Surgical treatment
If the rib fracture is more complicated, surgical treatment becomes necessary. The ends of the fracture are then fixed with screws and plates. Such treatment of the rib fracture often shortens the healing time of the injury.
Stabilization reduces the mobility of the fragments, allowing new bone material to be formed more quickly. An indication for such a surgical procedure may be an unstable chest wall following a serial rib fracture. Even if the ends of the fracture have shifted (dislocation), surgery may be necessary if it is not possible to position them in their original position (reduction) from the outside.
Another reason for surgery is when the rib fracture has injured the internal organs of the abdomen and chest. A displaced fracture can lead to a pneumothorax due to injury to the lung tissue. In this case one lung collapses and is no longer functional.
In this case, the lung has to be unfolded again in the short term by inserting a small tube (drainage) into the pleura.The air that has been incorrectly introduced into the pleura can now be sucked out through this tube and the lung unfolds again. Bleeding into the lung or the thorax is also feared. Here the source of bleeding must be found and surgically removed.
Injuries to the spleen are also a dangerous complication due to the high risk of bleeding. The spleen can be impaled through the ribs or ruptured on its own. In this case, too, it is vital to locate the source of bleeding and to surgically treat the injury. Depending on the height of the rib fracture, the heart, liver or kidneys may also be injured. If there is the slightest suspicion of an organ injury, an appropriate examination should be performed and the damaged organ should be treated surgically.
Prognosis/fracture healing
Fractures of the ribs usually heal relatively quickly and without problems – even in the case of fractures of pieces or serial rib fractures. The different types of rib fractures require different amounts of time to heal completely. The exact location of the fracture is particularly important.
Roughly speaking, it takes about twelve weeks for a rib fracture to heal completely. So-called scavenger cells first break down the destroyed bone tissue. The ends of the fracture then grow together again in a bony fashion.
First, the gap between the bone ends is filled with bone replacement material (callus), which is less resilient and less resistant. Although the pain is usually significantly reduced during this three- to four-week phase, it is important that patients take it easy on their bodies to avoid further injury to the rib. Gradually, the bone replacement material is replaced by proper, robust bone.
In the case of a displaced (dislocated) fracture, where the fracture ends do not stand regularly on each other, fracture healing is usually delayed. The patient’s recovery depends crucially on complications and concomitant injuries such as a pneumothorax or injuries to blood vessels or internal organs. Intercostal neuralgia can occur as a complication of the healing of a rib fracture. It results from injury to the vascular nerve bundle that lies under each rib.
