Introduction
A rib fracture (rib fracture) is the fracture of the bony or cartilaginous part of a rib. The most common cause of rib fractures is massive violence, mainly due to trauma to the thorax (trauma of the ribcage). If a rib fracture occurs spontaneously or as a result of a very minor violent impact that is not sufficient to explain the fracture, other underlying conditions such as osteoporosis or bone metastases must be considered.
If the force applied is less severe, a contusion of the rib may occur, but the symptoms are initially hardly distinguishable from those of a rib fracture. Rib fractures occur frequently. In most cases, healing proceeds relatively quickly and without complications.
Nevertheless, the patient often has to be on sick leave for several days to weeks, depending on the professional activity. The diagnosis of a rib fracture can often be made by palpation. The patient complains of severe pain, which gets worse when pressure is applied, and crunching noises (crepitations) become audible when movement is made.
Larger displacements (dislocations) can be detected by means of an x-ray of the thorax. Fractures in which the edges of the fracture are not displaced can often only be visualized with ultrasound and are often dismissed as bruises. It is also important to make an ultrasound of the abdominal cavity, the pleura and the heart to rule out life-threatening internal injuries.
Normally, a rib fracture heals by itself within about twelve weeks without any problems. This prognosis is valid for simple fractures of one or two ribs or for stable fractures of three or more ribs on the same side of the thorax (serial rib fracture). The treatment of such rib fractures is usually conservative (non-surgical).
A simple rib fracture does not usually require any special therapy, as the ribs are fixed in place by their embedding in the muscles and ligaments of the thorax. The patient must be informed about his or her condition and the course of the disease over several weeks. The pain is treated with painkillers such as Ibuprofen, Tramadol or Novalgin.
If the pain is very severe, a nerve block can be performed. The patient is injected with a local anesthetic into the area of the nerve that supplies the affected rib. Adequate pain therapy is of particular importance in the treatment of a rib fracture so that the patient can breathe normally deep despite the rib injury.
If the affected person falls into shallow, gentle breathing due to pain, he or she is susceptible to infections of the respiratory tract and lungs. For this reason, immobilization of the rib fragments with a plaster cast, bandaging or plating is no longer common. In this case, special respiratory training can be useful.
Any irritable cough should also be treated, for example with Paracodin drops. If breathing is severely impaired, as in the case of a serial rib fracture, artificial respiration may be necessary. In the case of a serial rib fracture, the oxygen content of the blood should always be measured to check whether enough oxygen can be absorbed by the lungs and circulated in the body’s circulation.
