What happens when a rib is fractured
The ribs form a frame that moves with every breath, so the broken bone constantly moves and hurts. The fracture can be isolated, when one rib is damaged, or multiple. Particularly dangerous is a floating fracture, in which one rib is broken in two places and a section of the chest wall loses support: it collapses during inspiration and impairs the ventilation of the lungs. A sharp bone fragment can puncture the pleura and lung, and then air or blood enters the pleural cavity.
- Isolated fracture of one rib
- Multiple fractures of several ribs
- Floating (fenestrated) fracture
- Pathological fracture due to osteoporosis or metastases
- Fracture with displacement and damage to the pleura
Symptoms
The main symptom is a sharp local pain, which intensifies when inhaling, coughing, sneezing, turning the body and pressing on this place. A person instinctively breathes shallowly and holds his side with his hand. Sometimes a crunching sound is heard or felt. Swelling appears above the fracture site, and after a day or two a bruise appears. If the lung is affected, shortness of breath, a feeling of lack of air, and a cough streaked with blood occur.
- Point pain when inhaling and coughing
- Increased pain when pressing on the rib
- Shallow gentle breathing
- Swelling and bruising over the site of impact
- Crunching or feeling of displacement of fragments
- In case of complications - shortness of breath and hemoptysis
Diagnostics
The doctor examines the chest, palpates the ribs, listens to the lungs and measures the oxygen saturation of the blood. A chest x-ray is a basic study, but it does not show all fractures: thin cracks and damage to the cartilaginous part of the ribs are often not visible on the image. Much more accurate is computed tomography, which is prescribed for severe trauma, multiple fractures and suspected lung damage. Ultrasound of the pleural cavity quickly reveals the accumulation of blood or air.
- Examination and palpation of the chest
- Pulse oximetry
- Chest X-ray in two projections
- Chest CT scan for severe trauma
- Ultrasound of the pleural cavity
- General blood test
- Abdominal ultrasound for abdominal pain
Treatment
The broken rib is not fixed: the tight bandaging of the chest, which was previously used, restricts breathing and increases the risk of pneumonia, so it was abandoned. The mainstay of treatment is sufficient pain relief so that the person can take a deep breath and cough. The doctor selects medications, and if the pain is severe, he may perform an intercostal block. Breathing exercises several times a day are required. If air or blood accumulates in the pleural cavity, puncture or drainage is performed. Surgical fixation of ribs is rarely required, mainly for floating fractures.
- Adequate pain relief as prescribed by a doctor
- Avoiding tight chest bandaging
- Breathing exercises and coughing with a pillow at the chest
- Sleeping with the head of the bed raised
- Puncture or drainage of the pleural cavity in case of complications
- Surgical fixation for a floating fracture
- Physician supervision for multiple fractures
Recovery and complications
Pain usually decreases markedly after 2–3 weeks, and callus forms within 4–6 weeks; In older people and smokers, fusion occurs more slowly. In the first weeks you should not lift weights or engage in contact sports, but you should walk and move. The main complications are related to breathing: if a person does not clear his throat due to pain, congestion and pneumonia develop in the lungs. Less common are pneumothorax, hemothorax, and internal organ damage. If the pain increases instead of decreasing or a fever appears, you should consult a doctor again.
- Fusion in 4–6 weeks
- Limiting exercise for 4–6 weeks
- Pneumonia as the most common complication
- Pneumothorax and hemothorax
- Damage to the liver and spleen due to fracture of the lower ribs
- Chronic intercostal pain
- Quitting smoking speeds up healing