A rib fracture is a fracture of one or more ribs, which in most cases is due to external force. Rib fractures usually have a good course and heal without complications.
What is a rib fracture?
A rib fracture is a fracture of one of the twelve ribs of the human skeleton. Ribs have a bony and a cartilaginous portion, and a fracture of the cartilaginous portion is also called a rib fracture. On the other hand, if more than two adjacent ribs are fractured, it is called a serial rib fracture. If a single rib has two fractures, so that part of the rib is broken out of the rib joint, this is referred to as a partial rib fracture. In addition, a differentiation is made between displaced and non-displaced rib fractures. A rib fracture manifests itself by local pain in the chest area, which is aggravated by breathing movements, especially deep inhalation, as well as coughing. Depending on the type of rib fracture, various forms of respiratory impairment may occur. In addition, a rib fracture carries an increased risk of damage to nearby organs such as the heart, spleen, or aorta (main artery).
Causes
In most cases, a rib fracture is caused by external force resulting from a fall on the chest area or accident. Extreme force, such as in traffic, horseback riding, or bicycle accidents, results in serial rib fractures and/or partial rib fractures in many cases. If surrounding organs, especially the aorta, are injured as a result of the rib fracture, very severe bleeding into the lungs (hematothorax) or collapse of a lung lobe (pneumothorax) may occur. Due to pain, breathing can be severely impaired depending on the shape and extent of the rib fracture. For example, a serial rib fracture can cause inhibition of breathing or lead to inverse breathing, in which the rib cage, unlike in normal breathing, pulls inward when inhaling and expands outward again when exhaling. Furthermore, if osteoporosis (bone loss) is present, a rib fracture can be caused by even a severe cough.
Symptoms, complaints and signs
With this injury to the ribs, there is pain in the affected area. Often, breathing and movement are restricted when a rib fracture occurs. However, simple rib fractures are uncomplicated and do not require special treatment. Rib fractures are the most common chest injuries and result from direct or indirect trauma. Most commonly, they involve the fourth through ninth ribs. Ribs can break on the front, side or back. If multiple ribs are involved, a serial rib fracture is present. Pain increases with movement, breathing, laughing, sneezing or coughing. The affected rib is tender to pressure. If pressure is applied, a crunching sound can often be heard. Palpable is also air accumulated in the skin. Often the broken rib itself can be felt externally. Particularly in the case of serial rib fractures, further impairments may occur. Thus, it can lead to pulmonary contusions, which is accompanied by increased breathing problems. If severe pain and circulatory problems occur, the rib fracture requires treatment in any case. Fractures of the sternum may result in damage to the thoracic spine or cardiac contusions. If the lower ribs are affected, the kidneys or liver may be affected.
Diagnosis and course
A rib fracture is diagnosed during an X-ray examination in which the thorax is imaged in two planes. If there is specific evidence regarding the location of the rib fracture, a target radiograph may be performed. Because of the existing risk of pneumothorax, an X-ray should be taken in inspiration (inhalation) and expiration (exhalation). If an undisplaced rib fracture is suspected, a follow-up radiograph is indicated if symptoms do not resolve. Sonography (ultrasound examination) can be used to detect injury to the surrounding organs. In addition, an EKG will provide information about possible involvement of the heart. If a rib series fracture is present, a CT (computed tomography) scan can provide a comprehensive overview of the extent and location.Usually, rib fractures (including serial rib fractures and partial rib fractures) have a good course and heal without complications.
Complications
As a rule, rib fractures heal well. Sometimes, as a result of the rib fracture, air gets into the lungs (pneumothorax) or bleeding occurs there or in the chest. Accompanying this, skin emphysema may occur. Injury to the spleen cannot be ruled out either. In severe fractures, an independent rupture of the spleen may occur. An unstable chest with paradoxical breathing may also occur – respiratory distress and further complications are the result. If ventilation of the lungs is reduced as a result of the decreased respiratory motion, pneumonia may result. Adverse events may also occur during surgical treatment of a rib fracture. Swelling in the area of the surgery is relatively common, due to bruising or fluid accumulation. Nerve pain or sensory disturbances may also occur and sometimes persist for a long time. More rarely, the fracture recurs. Hardening and wound healing disorders also occur rather rarely, but cannot be ruled out. In addition, the prescribed painkillers and anti-inflammatory drugs may be associated with side effects and interactions. In the case of existing pre-existing conditions or allergies, further complications may arise here under certain circumstances.
When should you go to the doctor?
Pain in the area of the hip as well as shortness of breath and discomfort indicate a rib fracture. Medical evaluation is recommended if symptoms persist and cannot be relieved by rest and other general measures. Affected patients are best advised to consult their family doctor or go directly to the hospital. If the symptoms occur in connection with a fall or accident involving the ribs, the patient must see a doctor immediately. The same applies if there is acute shortness of breath or bleeding. In addition, people who are constantly coughing due to a chronic respiratory disease or who notice the aforementioned symptoms after chest compressions are particularly at risk. A rib fracture is treated by an orthopedist or surgeon. Most patients require physical therapy after the procedure. The patient only needs to take one or two follow-up visits after the rib fracture treatment. If there are any problems due to the prescribed painkillers, it is necessary to inform the doctor so that the medication can be adjusted.
Treatment and therapy
Undisplaced rib fractures are usually treated conservatively with analgesic medications such as ibuprofen, novalgin, or tramadol. If an irritable cough is present at the same time, additional expectorant cough suppressants such as Paracodin N drops are used to reduce the cough. If the rib fracture causes the patient to breathe easily, he or she should be checked regularly for infections in order to prevent pneumonia or to be able to treat it in time. In the case of a mantle pneumothorax (collapsed lung of low severity), X-rays should be taken at regular intervals to check for improvement in lung function. In the case of a pneumothorax, on the other hand, the collapsed lung must be brought to unfold again by means of a chest drainage. In a minimally invasive procedure, a tube is inserted into the pleural space (the gap in the pleura), through which the air in the pleura is sucked out by the negative pressure and the affected lung is relieved so that it can unfold again. In many cases, respiratory therapy is recommended for older patients affected by a rib fracture, as they are at risk of hypoventilation (restricted ventilation of the lungs) or atelectasis (collapsed sections of the lung lobes) as a result of the pain-induced protective breathing. In addition, painful damage to nerves in the intercostal region may be present as a result of a rib fracture (intercostal neuralgia), which must be treated appropriately (e.g., with nonsteroidal anti-inflammatory drugs).
Prevention
One measure that can prevent a rib fracture is, for example, wearing protective clothing during so-called contact sports such as football or martial arts to avoid injury to the rib cage.Elderly people at increased risk of skeletal injury due to osteoporosis should use walkers (rollators) if they are unsteady in their gait to avoid falls and consequent rib fractures.
Follow-up care
After a rib fracture, targeted physical therapy is useful to relieve pain, shorten the healing process, and restore full range of motion to the rib cage and thoracic spine. Pain after a rib fracture is usually caused by the respiratory movement of the rib cage. Therefore, respiratory therapy is useful. The patient learns important self-help techniques to avert respiratory distress. The physical therapist also demonstrates the correct execution of everyday movements and proper breathing techniques to keep the diaphragm and rib cage mobile. Aftercare for a rib fracture also includes manual therapy, massage and heat applications. These relieve pain-related tension in the shoulders, arms and thoracic vertebrae. Physical therapists often use kinesio tapes. The self-adhesive, elastic cotton tapes easily fix the bones and stabilize the corresponding parts of the body. In addition, they relieve pain and prevent the development of edema. The tapes are applied directly over the fracture site to ensure full mobility in the affected area. Many therapists offer magnetic therapy for rib fractures. Bone and tissue healing is stimulated and pain is reduced. Prior consultation with the treating physician is recommended. In order for a rib fracture to heal smoothly, all strenuous physical activity should be avoided. For example, heavy carrying or lifting is also prohibited during the follow-up period.
This is what you can do yourself
A simple rib fracture usually heals on its own with a few weeks of rest. However, if severe pain, circulatory problems or problems with breathing are added, the affected patient should seek medical treatment. It is possible that the fracture is complicated and/or has injured adjacent organs. If multiple ribs are affected, the chest may have become unstable, affecting breathing and the lungs. Surgeons or orthopedists can treat this properly. If the rib fracture or serial rib fracture is medically treated or uncomplicated, the patient can relieve pain by taking anti-inflammatory pain medications. Cooling, light compresses also relieve pain. Since coughing shakes the chest, it is also advisable to take cough blockers if you have a cold at the same time. Bandages and ligaments are no longer used to treat a rib fracture because they hinder breathing more than they stabilize the rib cage. Sports are off-limits for the first four weeks after the fracture, but moderate outdoor exercise is certainly advised. Longer walks activate the immune system and make patients feel better. Patients should also not retreat or take excessive care of themselves. While it takes up to eight weeks for a rib fracture to heal, the worst is over in as little as three weeks.
