Rib Fracture : Second Opinion Medical | Get The Best Doctors Help for Rib Fracture - Online Hospital | Mediangels.com

GET THE SECOND OPINION FOR RIB FRACTURE

 
 

INTRODUCTION


Rib fracture is fracture or break in one of the bones composing the rib cage. Rib fractures are very common in blunt trauma to the chest. Rib fractures in themselves seldom pose threat to life of the patient. However rib fracture can be an excellent outside marker for serious and life threatening injuries sustained to the internal visceral organs in the chest. It is worth noting that vital organs like Heart and Lungs are present inside the rib cage.
 

PATHOPHYSIOLOGY


In normal breathing, as we inhale the air our ribs and lungs expand. The ribs move out while the diaphragm goes downwards.  Whenever there is injury to the ribs, the patient experience immense pain that is exaggerated while breathing. Therefore, in an attempt to reduce the pain, patient avoids taking deep breadths. The breathing in itself becomes more painful with time and coughing. The lung underlying the injury if does not expand then there are high chances of infection. Patient can have fever, cough, shortness of breaths and it can progress to pneumonia.
In the rib fracture, the fragments of the fractured rib can also act like penetrating objects and can cause hemothorax or pneumothorax. In addition, the sharp edges of the rib separated by fractures can also play the role in causing penetrating injuries to the lung.
Ribs along with clavicle, sternum and scapula together form a hard structure that protects vital internal organs. Ribs four to nine are more commonly injured. The first rib sustain trauma in Road Traffic Accidents due to violent contraction of the Scalene muscle (pair of three muscle in lateral part of the neck).
 

CAUSES AND MODES OF INJURY


Rib fracture can be sustained by many ways. The commonest one is trauma like road traffic accidents and fall from height. In certain medical conditions the bones becomes much weaker and hence more likely to break with slightest trauma. Such condition can be Osteoporosis. In such conditions, even violent coughing can lead to rib fracture. Other medical conditions like cancer can spread to the ribs and can cause its fracture. Athletic activities, recreational and other outdoor activities increases risk of trauma and hence increase risk of rib fracture. In pediatric cases, non accidental injuries causes rib fractures in many instances.
 

EPIDEMIOLOGY


Prevalence
Rib fracture is present almost everywhere. More the road traffic accidents more will be chest trauma and hence the rib fractures.
Race
No racial predilection. 
Age
More in elderly age. The bone structure of children is more elastic than adults. Therefore, they are less likely to have fracture rib. Adults are involved in the motor vehicle accidents putting them at risk. Rib fracture in child is therefore a sign of very high force injury to the chest. Medical conditions like osteoporosis and cancer which increases the risk of rib fracture are common in adults. 
Mortality / Morbidity
Rib fractures in themselves are not life threatening. However, they can cause very serious complications that can be fatal.
 

HISTORY OF PATIENT


The information given by the patient about how he sustained the injury can arouse suspicious of a possible rib fracture. For instance, deformed steering wheel after a road traffic accident can point towards a possible rib fracture.
 

DIFFERENTIAL DIAGNOSIS


Costochondritis: Condition that causes chest pain due to inflammation of the cartilage and bones in the chest wall.
Back Pain
Fracture clavicle, fracture sternum
Esophagitis: Inflammation, irritation, or swelling of the esophagus
Pulmonary embolism: It is a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg.
 

COMPLICATIONS OF DISEASE


  1. Injury to the lung causing Pneumothorax (collection of air in the space around the lungs) and hemothorax (collection of blood in the space between the chest wall and the lung).
  2. Injury to the blood vessels like Aorta
  3. Atelectasis (collapse of part or much less commonly of all of a lung)
  4. Pneumonia.
  5. Adult respiratory distress syndrome 
  6. Other serious infections.
 

INVESTIGATIONS


Blood investigations generally not useful for rib fracture. However, it can report the medical picture of the patient and hence decide upon its fitness in case operation is to be done.
In case of lower rib fractures sometimes hematuria is present and hence urine analysis is advised.
X-Ray of the chest is commonly taken out for rib fracture. Sometimes the X-Ray does not show the fracture and hence follow up X-Rays can help. X-Ray chest can also help to know the underlying injuries like lung collapse, pneumothorax, hemothorax etc.
If fracture of the sternum or scapular fracture is seen then there are high chances of the fracture of the rib.
Sometimes Sonography of the chest and even Computed Tomography (CT) Scan is advised by some treating doctors.
 

TREATMENT OPTIONS


Emergency Management
Medical Management
Surgical Care
 

Emergency Management


In case of trauma to the chest sustaining fracture of one or more of the ribs, the patient should be examined for airway patency and put on supplementary oxygen, if breathing is compromised. Antibiotics and painkillers are given intravenously.
 

Medical Management


Isolated rib fracture can be treated on outpatient care basis. Application of ice over the area can also help the patient till he gets to the hospital. NSAIDS (non steroidal anti-inflammatory drugs are given with antibiotics. Deep breathing is encouraged to prevent complications like pneumonia. Incomplete rib fracture can heal on its own. Rib fracture is not to be immobilized like fractures at other places like arm.  Pain of the rib fracture can continue for several weeks also. Spirometer is also advised in cases of rib fracture by many treating doctors.
 

Surgical Care


In case of trauma to the chest causing rib fracture and involving the internal organs, surgical care is required.
 

SIGNS AND SYMPTOMS OF RIB FRACTURE


Patient with rib fracture will present with pain the chest. The pain is exaggerated by breathing. Patient sometimes feels the crepitus of the fractured rib. Shallow breathing can be seen. Point tenderness on palpation and chest wall deformity are common findings. 
The signs of insufficient breathing can sometimes become evident like cyanosis, increased respiratory rate but shallow breathing, use of accessory muscle of respiration. Depending upon the injury causing the rib fracture, probable injury to the internal organs can be present. Fracture of lower rib should arouse the suspicion of intra-abdominal organ injuries.
 

SPECIAL CARE


Do not smoke when you have sustained a rib fracture. Do not tightly tape or wrap the rib cage area. This decreases the capacity to breathe deeply which in turn can lead to complications like Pneumonia. Avoid strenuous activity.
 

PROGNOSIS


Rib fracture in young individuals have excellent prognosis. 
Good medical care and treatment facilities including the ICU care has improved the prognosis greatly.
 

REFERENCES


  1. Medscape
    http://emedicine.medscape.com/article/825981-overview
  2. Fractures: an overview. AAOS - American Academy of Orthopaedic Surgeons.
    http://orthoinfo.aaos.org/topic.cfm?topic=A00139
  3. WebMD
    http://www.webmd.com/a-to-z-guides/fractured-rib-topic-overview?page=2

Related Investigations

Wellness Profile A:

Iron Profile, Liver Profile, Lipid Profile, Kidney Profile, Pancreatic hormones, Electrolytes

Seek Investigation

Wellness Profile B:

Iron Profile, Hemogram, Vitamin Profile, Hormones Liver Profile, Lipid Profile, Kidney Profile, Pancreatic hormones, Electrolytes

Seek Investigation
About MediAngels
Committee
  • MediAngels is a physician run Online Hospital.
    MediAngels In News
    Investors Speak
  • MediAngels has been invested in by multiple marquee investors... read more
    Doctors by Speciality
    Contact Us
    Subscribe to our newsletter and be updated with latest on MediAngels:
  • Angels Health Pvt Ltd
    114, Ackruti Star, Central Road, MIDC
    Andheri (East), Mumbai - 400093
    Maharashtra, India

    Copyright © 2015 Angels Health Pvt Ltd. All Rights Reserved.

    Copyright ©2015 Health Pvt Ltd. All Rights Reserved.