Rib Fracture

What is a rib fracture?

A rib fracture is a crack or break in a rib. Your ribs are the bones that connect from the front of your chest around to your spine (backbone). All of the bones of your ribs make your rib cage.

What causes a rib fracture?

Your rib fracture may be caused by any of the following:

• Trauma: A direct blow to the chest may cause a rib fracture. There is a higher chance that other organs may be injured with this type of rib fracture. Flail chest may occur if 3 or more of your ribs are broken in 2 or more places. This condition may make it hard for you to breathe. When you take a breath, your rib cage expands (gets larger). The broken ribs with flail chest do not expand and may push inward on your organs.
  
  
• Stress: Stress fractures happen when the muscles attached to your ribs are used often. These fractures are usually small and heal with rest but may worsen if you continue to use the muscles. Rib stress fractures are most common in people who play sports, such as baseball pitching, basketball, and rowing. A strong, long-term cough may also increase your risk of having a rib stress fracture. A stress fracture caused by coughing is most common in women.

What are the signs and symptoms of a rib fracture?

You may have one or more of the following:

• A lump that may be felt on your chest.
  
  
• Broken rib bone that has cut through your skin.
  
  
• Chest pain that worsens when you breathe.
  
  
• Chest tenderness (pain when touched).
  
  
• A change in the shape of your chest.
  
  
• Trouble breathing or trouble taking deep breaths.

How is a rib fracture diagnosed?

Your caregiver will ask about your injury and examine you. He will ask about your breathing and pain, and will look for any signs of bleeding or bruising. You may need one or more of the following:

• Chest x-ray: This is a picture of your chest. Chest x-rays may show broken ribs, or fluid around your heart and lungs. Caregivers may use the x-ray to look for signs of infection, such as pneumonia, or to look for a collapsed lung.
  
  
• Computed tomography scan: This is also called a CT scan. A CT scan is an x-ray that uses computers to take pictures of your ribs. Your caregiver may use this test to look for broken ribs and for injuries to your other organs. These may include your heart, lungs, spleen, and liver. You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregivers see the pictures better. People who are allergic to iodine or shellfish (crab, lobster, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
  
  
• Ultrasound: A chest ultrasound is a test to see the inside of your chest. Sound waves are used to show pictures of your chest on a TV-like screen.
  
  
• Bone scan: This is a test done to look at the bones in your body. The bone scan shows areas where your bone is diseased or damaged. You will get a radioactive liquid, called a tracer, through a vein in your arm. The tracer collects in your bones. Pictures will then be taken to look for problems. Examples of bone problems include fractures (breaks) and infection.

How is a rib fracture treated?

• Rest: Rest your ribs to decrease swelling and allow the injury to heal faster. This may take up to 6 weeks. Avoid activities that may cause more pain or damage to your ribs. As your pain decreases, begin movements slowly.
  
  
• Medicines:
  
  
  • Pain medicines: You may be given medicine to take away or decrease pain. Do not wait until the pain is severe before you take your medicine.
    
    
  • Ibuprofen or acetaminophen: These medicines are available without a doctor's order. They may help decrease your pain and fever.
    
    
  • Intercostal nerve block: This is pain medicine that will make you numb for about 6 hours. It is given as a shot between 2 of your ribs in the fracture area. You may need this if your pain continues, or is getting worse even after you take oral pain medicines.
  
  
• Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.
  
  
• Lung aids: Your caregiver may give you a spirometer. A spirometer is a small tube that will help you with deep breathing. He may do chest physiotherapy, which is light hand clapping on your back to help remove lung mucus.
  
  
• Surgery: If many of your ribs are badly fractured, you may need surgery. Surgery is often needed for a flail chest. Broken ribs may be held together with plates and screws. An injury to an organ, nerve, or blood vessel may also be treated with surgery.

What are the risks of a rib fracture?

• Your medicines may cause nausea, vomiting, or stomach ulcers (sores). You may be allergic to the medicines used to treat your condition. You may have rashes, low blood pressure, or trouble breathing. You may bleed or get an infection if you have surgery. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• Without treatment, you may get an infection in your lungs or blood. Air or blood may also collect inside your chest after a rib fracture, and cause increased trouble breathing. When this happens, you may need a drain put into your chest to remove the air or blood. Life-threatening injuries may also be present with a rib fracture. These may include injuries to your organs such as your heart, lungs, liver, and spleen. Ask your caregiver if you have any questions or concerns on your rib fracture or treatment.

When should I contact my caregiver?

Contact your caregiver if:

• You have a fever.
  
  
• You have bruising on your chest.
  
  
• You have questions or concerns about your treatment or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You cough up thick or bloody sputum (spit).
  
  
• You have nausea, vomiting, or abdominal (stomach) pain.
  
  
• Your rib bone has cut through the skin of your chest.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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