The chest cavity contains your heart and lungs, organs that could be easily injured if not protected. That protection is given by your rib cage, a powerful defensive shield. They absorb blunt trauma that could otherwise cause major damage. Rib fractures, however, may occur when subjected to enough force, resulting in pain and difficulty with breathing.
In the U.S., 350,000 rib fractures are diagnosed and treated every year, with about seven percent resulting in hospitalization and, sometimes, surgical intervention. Trauma that is severe enough to fracture a rib can cause damage to the heart, lungs, and blood vessels. Upper abdominal structures like the liver, diaphragm, kidneys, and spleen may also be involved, depending on the point of trauma.
RIB CAGE ANATOMY
The human body has 12 pairs of ribs. These are divided into “true ribs”, “false ribs”, and “floating ribs.” The true ribs (ribs 1-7) connect via flexible cartilage to the breastbone, also called the “sternum.” False ribs (8-10) connect to each other and the sternum at the cartilage of the 7th rib. The 11th and 12th ribs “float” in front, with no connection to the breastbone. All ribs, however, connect to the thoracic spine in back. Ribs also connect to each other by muscles (called “intercostal” muscles).
SIGNS AND SYMPTOMS OF RIB FRACTURES
If a rib is broken, it may or may not show an obvious deformity. You can suspect a rib fracture if you note the following:
- Pain at the site of injury.
- Increased pain with breathing or movement.
- Bruising of the chest or back over the ribs.
- Grating sensation or sound when fractured bone ends rub against each other (also known as “bone crepitus”).
- “Splinting,” (tensing of muscles in an effort to decrease pain).
In uncomplicated single fractures, there is often no change in the appearance of the chest wall. More serious or multiple fractures may present with:
- Rapid, shallow breathing.
- Rapid heart rate.
- “Hemoptysis” (coughing up blood) or blood in the urine.
- Irregular appearance at the site of injury (bump or indentation).
- Asymmetrical movement of the chest wall (sign of a condition called “Flail Chest”).
A flail chest occurs when several adjacent ribs are fractured. It can be identified by placing one hand on each side of the chest, and observing movement during breathing. The uninjured side will rise during inspiration, but the flail injury will fall. This occurs because the “loose” segments of rib cage are pulled into the chest cavity when inhaling, increasing the work of breathing. Flail chest injuries often cause “pulmonary contusions,” a bruising of the lungs that interferes with oxygenation. Often, the patient requires ventilator support. Off the grid, these victims often do poorly.
flail chest
Serious fractures may puncture the lung, causing it to collapse, or cause internal bleeding. Efforts by the victim to limit pain by avoiding deep breathing may result in pneumonia, poor oxygenation, and even partial collapse (also called “atelectasis”). Treatment of a punctured lung will be discussed in a future article.
TREATING A RIB FRACTURE
In normal times, any patient with a suspected rib fracture should be taken immediately to a modern medical facility. The major goal of treatment is pain control. By decreasing the victim’s pain during breathing, you will preserve normal ventilation and prevent lung complications. The most commonly used medications are non-steroidal anti-inflammatory agents like Ibuprofen or Naproxen, although they may be risky if there is internal bleeding.
If an injury occurs in the wilderness, the patient should be lain in a position of comfort. This could be on the uninjured side, on their back, or in sitting position. Ice packs, if available, will help relieve discomfort. Don’t forget to put a thin layer of cloth between the ice and the victim’s skin. Ice packs should be applied for 20 minutes several times a day the first 48 hours after the injury, and as needed afterwards. Limit activities that cause pain and allow the patient to rest, but not be bedridden.
Some recommend slinging the arm on the side of the injury (see video below). A pillow or soft pack made of spare clothes can be placed between the arm and chest for support. This is especially useful when the patient coughs. Coughing helps prevent pneumonia and keeps your lungs expanding as they should.
OTHER OPTIONS TO TREAT A BROKEN RIB
Rib belt for lower rib fractures
Previously, fractured ribs were treated with a binder called a “rib belt”. Although this method relieves some pain, most sources are concerned that it may cause more harm than good by preventing the ability to take deep breaths. Although wrapping the chest is no longer routinely done, some practitioners still suggest placing several strips of elastic tape or, if available, specialized kinesiology tape, parallel to each other over the area of the injury. If you must do this, only tape the injury side and observe for any restriction of breathing. Beware displacing a rib inward, as any binding may push it further into the chest cavity and cause further damage.
Prevent pneumonia or lung collapse due to “under-breathing” by encouraging slow deep breathing exercises and gentle coughing every 2 hours or so. Your patient will experience less pain during this process by holding a blanket or pillow against the site of injury. Be on the lookout for signs of pneumonia like fever and cough.
The healing process from an umcomplicated rib fracture usually takes about 6 weeks, but the patient may not be pain-free until much later.
Joe Alton MD
Joe Alton, MD
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