflame a tendon and cripple an arm.
When several ribs are broken in several places a flail chest
Flail chest
A flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall...
results, and the detached bone sections will move separately from the rest of the chest.
Causes
Rib fractures can occur without direct trauma and have been reported after sustained coughCough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
ing and in various sport
Sport
A Sport is all forms of physical activity which, through casual or organised participation, aim to use, maintain or improve physical fitness and provide entertainment to participants. Sport may be competitive, where a winner or winners can be identified by objective means, and may require a degree...
s – for example, rowing
Rowing (sport)
Rowing is a sport in which athletes race against each other on rivers, on lakes or on the ocean, depending upon the type of race and the discipline. The boats are propelled by the reaction forces on the oar blades as they are pushed against the water...
and golf
Golf
Golf is a precision club and ball sport, in which competing players use many types of clubs to hit balls into a series of holes on a golf course using the fewest number of strokes....
– often in elite athletes. They can also occur as a consequence of diseases such as cancer or infections (pathological fracture).
Fragility fractures of ribs can occur due to diseased bone structure, e.g. osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
and metastatic
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
deposits.
Diagnosis
Broken ribs are often indicated by the following symptomSymptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s:
- Pain when breathing or with movement
- A portion of the chest wall moving separately from the rest of the chest (flail chest)
- A grating sound with breathing or movement
- Where the mechanism of injury would indicate substantial force to the ribs
Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic
Thorax
The thorax is a division of an animal's body that lies between the head and the abdomen.-In tetrapods:...
injuries such as pulmonary contusion
Pulmonary contusion
A pulmonary contusion is a contusion of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, potentially leading to inadequate oxygen levels...
. Rib fractures are also a sign of more serious injury in elderly people.
Treatment
There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Adequate analgesiaAnalgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
can avoid this.
Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera
Viscus
In anatomy, a viscus is an internal organ, and viscera is the plural form. The viscera, when removed from a butchered animal, are known collectively as offal...
(e.g., lung contusion
Bruise
A bruise, also called a contusion, is a type of relatively minor hematoma of tissue in which capillaries and sometimes venules are damaged by trauma, allowing blood to seep into the surrounding interstitial tissues. Bruises can involve capillaries at the level of skin, subcutaneous tissue, muscle,...
) or remotely (e.g., cervical spine injury).
Spontaneous fractures in athletes generally requires a cessation of the cause, e.g., time off rowing, whilst maintaining cardiovascular fitness.
Treatment options for internal fixation/repair of rib fractures include:
- Acute Innovations RibLoc is a titanium U-shaped plate that is sized to match rib thickness and uses screws that fixate to anterior and posterior of plate and provide fixation without needing bone purchase for screws and without risking damage to the neurovascular bundle. These plates can be contoured to match the rib segment being plated and come in various lengths.
- Judet and/or Sanchez Plates/Struts are a metal plate with strips that bend around the rib and then is further secured with sutures.
- Synthes MatrixRIB Fixation System has two options: a precontoured metal plate that uses screws to secure the plate to the rib; and/or a intramedullary splint which is tunneled into the rib and secured with a set screw.
- Anterior locking plate are metal plates that have holes for screws throughout the plate. The plate is positioned over the rib and screwed into the bone at the desired position. The plates may be bent to match the contour of the rib section.