Rib Fractures

Rib fractures are commonly injured, in part due to their narrowness and the fact that it takes little pressure to crush the ribcage and to cause a crack in one or more ribs.

Anatomy of the Rib Cage

The main purpose of the rib cage is the protection of the heart and lungs, two vital organs that are completely held within the structure of the rib cage. It contains multiple bones that are connected along the length of the ribs by the intercostal muscles, which are muscles of breathing that work alongside the diaphragm. The rib cage moves in and out with each breath in order to allow the lungs to expand.

There are twelve ribs, each attached to its matching vertebra. The first seven of these ribs (seven on each side) are known as “true ribs” because they completely encircle the chest cavity, attached in the front to the sternum in front of the body. The next three ribs are called “false ribs” because they are shorter and are attached to each other by the costal cartilage. All three ribs are ultimately connected to the seventh rib. The final two ribs are called “floating ribs” because they are very short, do not come around to the front, and do not connect to anything except the vertebrae.

Rib Fractures

A rib fracture is a break in at least one of the bones that make up the rib cage. Generally, more than one rib is fractured at a time. The first rib is almost never fractured because it is hiding behind the clavicle (collarbone). Fractures of the ribs 2-7 are relatively common, especially on the sides of the body, although fractures can appear on the front and back as well. There are rarely fractures of the 11th and 12th rib due to their nature and lack of attachment to other body structures.

While the first rib is rarely fractured, it, along with the second rib, is associated with severe blood vessel and nerve injuries, especially if the rib fracture is displaced. First and second rib fractures are also more associated with facial fractures and head injuries than other rib fractures.

The middle ribs are most commonly fractured. They usually happen from blunt force trauma to the chest or from crush injuries to the chest, often associated with a fall or with a motor vehicle accident. The weakest spot in the rib cage is at the angle of the rib. The 7th through the 10th ribs sustain the most fractures of all the ribs.

A fracture in the lower ribs can potentially puncture or tear the diaphragm, which can result in a diaphragmatic hernia. Rib fractures can also puncture the lung or any of the abdominal contents. If a rib is fractured in two or more places, a flail chest can happen, which can affect the breathing and can be life threatening.

Symptoms of Rib Fractures

Most simple rib fractures are associated only with pain and tenderness at the site of the fracture or fractures. Fractures that are displaced can have more symptoms, depending on what part of the body has been injured by the fracture fragments.

In general, symptoms of a rib fracture include:

  • Pain near the affected rib fracture
  • Pain increased while coughing
  • Severe tenderness at the site of the fracture
  • Swelling in the affected area
  • Bruising in the affected area
  • Pain with breathing
  • Evidence of internal bleeding such as low blood pressure
  • Difficulty breathing if there is a collapsed lung
  • Nerve damage with numbness, pain or paralysis down the affected arm

Because rib fractures are mostly simple, many do not get diagnosed or treated at all and they eventually heal on their own.

Causes of Rib Fractures

Any time there is trauma to the chest, the ribs can be fractured. Common things that can cause rib fractures include:

  • Automobile accident. These are often crush injuries.
  • Any blunt trauma to the chest.
  • A fall from a height.
  • Any other crush injury to the chest.
  • An altercation.
  • Sporting injury.
  • Cardiopulmonary resuscitation (CPR)
Diagnosis of a Rib Fracture

Most rib fractures can easily be picked up using a plain film PA chest x-ray. The anterior and lateral aspect of the rib cage is better seen on plain film than the posterior rib cage. If the rib fracture is not seen on plain film but is still suspected, a bone scan can be done which will show up healing areas of bony tissue using a radioactive substance injected into the bloodstream.

A CT scan or MRI scan can also show rib fractures that are difficult to pick up on using plain film. The MRI exam has the added advantage of detecting the presence of any soft tissue injury associated with the fracture. Rarely are these necessary, however, because x-ray is adequate.

Treatment of Rib Fractures

Rib fractures can be simple and not dislocated or they can be dislocated and potentially dangerous. If you have internal injuries as a result of your fractured rib, you may need to be hospitalized and have your internal injuries treated by means of surgery or watchful waiting. In the hospital, you can be given strong pain medications to ease the plain.

It makes sense to use a stronger pain medication for rib fractures than might be given for other fractures. This is because you tend to splint the side of the body that is so painful with breathing. It causes you to underbreathe on the affected side and this can lead to pneumonia on the side of the body that the fracture is located. As the fracture heals and it becomes easier to breathe, you can begin to switch to nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen. Even Tylenol can be used as an effective pain reliever.

In the past, rib fractures were treated by taping or binding the chest for comfort but it has since been found that doing so prevented breathing as deeply as necessary. Pneumonia can be caused by this. No taping or wrapping is necessary to heal rib fractures. It takes about 6 weeks for rib fractures to heal.

The doctor will recommend you do the following things to heal your rib fracture:

  • Place ice over the affected area
  • Get more rest than you normally do.
  • Take pain medication as prescribed or recommended.
  • Take a deep breath or cough at least once an hour.
  • Lie on your injured side so that you can breathe more easily.
Complications of Rib Fractures

The most common complication of a fractured rib is underbreathing so that pneumonia builds up on the side of the fracture. This is why it is recommended that you breathe deeply or cough once an hour in the first few days after having the fracture.

Fractures of the first and second ribs can be displaced so that the nerve bundles and blood vessels can be damaged with permanent nerve damage or uncontrolled bleeding in the neck and upper chest area.

Fractures of the lower ribs can puncture the diaphragm and injure the spleen, liver, kidneys or bowels. Such complications need to be picked up fairly quickly as there can be a risk of internal bleeding or peritonitis.

Another common complication is that of a punctured lung with or without a collapsed lung. Displaced rib ends tear through the parenchyma of the lung. There can be increased shortness of breath associated with this type of rib fracture.

If you or a loved one has suffered a rib fracture as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916-921-6400 or toll-free at 800-404-5400 to set up a FREE consultation.

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