How do rib fractures happen, and how can they be treated?

location of heart in rib cageThe ribcage is a bony structure in the human chest that protects the heart and lungs. It consists of 24 curving bones in 12 pairs. Some are connected to the sternum (breastbone) by a flexible but tough type of tissue called costal cartilage; others are called “floating” ribs because they connect only to the spine.

There are many structures in the chest that can be damaged in a traumatic accident. Accident victims may feel pain from strained muscles, bruised soft tissue, or even internal organ damage. This can make it difficult to self-diagnose rib fractures after an accident. If you feel pain in your chest after an accident, see a doctor immediately.

How can rib fractures happen?

The ribs are tough bones, designed to protect some of the most vital organs in the human body. Given sufficient stress, however, even these bones can crack. Rib fractures happen most often following blunt trauma to the chest. In a car accident, this may happen when someone is slammed into a steering wheel, dashboard, or the back of a seat. In very severe accidents, the force of a body jerking against a seatbelt or a rapidly inflating airbag may be enough to cause a fracture.

Rib fractures can also occur when someone is thrown from a bicycle or motorcycle. Pedestrians are also vulnerable to rib fractures when they are struck by large, fast-moving vehicles.

In elderly adults, rib fractures are most likely to result from falls. In some cases, ribs can fracture due to repeated stress or underlying conditions like metastasizing cancer that weaken the rib bones.

Where are ribs most frequently fractured?

Ribs are most frequently fractured at the point of impact or at the posterolateral bend, where the rib is typically weakest. Ribs 4 through 9 are the most commonly fractured ribs.

In fractures caused by motor vehicle accidents, the first rib is known to be vulnerable to fractures at the groove for the subclavian artery. Doctors believe that these fractures are usually caused by the sudden contraction of the scalene muscles, which can happen when the head and neck are thrown forward by the force of a crash.

What are the potential complications of rib fractures?

In young and otherwise healthy patients, a single fractured rib is unlikely to be a life-threatening injury. Rib fractures can, however, cause a variety of complications.

The pain from a fractured rib may cause respiratory splinting, a condition in which a patient’s ability to breath in is impaired by severe pain. Respiratory splinting can lead to atelectasis (the partial or complete collapse of a lung) and pneumonia (an infection that causes the delicate air sacs inside the lung to become inflamed, making it difficult to breathe).

If a splinter of broken hone penetrates the lung, it may cause a hemothorax (a collection of blood between the lung and chest wall) or a pneumothorax (a collection of air between the lung and chest wall, often referred to as a collapsed lung).

If multiple contiguous ribs are fractured, a condition called flail chest can develop. Flail chest happens when the fracture prevents the muscles of the chest and diaphragm from operating normally, potentially causing serious breathing problems.

Rib fractures may also be paired with other trauma to the internal organs or other damage to bones or soft tissue. First rib fractures are particularly likely to be associated with severe damage to the spine or vascular system. Fractures of the first and second ribs can also be associated with damage to the brachial plexus of nerves, injuries to the thoracic artery, and head and facial damage. Lower rib fractures are most likely to be associated with damage to the spleen, liver, or diaphragm.

How are rib fractures treated?

While many fractured bones can be stabilized with a splint or cast, it is not possible to place a cast around a rib. While it was once common practice to wrap or tape the area of the injured rib, doctors now discourage this practice, since any treatment that prevents a patient from taking deep breaths can increase the risk of lung damage or infections.

Most fractured ribs will be treated with a combination of rest and pain management. In some cases, aspirin or ibuprofen, combined with rest and ice, may be enough to promote healing of a fracture rib. A doctor who is concerned about a patient’s lung function may also prescribe the use of an incentive spirometer, a medical device that helps keep the lungs active and clear throughout the process of recovery.

In very severe cases, a surgeon may stabilize the fracture with metal plates or the patient may be placed on a ventilator.

Sources:

http://www.healthline.com/human-body-maps/ribs

http://emj.bmj.com/content/19/6/490.full

http://emedicine.medscape.com/article/825981-overview

http://www.mayoclinic.org/diseases-conditions/atelectasis/basics/definition/con-20034847

http://www.webmd.com/lung/tc/pneumonia-topic-overview

https://www.nlm.nih.gov/medlineplus/ency/article/000126.htm

http://www.mayoclinic.org/diseases-conditions/pneumothorax/home/ovc-20179880

https://osmc.net/services-specialties/hw-view.php?DOCHWID=zt1003spec

http://my.clevelandclinic.org/health/treatments_and_procedures/hic_Your_Pre-Surgery_Visit_to_the_IMPACT_Center/hic-how-to-use-an-incentive-spirometer

http://www.aast.org/rib-fractures

Image source

Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762.