Rib fracture: Difference between revisions
| Line 52: | Line 52: | ||
===Admission=== | ===Admission=== | ||
*≥ 65 years of age | |||
*3-5 uncomplicated rib fractures | |||
*RR > 18/min despite adequate pain control | |||
*Incentive spirometry < 75% of predicted | |||
*Unable to control pain with oral medications | |||
*Consider for: | *Consider for: | ||
**Elderly patient with multiple rib fractures, hypotension, pulmonary contusion, hemothorax, pneumothorax, or age >85<ref>Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84.</ref> | **Elderly patient with multiple rib fractures, hypotension, pulmonary contusion, hemothorax, pneumothorax, or age >85<ref>Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84.</ref> | ||
| Line 57: | Line 63: | ||
**Significant associated injury | **Significant associated injury | ||
**Pre-existing pulmonary disease | **Pre-existing pulmonary disease | ||
===ICU=== | |||
*Severe rib fractures (e.g., > 5 ribs, multiple displaced fractures, flail chest) | |||
*Signs of significant respiratory compromise (e.g., SpO2 < 92%) | |||
*Risk of respiratory decompensation (e.g., older age, COPD, neuromuscular disease) | |||
*Discretion of clinician managing patient | |||
==See Also== | ==See Also== | ||
Latest revision as of 02:13, 30 October 2024
Background
- Most common injury in blunt chest trauma
- 9th, 10th, 11th rib fractures associated with intra-abdominal injury
- Elderly patients have double the mortality of younger patients
- <2 years old with >2 rib fractures → 50% mortality
- Ribs more flexible in children, so fractures require extreme force
- Consider non-accidental trauma
Clinical Features
- Chest wall pain
- May have chest wall crepitus or ecchymosis
- Pain on inspiration
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Ribs labled on CXR.
CXR with multiple old/healed fractured ribs of the person's left side (oval).
Right sided pneumothorax with multiple rib fractures.
Workup
Rib series typically not indicated
- CXR
- May only pick up 24% of fractures[1]
- CT chest
- Better sensitivity (63%) and specificity (97%)[2]
- Ultrasound
- Has been shown to detect rib fractures not seen on radiographs[3]
Diagnosis
- Typically made on imaging (see above)
- Consider flail chest, if multiple ribs are fractured in 2 or more places and paradoxical chest wall movement
Management
- Adequate analgesia
- Incentive spirometry
NOT Indicated
- Rib belts or other chest wall wrapping has no place in treatment and should be discouraged
Disposition
Discharge
- Consider for:
- Isolated rib fractures
- Young, otherwise healthy patient
- Good respiratory effort and cough (able to clear respiratory secretions)
- Pain controlled with PO medications
Admission
- ≥ 65 years of age
- 3-5 uncomplicated rib fractures
- RR > 18/min despite adequate pain control
- Incentive spirometry < 75% of predicted
- Unable to control pain with oral medications
- Consider for:
- Elderly patient with multiple rib fractures, hypotension, pulmonary contusion, hemothorax, pneumothorax, or age >85[4]
- Flail chest
- Significant associated injury
- Pre-existing pulmonary disease
ICU
- Severe rib fractures (e.g., > 5 ribs, multiple displaced fractures, flail chest)
- Signs of significant respiratory compromise (e.g., SpO2 < 92%)
- Risk of respiratory decompensation (e.g., older age, COPD, neuromuscular disease)
- Discretion of clinician managing patient
See Also
References
- ↑ Rainer TH, Griffith JF, Lam E, et al. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma 2004:56;1211–13.
- ↑ Schulze C, Hoppe H, Schweitzer W, et al. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int. 2013; 233(1-3):90-98.
- ↑ Turk F, Kurt AB, Saglam S. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 2010;17(6):473-477. doi:10.1007/s10140-010-0892-9
- ↑ Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84.