A rib fracture is a break in one or more ribs, usually from a fall, a car crash or a direct blow, and less often from severe coughing. The main danger is shallow breathing from pain, which leads to pneumonia, plus injury to the lung, spleen or liver.
Key symptoms
- Sharp chest wall pain that worsens with breathing, coughing or moving
- Shallow breathing to avoid pain
- Bruising over the chest
- Shortness of breath if the lung is injured
What you find on exam
- Point tenderness and crepitus over the rib
- Breath sounds and oxygen saturation
- Paradoxical chest movement (flail chest)
- Abdominal exam for spleen or liver injury with lower rib fractures
Tests
- Chest X-ray for pneumothorax, hemothorax and fractures
- CT chest in major trauma or several fractures
- Bedside ultrasound (eFAST) in trauma
- Pulse oximetry and, in severe cases, a blood gas
Treatment basics
- Scheduled acetaminophen and NSAIDs, opioids if needed
- Nerve block or epidural for several fractures or older patients
- Incentive spirometry and deep breathing to prevent pneumonia
- Chest tube for pneumothorax or hemothorax; rib fixation in selected flail chest
Red flags
- Worsening breathlessness or falling oxygen saturation
- Three or more fractures or flail chest, especially in an older adult
- Lower rib fracture with abdominal pain or low blood pressure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.