Rib Fracture

RIB FRACTURE – Definition, Etiology, Signs and Symptoms and Treatment

Fractures of the first and second ribs may be more likely to be associated with head and facial injuries than other rib fractures. The middle ribs are the ones most commonly fractured. Fractured usually occur from direct blows or from indirect crushing injuries. The weakest part of a rib is just anterior to its angle, but a fracture can occur anywhere.

The most commonly fractured ribs are the 7^th and 10^th. A lower rib fracture has the complication of potentially injuring the diaphragm, which could result in a diaphragmatic hernia. Rib fractures are usually quite painful because the ribs have to move to allow for breathing. Even a small crack can inflame a tendon and cripple an arm. When several ribs are broken in several places, a flail chest results, and the detached bone sections will move separately from the rest of the chest.

DEFINITION

A rib fracture is a breaking or fracture in one or more of the bones making up the rib cage. The first rib is rarely fractured because of its protected position behind the clavicle. If it is broken, serious damage can occur to the brachial plexus of nerves and the subclavian vessels.

ETIOLOGY

• Rib fractures can occur without direct trauma and have been reported after sustained coughing
• Various sports, for example, rowing and golf, often in elite athletes. They can also occur as a consequence of diseases such as cancer or infections
• Fragility fractures of ribs can occur due to diseased bone structure, e.g., osteoporosis and metastatic deposits.

SIGNS AND SYMPTOMS

• Pain when breathing or with movement
• A portion of the chest wall moving separately from the rest of the chest (flail chest)
• A grating sound with breathing or movement
• Where the mechanism of injury would indicate substantial force to the ribs

TREATMENT

There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression. This can contribute to formation of secondary chest infection.

• Adequate analgesia can avoid pain
• It is a potentially life-threatening injury and will often require a period of assisted ventilation
• Acute innovations RibLoc is a titanium U-shaped plate that is sized to match rib thickness and uses screws that fixate to anterior and posterior of plate and provide fixation without needing purchase for screws and without risking damage to the neurovascular bundle. These plates can be contoured to match the rib segment being plated and come in various lengths.
• Judet and/or Sanchez Plates/Struts are metal plates with strips that bend around the rib and then are further secured with sutures
• Synthes MATRIX RIB Fixation System has two options. A precontoured metal plate that uses screws to secure the plate to the rib and an intramedullary splint which is tunneled into the rib and secured with a set screw.
• Anterior locking plates are metal plates that have holes for screws throughout the plate. The plate is positioned over the rib and screwed into the bone at the desired position. The plates may be bent to match the contour of the rib section.