Rib fracture

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Traumatic rib fracture. There is subcutaneous emphysema, but no obvious pneumothorax.
Zoomed in view.

Fracture of the ribs, usually traumatic. Rib fractures from coughing are described.[1] Iatrogenic causes may include sternal retraction at sternotomy.[2]

Up to 50% may be missed on a standard CXR with one series of 50 showing a pick-up of only 12%.[3], but a standard CXR should be performed to detect complications such as pneumothorax, haemothorax or lung contusions.

In the past, some centres performed "rib series" to look more closely for fractures, but this is largely deprecated as this does not change management; uncomplicated rib fractures are managed conservatively.[4][5]

Flail chest is usually apparent clinically.

Treatment

Symptomatic. Regular analgesia.

Consider thoracic epidural or intercostal nerve blocks if regular maximal oral analgesia is not effective.

Respiratory failure from atelectasis or superimposed pneumonia may require ventilatory support.

References

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