What is a rib fracture?
A fractured or broken rib refers to a crack or a break in one of the bones in the rib cage, which comprises 12 pairs of ribs and their attachment by cartilage to the sternum. While the curved design of the ribs makes them naturally resistant to injury, rib fractures are still fairly common injuries and are usually caused by trauma to the chest. Since the ribs protect the organs located in the chest and aid in breathing, a rib fracture can sometimes lead to serious complications if left untreated.
Types of rib fractures
An X-ray with displaced and nondisplaced ribs
When ribs are completely broken in half, they tend to move out of place. This is known as a displaced rib fracture and is more likely to result in complications such as punctured lungs. A fractured rib that stays in place is called a nondisplaced rib fracture.
Rib fractures can either be simple or complex.
Simple fractures, also known as hairline fractures, only affect a single rib that is usually nondisplaced.
Complex rib fractures involve multiple ribs and are often displaced and more severe in nature.
One serious type of rib fracture is flail chest or flail segments. This refers to a condition where multiple adjacent ribs are broken in multiple places. When this occurs, part of the chest wall separates from the rest of the ribs, becoming a free-floating segment that moves independently of the rest of the ribs. Patients with flail chests will experience difficulty breathing and their chests will also move unevenly when breathing.
Complications of untreated rib fractures
Left untreated, rib fractures could lead to a number of complications, such as:
- Punctured lungs
- Collapsed lungs (pneumothorax)
- Pulmonary contusions
- Ruptures in the aorta or other major blood vessels
- Injury to the spleen, liver, or kidneys
It is also likely that the trauma leading to the rib fracture could have caused other injuries in the body. Therefore, it is important to seek treatment as soon as possible.
Causes of rib fractures
The most common cause of rib fractures is trauma to the chest, often from a car accident, a fall, hitting a hard object, or a sports-related accident. Many people who suffer from these types of accidents can get rib fractures without experiencing any obvious symptoms. They choose not to visit a doctor to check for injuries and later experience much more severe complications, such as puncture to the lungs.
Rib fractures can also occur following repeated chest movements, or even prolonged bouts of severe coughing. Underlying medical conditions, such as osteoporosis, or a cancerous lesion in the ribs, can lead to a greater risk of rib fractures.
Symptoms of a rib fracture
Rib fractures can cause mild to severe pain in the affected area. This pain is often exacerbated by:
- Movements such as bending or twisting
- Deep breaths
- Pressure to the affected area
- Sneezing, coughing, or laughing
Besides pain, other symptoms of rib fractures include:
- A crunching or grinding sound during movement
- Muscle spasms in the chest
- Breathing difficulties
- The deformed appearance of the ribcage
When to see a doctor
You should see a doctor if you experience any of the above symptoms following trauma to the ribs. It is important to seek treatment even if the symptoms are mild. In addition, you may require emergency treatment if you are also experiencing any of the following symptoms:
- Abdominal pain
- A cough that produces blood or mucus
- Increasing difficulty with breathing
Rib fractures are often investigated with chest X-rays. Both displaced and nondisplaced fractures can usually be seen on X-rays. X-rays can also show other issues, such as pneumothorax. Unfortunately, rib fractures do not always show up on X-rays, especially in cases of hairline fractures. In such cases, other types of diagnostic imaging may be necessary.
Chest CT scans are a good option when rib fractures fail to appear on X-rays. They are more sensitive and can provide a clearer diagnosis compared to X-rays. In addition, CT scans can show if there has been damage to the soft tissue or organs, such as the lungs, liver, spleen, or kidneys. This is especially useful if there has been a delay in receiving treatment, or if it is likely that the trauma leading to the rib fracture could have caused other injuries as well.
3D reconstruction of a patient’s fractured ribs
3D Reconstruction can also be done in conjunction with CT scans. This is most useful in severe and complex rib fractures that require surgery, as 3D reconstruction can aid in visualisations for operative planning.
In most cases, rib fractures can be treated at home and will heal on their own over time. To manage the pain caused by rib fractures, you may be prescribed various painkillers, such as ibuprofen or naproxen. In cases of severe pain, stronger medications may be prescribed.
With rest, a rib fracture will often heal in about 6 weeks. During this time, you should cough or take deep breaths regularly to prevent pneumonia and pneumothorax.
Surgery is necessary to treat rib fractures if there are displaced fractures, more than 3 fractures, flail chest and other complications in the chest. In such cases, a patient may have to undergo rib fixation surgery, where metal plates and screws are used to stabilise the ribs to ensure proper breathing and healing. The recovery period for this procedure is 3 weeks with regular physiotherapy.
However, the effects of the procedure set in quickly, and you should feel better after about 3 days.
X-ray of the patient with metal plates
While rib fractures often heal on their own, it is important to seek medical treatment if you suspect that you are suffering from a broken rib. A doctor will be able to ensure that you are not suffering from any other injuries and prevent any serious complications from arising.
Since rib fractures are often the result of accidents, it can be difficult to prevent them from occurring. If you regularly participate in sports that may result in rib fractures, ensure that you are wearing protective equipment to minimise your chances of getting injured. You can also reduce your risk of household falls by keeping your home tidy and well-lit, as well as using skidproof mats. You may also consider increasing your intake of calcium and vitamin D to maintain healthy bone strength, which can decrease your likelihood of a rib fracture if you suffer from any accidents.