Materiały źródłowe

• #1 Rib Fracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK541020/

  Rib fractures can occur from either direct penetrating or blunt trauma. […] The most feared complication of rib fractures is the flail chest where three or more rib fractures at two points on the involved ribs, creating a floating rib segment and causes this segment to move paradoxically with the rest of the chest wall. […] Rib fractures can be traumatic or atraumatic. […] Most rib fractures are due to direct penetrating or blunt trauma to the chest. […] Rib fractures may also be pathologic as a result of cancer metastasis from other organs. […] Through repetitive stress and microtrauma, athletes can develop rib fractures with chronic use. […] Spontaneous rib fractures can also occur due to severe cough and are more likely to occur in those with osteoporosis or underlying lung disease. […] The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. […] The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.

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  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #1 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Rib fractures are common injuries that occur most often following blunt thoracic trauma but can also result from severe coughing, athletic activities (eg, rowing, swinging golf clubs, throwing, which can cause rib stress fractures), and nonaccidental trauma (ie, child abuse). Concomitant injuries and complications range from mild discomfort to life-threatening conditions such as pneumothorax, splenic laceration, and pneumonia. […] Most rib fractures are caused by direct trauma to the chest wall. This can occur from blunt (eg, motor vehicle collision) or penetrating (eg, gunshot) trauma. A single blow may cause rib fractures in multiple places. Traumatic fractures most often occur at the site of impact or the posterolateral bend, where the rib is weakest. […] Cancers that metastasize to bone (eg, prostate, breast, kidney) frequently become apparent in a rib and cause pathologic fractures. Ribs are relatively thin compared with major long bones and are more likely to fracture when invaded by a metastatic lesion.

• #1 Rib Fractures – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/chest-injuries/rib-fractures

  Rib fractures usually result from strong blunt force, such as a fall from a height, a motor vehicle crash, or a hit with a baseball bat. However, sometimes in older adults who have osteoporosis, only a slight force (as occurs in a minor fall) is required. […] The fracture itself is rarely serious, although the force that caused the fracture occasionally causes other problems, such as a bruised lung (pulmonary contusion) or a collapsed lung (pneumothorax). An injury that fractures the lower ribs sometimes also damages the liver or spleen. The more ribs that are broken, the more likely lungs or other organs are to be damaged. […] In flail chest, a segment of the chest wall separates from the rest and moves in the opposite direction from the rest of the chest wall when a person breathes. Breathing becomes more difficult and tiring. Usually, a blow strong enough to cause flail chest also bruises the lung beneath the injured area (called pulmonary contusion).

• #1 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Ribs can sustain stress fractures from repetitive minor trauma. Stress fractures may be seen in patients with a chronic cough and in athletes, particularly rowers, golfers, throwers, and others. The first rib is susceptible to stress fractures in throwing athletes due to the unique forces exerted during the throwing motion. […] In the absence of significant trauma (eg, motor vehicle collision), rib fractures in infants are extremely uncommon. Possible nonaccidental trauma (ie, child abuse) must be investigated when such fractures are discovered. […] Multiple rib fractures (≥3) or fractures in the upper or lower rib cage are associated with internal injuries such as liver or spleen lacerations, mediastinal injury, pneumothorax, hemothorax, flail chest, and pulmonary contusions. These fractures are sustained by patients as a result of more serious trauma.

• #1 Rib fractures – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000236

  Rib fractures may be due to blunt force injury, falls, non-accidental injury, CPR, or more rarely, sporting activities, or metastatic lesions and primary bone tumours. […] Rib fractures are common injuries that most frequently are due to blunt force trauma (including falls and non-accidental injury), but can also occur as a result of aggressive cardiopulmonary resuscitation, athletic activities, or primary bone tumours and metastatic lesions (’pathological fractures’). […] An increased number of fractured ribs correlates with increased morbidity and mortality.

• #1 Rib Fracture: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/825981-overview

  The mechanism of first-rib injury in motor vehicle accidents seems to be a violent contraction of the scalene muscles brought on by the sudden forward movement of the head and neck. […] A single blow may cause rib fractures in multiple places. Traumatic fractures most often occur at the site of impact or the posterolateral bend, where the rib is weakest. […] Due to the greater pliability of children’s ribs, greater force is required to produce a fracture.

• #1 Care options for patients with rib fracture – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/trauma/news/care-options-for-patients-with-rib-fracture/mac-20578996

  Rib fractures are commonly seen in trauma care, either as standalone injuries or as part of polytrauma, says Brian D. Kim, M.D., a trauma surgeon at Mayo Clinic in Minnesota. […] The mechanism of injury in rib fracture varies by U.S. region, yet motor vehicle crashes and falls from ground level or height are common causes nationwide, says Dr. Kim. […] Individuals with osteopenia or osteoporosis have an increased risk of fracturing ribs, which he indicates is expected. […] Dr. Kim notes that at times, patients and healthcare professionals attempt to differentiate between a broken or cracked rib, which he believes can lead to confusion. […] For clarity, he prefers to simply refer to this injury as a rib fracture. […] Dr. Kim also mentions that a rib injury may involve displacement.

• #1

  https://journals.lww.com/aotm/fulltext/2007/02040/isolated_rib_fractures_in_geriatric_patients.6.aspx

  Elderly patients sustaining blunt chest trauma had significant morbidity and potential for mortality. […] Rib fractures occur more commonly with increasing age, which usually associated with decreased bone density. […] Increased morbidity and mortality in elderly patients with traumatic rib fractures are attributed to several factors such as anatomical difference between young and elderly people (osteoporosis, decreased muscle mass and thinned vertebral bodies), as well as decreased physiological reserve (low cardiopulmonary status and lower immunity), and more likelihood of presence of associated comorbidities. […] Increased number of rib fractures was found to correlate with the morbidity in our patients. […] Increase in the number of rib fractures correlated directly with increasing pulmonary morbidity and mortality.

• #1 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?id=3765

  Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. […] The mechanism of CIRF can be explained in several ways. First of all, CIRF is accepted as a specific and less common type of stress fracture; thus, repetitive mechanical stress on the ribs with adaptive bone remodeling and muscle fatigue is thought to play a role in the development of the CIRF. […] Repeated trauma due to repetitive cough may cause inelastic deformation of the middle third of the ribs between the fifth and 10th ribs, which is the most vulnerable part of the rib, as well as of the costochondral junctions. […] The second mechanism is thought to be linked with contrary muscle forces acting on the ribs. […] Several risk factors for the development of CIRF have been reported. Osteoporosis, COPD, prolonged use of high dose steroids, and asthma are among them.

• #1 Rib Fracture: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/825981-overview

  The chest wall protects underlying sensitive structures by surrounding internal organs with hard osseous structures, including the ribs, clavicles, sternum, and scapulae. An intact chest wall is necessary for normal respiration. […] Rib fractures may compromise ventilation by a variety of mechanisms. Pain from rib fractures can cause respiratory splinting, resulting in atelectasis and pneumonia. Multiple contiguous rib fractures (ie, flail chest) interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiency. Fragments of fractured ribs can also act as penetrating objects leading to the formation of a hemothorax or a pneumothorax. Ribs commonly fracture at the point of impact or at the posterior angle (structurally their weakest area). Ribs 4 through 9 are the ones most commonly injured.

• #1 Rib fractures | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/rib-fractures?lang=us

  Rib fractures are a common consequence of trauma and can cause life-threatening complications. […] The 4th-10th ribs are the most commonly fractured. Fractures of the 1st-3rd ribs are associated with high-energy trauma. […] When the rib is fractured twice, the term floating rib is used to describe the free fracture fragment, and when three or more contiguous floating ribs are present this is called a flail chest. […] Buckle rib fractures can also occur, one of the rare instances of buckle fractures in a mature skeleton. […] Blunt and penetrating trauma: e.g. motor vehicle accidents, falls, assaults are the most common injury in blunt thoracic trauma, occurring in 50% of cases. […] Decreased bone density increases risk of rib fractures. […] Aside from immediate traumatic complications outlined above, atelectasis and pneumonia may develop, mainly due to poor respiratory effort secondary to pain, and this increases the morbidity and mortality due to rib fractures.

• #1 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures/print

  The first rib is unique in that the scaleni insert onto it, and it therefore is exposed to stresses from the action of these neck muscles. The superior ribs (numbers 1 to 3) are protected by the scapula, clavicle, and soft tissue, while the inferior „floating” ribs are relatively mobile. Therefore, the more vulnerable middle ribs (numbers 4 to 10) are most susceptible to injury from blunt trauma. Fractures of superior ribs reflect trauma involving significant force and the potential for injury to major vessels and lung parenchyma. […] Both displaced and nondisplaced fractures can be seen in adults and children. Due to the greater pliability of children’s ribs, greater force is required to produce a fracture.

• #1

  https://www.aast.org/resources-detail/rib-fractures

  The most common mechanism causing rib fractures is blunt trauma (i.e. automobile accidents, falls from height, assault, or even severe coughing). Blunt trauma causes rib fractures by exerting direct pressure on the rib causing it to break. Approximately 10% of all patients admitted for blunt chest trauma have one or more rib fractures. Although the injury mechanism itself is an important consideration when discussing rib fractures; patient specific considerations are also important. Patients with advanced age, osteoporosis or osteopenia have an increased risk of number and severity of fractures. […] Rib fractures are typically diagnosed on chest x-ray and the severity of the fracture is easily seen. Simple (non-displaced) fractures appear as cracks in the rib or a jagged edge. Displaced fractures appear to lack contour along the edge of the rib on x-ray. Floating segments of ribs, known as a flail chest, can also be easily seen on x-ray. Other imaging modalities such as CT scans also diagnose rib fractures and are more sensitive to identify them. CT scans are useful to determine if underlying lung injury is present, known as a contusion, or to identify if air has escaped the lung as a pneumothorax.

• #1 Bruised rib care: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000967.htm

  A rib contusion, also called a bruised rib, can occur after a fall or blow to your chest area. A bruise occurs when small blood vessels break and leak their contents into the soft tissue beneath the skin. This causes the skin to become discolored. […] Common causes of bruised ribs are car accidents, sports injuries, or falls. Severe or prolonged coughing can also cause bruised ribs. […] A rib bruise due to a blunt force may cause bleeding and injury to the tissues under the skin. […] Depending on the force of the blow, you may have other injuries, such as broken ribs or damage to the lungs, liver, spleen or kidney. This is more likely in car accidents or falls from a great height. […] Bruised ribs recover in the same manner as fractured ribs, but a bruise takes less time to recover than a rib fracture. […] An x-ray, MRI, or CT scan is rarely needed to confirm the diagnosis. Imaging studies may be needed to check for more serious injuries, such as a rib fracture or damage to internal organs.

• #1 Bruised vs. Broken Ribs: What’s the Difference?

  https://www.verywellhealth.com/bruised-broken-or-fractured-ribs-4582241

  Broken and bruised ribs are different injuries. With a broken rib, the bone has been fractured either particularly or completely. A „bruised” rib means the supportive muscles and tissues around your ribcage have been injured. […] Most rib injuries happen when there is blunt force trauma to the chest wall, such as from a car accident or a fall. […] A bruised rib occurs when there is an injury to the chest wall but the bones of the ribcage are not actually injured. The pain of a bruised rib comes from the strain or damage to: Muscles of the chest (including the intercostal muscles that aid with breathing), Cartilage (which connects your ribs to your sternum), Tendons (which connect muscle to bone), Ligaments (which connect two bones or cartilage), Fascia (a membrane that holds every organ, bone, and muscle in place).

• #1 Buckle rib fracture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/buckle-rib-fracture?lang=us

  Buckle rib fractures are incomplete fractures involving only the inner cortex. They typically occur due to an anterior compressive force to the chest, most commonly during external cardiac massage, but can be seen following any such traumatic injury. […] Buckle fractures are usually seen in the middle ribs (anterior one-third) and in a line. The anterior force responsible for the rib injury may also cause a similar sternal fracture. […] Buckle is an engineering term describing cortical disruption to the compressive (inner) side of a structure (i.e. the rib) and maintenance of the tensile (outer) side cortex.

• #1 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  Fractures of the first rib are rare. The significance of a first rib fracture is the association with cervical spine trauma, multiple rib fractures, or life-threatening vascular injuries. […] Fractures of the first rib imply a violent force; this pattern of fractures may signify injury to the adjacent subclavian vein and brachial plexus. Isolated first rib fractures are seen in association with cranial and maxillofacial injuries and are probably secondary to avulsion of the first rib by its muscular attachment rather than direct trauma to the rib, which is relatively protected. […] Fractures of the fifth to ninth ribs can be single or multiple. Multiple fractures can present as flail chest, which is present when paradoxical respiratory movement occurs in a segment of the chest wall. […] An inward displacement of the rib fracture fragments at the time of the injury may lacerate the lung parenchyma and produce a pneumothorax, with a possible hemothorax.

• #1 Rib fracture characteristics increasing the risk of hemothorax: a multicenter study | Scientific Reports

  https://www.nature.com/articles/s41598-024-79548-z

  Our study clearly demonstrated a concrete relationship, showing that the presence of at least one displaced rib fracture increased the risk of hemothorax by a factor of 2.7. […] Our study aligns with the existing literature in demonstrating that anterior rib fractures have the lowest risk of hemothorax when considering the clinical reflection of anatomical features. […] The occurrence of hemothorax has been linked to the nature and intensity of trauma in numerous studies documented in the literature. […] Our study suggests that the risk of hemothorax is influenced by the local characteristics of the rib fracture, regardless of the severity of trauma. […] Our study concluded that there is a significant increase in the risk of hemothorax associated with more rib fractures and specifically more posterior rib fractures. […] We discovered that the displacement of even a single rib fracture significantly increased the risk of hemothorax.

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  https://www.aast.org/resources-detail/rib-fractures

  The most common symptom of rib fractures is pain. Pain is typically elicited with breathing or coughing. If the fractures are complex, the patient may suffer from additional damage to underlying structures. The sharp fractured end of the rib can puncture the lung, causing air leakage, a condition called a pneumothorax, which is potentially life threatening. In addition to pain, shortness of breath and decreased oxygen content in the blood can result from these injuries. A flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can result in a clinical entity called acute lung injury. In its most severe form, acute lung injury can lead to a life threatening entity called adult respiratory distress syndrome (ARDS). Respiratory failure is usually caused by the underlying pulmonary contusion but not by the anatomic flail chest itself. In addition, the flail segment moves in the opposite direction as the rest of the chest wall because of the ambient pressure in comparison to the pressure inside the lungs. This so-called „paradoxical motion” can increase the work and pain involved with breathing.

• #1 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  Rib fractures are associated with pulmonary contusions in 20-40% of cases. The injury is characterized by capillary disruption that results in the presence of intra-alveolar and interstitial hemorrhage, edema, protein, and fluid obstruction of the small airways with leukocyte infiltration. […] The idea that thoracic cage injuries are predictive of acute traumatic aortic tears is controversial. […] A flail chest is present when a paradoxical respiratory movement occurs in a segment of the chest wall, the result of at least 2 segmental fractures in each of 3 adjacent ribs or costal cartilages. […] The number of rib fractures correlates with mortality in adult trauma patients, rising sharply in patients with more than 6 fractured ribs. […] The association of lower rib fractures with pelvic fractures has been associated with a higher incidence of solid organ injury.

• #1 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  A spontaneous fracture of a midthoracic rib should alert the clinician for an underlying metastasis, multiple myeloma, or hyperparathyroidism. […] Hemorrhage around and within the adrenal glands represents a risk that is associated with fractures of the lower ribs. Fractures of the lower ribs are also commonly associated with visceral injury to the kidneys and the spleen. […] A pneumothorax is a common sequela of blunt trauma. Fracture fragments that lacerate the lung parenchyma can cause bleeding into the pleural cavity and result in a pneumothorax. […] The incidence of a pneumothorax is not as high with one rib fracture, but the risk increases as the number of broken ribs increases. […] The incidence of hemopneumothoraces in patients with rib fractures is 30%. A hemothorax is usually the result of a lacerated intercostal artery; however, bleeding from broken ribs usually stops before a sufficient volume is lost and before emergency thoracotomy is required.

• #1 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  A broken rib occurs when one of the bones in the rib cage breaks or cracks. […] A broken rib can harm blood vessels and internal organs. Having more than one broken rib increases the risk. […] Complications depend on which ribs break. Possible complications include: […] A sharp end from a break in one of the first three ribs at the top of the rib cage could pierce a major blood vessel, including the aorta. […] The jagged end of a broken middle rib can punch a hole in a lung and cause it to cave in. […] The ends of a broken lower rib can cause serious harm to the spleen, liver or a kidney.

• #1 Rib Injury | Rib Injury Clinic

  https://www.ribinjuryclinic.com/conditions/rib-injury/

  Even relatively minor chest injuries can lead to internal injury to the lung (lung bruising (contusions), collapse (pneumothorax), effusions (blood or fluid) and rarely hernias (whether the lung or upper abdominal contents starts providing between broken ribs) or even a diaphragmatic (the muscle between the abdomen and the chest) hernia whereby the bowel contents slip into the chest from a hole or hernia in the diaphragm.

• #1

  https://www.orthobullets.com/knee-and-sports/12108/rib-stress-fracture

  A rib stress fracture in an uncommon site of stress fracture that typically occurs due to repetitive contraction of the chest wall muscles. […] Pathophysiology […] stress placed on a rib during repetitive contraction of an attached muscle. […] accentuated during training because muscles strengthen more rapidly than bone. […] muscle fatigue during prolonged activity places a bone at risk for fracture by lessening the ability of a muscle to absorb and dissipate opposing forces. […] anatomic sites of weakness […] first rib stress fx […] groove for subclavian artery is site of weakness due to superiorly directed forces from the scalene muscles and inferiorly directed forces from the serratus anterior and intercostal muscles.

• #1 Rib fracture – When you should be worried about a broken rib

  https://physiopretoria.co.za/pain/front/rib-fracture

  If the bone integrity is compromised by a disease, like osteoporosis or dysplasia, it can cause multiple rib fractures. Less force is required to break the rib, as the structure of the bone is frail. […] Rib fractures normally heal in 6 weeks, but due to the constant movement of the rib cage during breathing, its difficult to prevent movement at the fracture site, this delays healing and may take up to 6 months to recover. […] Rib fractures vary in intensity and the time it takes to heal. A single cracked rib from coughing takes less time to heal compared to multiple rib fractures, or even when a lung or spleen is punctured. […] A flail chest is when three or more neighbouring ribs are fractured in two or more places, resulting in instability. Essentially there are free-floating segments that are not anchored to the rest of the chest wall. […] A pneumothorax results from the lung tissue being penetrated, blood and air filling up the plural cavity between the lung and the inside wall of your chest, limiting the lung to expand.

• #1 Broken or bruised ribs

  https://www.nhs.uk/conditions/broken-or-bruised-ribs/

  Bruised or broken ribs can be very painful, but usually heal by themselves. […] Broken or bruised ribs are usually caused by a fall, a blow to the chest or severe coughing. […] Ribs cannot be easily splinted or supported like other bones, so they’re usually left to heal naturally. […] Broken or bruised ribs usually get better by themselves within 2 to 6 weeks. […] You might need stronger painkillers or have a chest infection that needs antibiotics. […] It could mean a broken rib has damaged something else, like your lung, liver or spleen.

• #1 Care options for patients with rib fracture – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/trauma/news/care-options-for-patients-with-rib-fracture/mac-20578996

  While Dr. Kim explains he has treated patients with organ damage such as to the diaphragm or spleen caused by a floating piece of a fractured rib, he calls this scenario uncommon. More commonly, displaced rib fractures may also be associated with intercostal damage, either muscular, vascular or both. […] The typical healing time of a nondisplaced rib fracture in an otherwise healthy individual ranges from 6 to 12 weeks. […] Most fractured ribs heal without surgical intervention. […] Dr. Kim indicates that a multimodal pain management regimen and commonsense activity reduction can assist with pain relief. […] A patient with a rib fracture not only experiences pain but also is at risk of pneumonia, as poorly controlled pain can affect respiratory mechanics, says Dr. Kim. […] He notes that avoiding deep breaths then leads to poor secretion clearance and low tidal volume breathing.

• #1 Broken or Bruised Ribs: Symptoms, Diagnosis, Treatment

  https://patient.info/bones-joints-muscles/rib-injuries

  Broken or bruised ribs occur when there is a force to the chest such as from a fall, road accident or assault. […] Complications can occur if internal organs are damaged by the sharp end of a broken rib. […] Rib injuries include bruising a rib or the muscles surrounding or between the ribs. They also include rib fractures- a break in one or more of the rib bones. […] Broken (fractured) or bruised ribs often heal in about six weeks. However, the recovery time may be longer, especially for displaced fractures (when the broken ends of the rib no longer line up with one another). […] Rib fractures or bruising often make it difficult to breathe deeply or cough properly due to pain. This can make it difficult to clear mucus in the chest, leading to chest infections. […] Complications can occur if internal organs are damaged by the sharp end of a broken rib.

• #1 Help broken ribs heal faster – how to know if you’re healing normally | Nebraska Medicine Omaha, NE

  https://www.nebraskamed.com/trauma/help-broken-ribs-heal-faster

  Rib fractures take a little longer to heal than other bones because they are continuously moving. A rib fracture can take up to 12 weeks to heal. „The natural progression for healing is for small improvements in pain and breathing over time. For patients with rib fractures without fixation (surgical stabilization of rib fractures), roughly 60% are not back to full work capacity at six months, and 70% are still having some degree of pain one year from the injury,” says Zachary Bauman, DO, Nebraska Medicine trauma medical director. […] Yes, there are surgical interventions for rib fractures. These may depend on your situation and if the injury is in conjunction with other issues like nerve or muscle damage. A doctor will often take a look inside the chest cavity to ensure the lung is not trapped in the fracture as that can cause ongoing pain.

• #1 Rib Fractures – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/chest-injuries/rib-fractures

  Because of the pain, people may breathe less deeply, increasing the risk of complications, such as collapse of parts of the lung (atelectasis) and pneumonia. […] People with flail chest often need to have their breathing supported with a ventilator until the injuries heal. Some people with flail chest may need surgery to stabilize the ribs and reduce the risk of complications, including pneumonia, lengthy hospital stays, and death.

• #1 Broken or Bruised Ribs: Symptoms, Diagnosis, Treatment

  https://patient.info/bones-joints-muscles/rib-injuries

  Pneumothorax occurs if the membrane around the lung is damaged. […] A sharp fractured rib can let air from the lung get in underneath the skin. […] This is similar to a pneumothorax except that there is blood, not air, trapped around the lung. […] Rib fractures can cause internal damage to these organs. […] Rib injuries can occasionally be caused by coughing or straining.

• #1 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Intrathoracic injury, such as pneumothorax or pulmonary contusion, can occur in association with rib fractures at any level. The risk of intra-abdominal or intrathoracic injury increases if two or more rib fractures are present at the same level. […] First rib fractures are associated with greater overall injury severity and life-threatening internal injury (including injuries to the brain, spine, lungs, and pelvis), while isolated first rib fractures from playing sports do not carry the same risk. […] Displaced rib fractures increase the risk of injury to the lung and proximate intercostal blood vessels (common cause of hemothorax). A delayed hemothorax can occur days to weeks after the rib fracture, and can occur without a hemothorax initially or may start as a trace hemothorax that gradually progresses.

• #1 Broken ribs | They are normally painful | We treat kid’s Broken Ribs

  https://medicalcitykidsortho.com/broken-ribs/

  Chest trauma, such as from a heavy fall, a car accident, or contact sports, is the most prevalent cause. As a result, when a child breaks a rib it is quite painful. […] The most common causes of broken ribs are direct strikes, such as those from automobile accidents, falls, child abuse, or contact sports. Ribs can fracture as a result of repetitive damage from activities like golf and rowing, as well as strong and persistent coughing. […] There are potential complications from broken ribs, torn blood vessels, punctured lungs, and lacerated organs. […] Non-union occurs when a fractured rib fails to heal completely without medical intervention, such as surgery. […] Delayed union refers to a fracture that takes longer than the usual timeframe to heal, typically not achieving full bone union within six months. […] Mal-union is characterized by a fracture that heals but in a misaligned position. […] By recognizing these differences, medical professionals can develop an effective treatment plan tailored to address the specific healing challenge presented by each condition.

• #1 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  A common dogma among doctors is that pain after rib fractures that have been treated just with pain relief lasts up to six weeks. Unfortunately, this isn’t really the case. […] There are recent studies describing persistent pain and disability, with up to 76% of patients with uncomplicated rib fractures reporting pain at two months after the injury, and up to 56% of them still complaining of pain six months after the injury. […] Approximately 13% of patients report that their quality of life is being affected by chronic pain one year after simple rib fractures. […] Additionally, in another study, 30% of patients with rib fractures that had been managed conservatively with standard pain relief were not able to return to pre-injury employment even two years after their injury. […] This significant long-term pain and disability has a huge socio-economic impact and is putting increasing pressure on doctors to find and try alternative treatments for uncomplicated rib fracture injuries.

• #1 Rib Fractures: Pain Management – OpenAnesthesia

  https://www.openanesthesia.org/keywords/rib-fractures-pain-management/

  In patients with pulmonary contusions and potential hemorrhage, gas exchange is typically impaired due to the subsequent edema and reduced lung compliance. This leads to worsening hypoxemia, hypercarbia, and increased respiratory effort. […] In patients with a flail chest, breathing mechanics may be altered. Displaced fractures may also damage surrounding lung structures leading to tears in the pleura and damage to intercostal vessels, possibly leading to pneumothorax and hemothorax. […] Risk factors for developing complications following rib fractures include elderly patients older than 65 years, frailty or significant comorbidities, smokers and pre-existing chronic respiratory disease, prior use of anticoagulation, flail chest, pulmonary contusion, pneumothorax, or hemothorax, associated major trauma, and clinical signs of lower respiratory infection.

• #1 Rib fracture – WikEM

  https://wikem.org/wiki/Rib_fracture

  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 […] Ribs more flexible in children, so fractures require extreme force.

• #1

  https://journals.lww.com/aotm/fulltext/2007/02040/isolated_rib_fractures_in_geriatric_patients.6.aspx

  In the current study, chronic lung disease was found correlated with mortality; this explains the causes of mortality in this study, viz, respiratory failure and pulmonary infection. […] Pneumonia was found to be an independent predictor of death in old patients with fractured ribs. […] Among the preadmission comorbidities, only diabetes was found to be associated with increased morbidity.

• #1 Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank | Trauma Surgery & Acute Care Open

  https://tsaco.bmj.com/content/5/1/e000441

  Patients with flail chest tend to have significantly worse outcomes than those diagnosed with multiple rib fractures. […] The stability of the chest wall appears to be an important prognostic factor for mortality, and flail chest is often associated with high impact trauma. […] Therefore, patients with flail chest should be considered as an independent entity and surgical treatment might play a pivotal role in improving outcome for these patients.

• #1 Pathophysiology of Rib Fractures and Lung Contusion | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-91644-6_3

  Rib fractures and lung contusions are common among traumatically injured patients and are a major source of morbidity and mortality. These injuries typically result from significant force to the chest wall most commonly blunt in nature, but penetrating mechanisms can also be implicated. The effective care of these patients necessitates an understanding of the pathophysiology of the disease, which we will review in this chapter. […] We will start with a review of the relevant anatomy followed by a discussion focused on the pathophysiology of rib fractures and pulmonary contusions in addition to associated conditions involving the chest such as hemothoraces and pneumothoraces. […] We will conclude with a discussion of differences in pathophysiology among patients at the extremes of age.

• #1 Rib Fractures – Parents Accused

  https://www.parentsaccused.co.uk/rib-fractures/

  When a rib fracture is identified in an infant, doctors are likely to have concerns and care proceedings may be initiated. […] The mechanism to fracture a rib is usually thought to be squeezing or compression of the chest. The amount of force needed to cause a rib fracture is not known but it is thought that normal handling or rough play would not cause a fracture in a child with normal bones. The ribs of an infant are soft and pliable/bendy so it is thought that considerable force is necessary to break them. […] Direct research on force is lacking due to the limits on experimentation, however, literature often considered to back up this theory includes a 50 year review of CPR carried out on children (where the chest is pushed hard – by a third – to resuscitate) in which very few children sustained rib fractures and a review of rib fractures during the birthing process (although babies have their rib cage squeezed during childbirth, there are very few reported cases of fractures as a result of birth).

• #1 Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States

  https://www.jtraumainj.org/journal/view.php?doi=10.20408/jti.2023.0065

  Different mechanisms of injury result in distinct rib fracture patterns. […] The mechanism of injury (MOI) is an important predictor of the extent of injury in trauma patients. […] The major finding of this investigation is that there is a significant association between the MOI and rib fracture pattern. […] If a specific injury pattern could be predicted based on the MOI, focused imaging modalities such as three-dimensional (3D) rendering and use of arterial phase CT scans could be tailored to the correct mechanism. […] Linking the MOI and rib fracture injury patterns may help us detect various injuries, one in particular has much promise: diaphragm injuries. […] Unique rib fracture patterns are generated by different mechanisms of injury.

• #1 Diagnosis and management of a trapped lung or diaphragm by fractured ribs: analysis of patients undergoing rib fracture repair | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-019-0581-x

  There are few reports regarding a lung or diaphragm trapped by a fractured rib. This study aimed to describe the clinical presentations, diagnosis, and management of these intrathoracic pathologies. […] A total of 38 consecutive patients who underwent SSRF were analyzed. Three patients had a trapped lung and one had a trapped diaphragm. […] As per our analysis, the incidence of a trapped lung or diaphragm was 10.5%. If a patient presents with persistent intractable dynamic pain, thoracoscopic exploration with concurrent SSRF may be a feasible and effective treatment option. […] The aim of the study was to describe cases with a trapped lung or diaphragm, including the mechanism of trauma, diagnosis, surgical approaches and outcomes, development of the condition over time, and presentation.

• #1 Diagnosis and management of a trapped lung or diaphragm by fractured ribs: analysis of patients undergoing rib fracture repair | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-019-0581-x

  The median duration between injury and surgery was 25 days. The patients with trapped lungs underwent repair and resection. The patient with a trapped diaphragm underwent thoracoscopic release. […] A definitive diagnosis can made by VATS exploration. […] The incidence was 10.5% (4/38). […] Lung atelectasis with intercostal extension of the parenchyma or loss of the double-domed contour of the diaphragm is a common radiographic abnormality that was observed in 50% of cases. […] We prefer repair and resection for management of a trapped lung. […] Repair and resection for a trapped lung and surgical release for a trapped diaphragm are both feasible and safe.

• #1

  https://link.springer.com/article/10.1007/s00068-020-01353-w

  Rib fractures (RF) occur in 10% of trauma patients; associated with significant morbidity and mortality. […] The purpose was to examine RF patterns hypothesizing RF become more displaced over time. […] Average fracture displacement was significantly increased for all rib groupings except 1112 in all planes (p0.002). […] RF become more displaced over time. Pain regimens and SSRF considerations should be adjusted accordingly.

• #1 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  A recent American multicentre, prospective, controlled clinical trial revealed that there might be an answer in costal-fixation surgery for uncomplicated rib fractures, especially since it showed an improvement in pain-intensity levels within the operative group, as compared with the non-operative group. […] Since the only predictive factor for ongoing pain and disability identified so far is the pain intensity during the first few days after injury, it has been suggested that the possible mechanism leading to the chronicity of the pain after rib fractures is that the initial high-intensity pain might be sensitising the central nervous system to pain perception. […] Therefore, an early interventional approach to reduce acute pain after rib fractures might improve the outcomes for these patients.

• #1 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  The rationale behind this hypothesis is that costal fixation could lead to reduced inflammation and nerve injury by restricting and preventing further fracture movement and thus reducing pain. […] Rib fractures are a very common injury often associated with immense levels of persistent pain and disability, which have a large psycho-socio-economic impact on patients and our healthcare systems. […] Although there are many challenges when it comes to the treatment of rib fractures, including the lack of clinical research and evidence, it is quite obvious that the current conservative treatment of rib fractures does not efficiently facilitate pain relief or even a prompt return to everyday activities. […] New methods for treating rib-fracture patients that alleviate pain and reduce disability are urgently required and are expected to have a positive impact not only on individual patients but also on the wider community. […] It therefore doesn’t come as a surprise that the surgical treatment of rib fractures in the absence of a flail chest is drawing increased surgical attention lately.

• #1 Treatment for rib injury often includes pain management | UCLA Health

  https://www.uclahealth.org/news/article/treatment-rib-injury-often-includes-pain-management

  The primary treatments for rib fractures are medications to help manage pain and inflammation and instructions to limit movement. Depending on the severity of someones injury and the number of ribs involved, healing can take from six weeks to several months. […] Recently, researchers have been looking into using an injectable adhesive to stabilize the broken bone. As healing takes place, the adhesive would be absorbed by the body. The approach remains in the research phase and is not yet available.

• #2 Rib Fracture: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/825981-overview

  The chest wall protects underlying sensitive structures by surrounding internal organs with hard osseous structures, including the ribs, clavicles, sternum, and scapulae. An intact chest wall is necessary for normal respiration. […] Rib fractures may compromise ventilation by a variety of mechanisms. Pain from rib fractures can cause respiratory splinting, resulting in atelectasis and pneumonia. Multiple contiguous rib fractures (ie, flail chest) interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiency. Fragments of fractured ribs can also act as penetrating objects leading to the formation of a hemothorax or a pneumothorax. Ribs commonly fracture at the point of impact or at the posterior angle (structurally their weakest area). Ribs 4 through 9 are the ones most commonly injured.

• #2 Care options for patients with rib fracture – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/trauma/news/care-options-for-patients-with-rib-fracture/mac-20578996

  Rib fractures are commonly seen in trauma care, either as standalone injuries or as part of polytrauma, says Brian D. Kim, M.D., a trauma surgeon at Mayo Clinic in Minnesota. […] The mechanism of injury in rib fracture varies by U.S. region, yet motor vehicle crashes and falls from ground level or height are common causes nationwide, says Dr. Kim. […] Individuals with osteopenia or osteoporosis have an increased risk of fracturing ribs, which he indicates is expected. […] Dr. Kim notes that at times, patients and healthcare professionals attempt to differentiate between a broken or cracked rib, which he believes can lead to confusion. […] For clarity, he prefers to simply refer to this injury as a rib fracture. […] Dr. Kim also mentions that a rib injury may involve displacement.

• #2 Rib Fractures – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/chest-injuries/rib-fractures

  Rib fractures usually result from strong blunt force, such as a fall from a height, a motor vehicle crash, or a hit with a baseball bat. However, sometimes in older adults who have osteoporosis, only a slight force (as occurs in a minor fall) is required. […] The fracture itself is rarely serious, although the force that caused the fracture occasionally causes other problems, such as a bruised lung (pulmonary contusion) or a collapsed lung (pneumothorax). An injury that fractures the lower ribs sometimes also damages the liver or spleen. The more ribs that are broken, the more likely lungs or other organs are to be damaged. […] In flail chest, a segment of the chest wall separates from the rest and moves in the opposite direction from the rest of the chest wall when a person breathes. Breathing becomes more difficult and tiring. Usually, a blow strong enough to cause flail chest also bruises the lung beneath the injured area (called pulmonary contusion).

• #2 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?id=3765

  Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. […] The mechanism of CIRF can be explained in several ways. First of all, CIRF is accepted as a specific and less common type of stress fracture; thus, repetitive mechanical stress on the ribs with adaptive bone remodeling and muscle fatigue is thought to play a role in the development of the CIRF. […] Repeated trauma due to repetitive cough may cause inelastic deformation of the middle third of the ribs between the fifth and 10th ribs, which is the most vulnerable part of the rib, as well as of the costochondral junctions. […] The second mechanism is thought to be linked with contrary muscle forces acting on the ribs. […] Several risk factors for the development of CIRF have been reported. Osteoporosis, COPD, prolonged use of high dose steroids, and asthma are among them.

• #2

  https://journals.lww.com/aotm/fulltext/2007/02040/isolated_rib_fractures_in_geriatric_patients.6.aspx

  Elderly patients sustaining blunt chest trauma had significant morbidity and potential for mortality. […] Rib fractures occur more commonly with increasing age, which usually associated with decreased bone density. […] Increased morbidity and mortality in elderly patients with traumatic rib fractures are attributed to several factors such as anatomical difference between young and elderly people (osteoporosis, decreased muscle mass and thinned vertebral bodies), as well as decreased physiological reserve (low cardiopulmonary status and lower immunity), and more likelihood of presence of associated comorbidities. […] Increased number of rib fractures was found to correlate with the morbidity in our patients. […] Increase in the number of rib fractures correlated directly with increasing pulmonary morbidity and mortality.

• #2 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Rib fractures are common injuries that occur most often following blunt thoracic trauma but can also result from severe coughing, athletic activities (eg, rowing, swinging golf clubs, throwing, which can cause rib stress fractures), and nonaccidental trauma (ie, child abuse). Concomitant injuries and complications range from mild discomfort to life-threatening conditions such as pneumothorax, splenic laceration, and pneumonia. […] Most rib fractures are caused by direct trauma to the chest wall. This can occur from blunt (eg, motor vehicle collision) or penetrating (eg, gunshot) trauma. A single blow may cause rib fractures in multiple places. Traumatic fractures most often occur at the site of impact or the posterolateral bend, where the rib is weakest. […] Cancers that metastasize to bone (eg, prostate, breast, kidney) frequently become apparent in a rib and cause pathologic fractures. Ribs are relatively thin compared with major long bones and are more likely to fracture when invaded by a metastatic lesion.

• #2 Rib injuries | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rib-injuries

  Broken ribs cant be set in a cast, so treatment aims to relieve pain while the injury heals. […] Rib injuries typically occur when the chest is directly hit. […] A rib is most likely to fracture at its outer curve, which is its weakest point. […] Flail chest is the most common serious injury to the ribs. […] The key sign of flail chest is paradoxical movement, which means the natural movement of the ribcage during breathing is in reverse. […] The ribs enclose vital organs such as the heart and lungs, so chest trauma can cause life-threatening injuries. […] Treatment aims to relieve pain while the injury heals, which can take up to six weeks (in the case of fracture), and 12 weeks or more if the rib has been torn from the cartilage.

• #2 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures/print

  The first rib is unique in that the scaleni insert onto it, and it therefore is exposed to stresses from the action of these neck muscles. The superior ribs (numbers 1 to 3) are protected by the scapula, clavicle, and soft tissue, while the inferior „floating” ribs are relatively mobile. Therefore, the more vulnerable middle ribs (numbers 4 to 10) are most susceptible to injury from blunt trauma. Fractures of superior ribs reflect trauma involving significant force and the potential for injury to major vessels and lung parenchyma. […] Both displaced and nondisplaced fractures can be seen in adults and children. Due to the greater pliability of children’s ribs, greater force is required to produce a fracture.

• #2 Bruised vs. Broken Ribs: What’s the Difference?

  https://www.verywellhealth.com/bruised-broken-or-fractured-ribs-4582241

  Broken and bruised ribs are different injuries. With a broken rib, the bone has been fractured either particularly or completely. A „bruised” rib means the supportive muscles and tissues around your ribcage have been injured. […] Most rib injuries happen when there is blunt force trauma to the chest wall, such as from a car accident or a fall. […] A bruised rib occurs when there is an injury to the chest wall but the bones of the ribcage are not actually injured. The pain of a bruised rib comes from the strain or damage to: Muscles of the chest (including the intercostal muscles that aid with breathing), Cartilage (which connects your ribs to your sternum), Tendons (which connect muscle to bone), Ligaments (which connect two bones or cartilage), Fascia (a membrane that holds every organ, bone, and muscle in place).

• #2 The Difference Between Bruised and Broken Ribs – Ventura Orthopedics

  https://venturaortho.com/difference-between-bruised-and-broken-ribs/

  Bruised ribs or a rib contusion occurs following a direct impact to the torso. […] A direct blow to the chest or to the ribs themselves may cause the ribs to bruise, break or separate from the breastbone. […] While bruised ribs are extremely painful, in most cases they heal completely. The injury is referred to as bruised ribs but majority of the pain is caused by injury to the surrounding muscle and rib cartilage. […] A rib fracture is common in contact sports and usually occurs following a hard impact to the chest by an elbow or similar. […] It is possible that the fracture may cause internal damage so seeking medical advice is recommended, especially if the pain is severe. […] One of the most persistent symptoms of a broken rib is chest pain when taking a breath. […] Simple fractures will usually heal by themselves.

• #2 Cracked Rib: Symptoms, Diagnosis, Treatment, and More

  https://www.verywellhealth.com/broken-ribs-symptoms-1298895

  A fractured rib is the preferred medical term for a cracked or broken rib. A cracked rib is more of a description than a medical diagnosis and suggests a rib that has been partially fractured. A broken rib, which is the same thing as a fractured rib, describes any break in the bone. […] Any blunt impact to the chest or back can cause a rib fracture, including a fall, a sports injury, a car accident, or even violent coughing. […] Fractured ribs are usually caused by a fall, a blow to the chest, or severe coughing. […] Common causes of fractured ribs include: car accidents, pedestrian accidents, falls, impact injuries from sports like football or rugby, repetitive stress exerted during sports like rowing or golf, violent coughing. […] Rib fractures are the most common bone fracture, accounting for 10% to 20% of all blunt trauma injuries seen in emergency departments.

• #2 Rib fracture characteristics increasing the risk of hemothorax: a multicenter study | Scientific Reports

  https://www.nature.com/articles/s41598-024-79548-z

  Our study clearly demonstrated a concrete relationship, showing that the presence of at least one displaced rib fracture increased the risk of hemothorax by a factor of 2.7. […] Our study aligns with the existing literature in demonstrating that anterior rib fractures have the lowest risk of hemothorax when considering the clinical reflection of anatomical features. […] The occurrence of hemothorax has been linked to the nature and intensity of trauma in numerous studies documented in the literature. […] Our study suggests that the risk of hemothorax is influenced by the local characteristics of the rib fracture, regardless of the severity of trauma. […] Our study concluded that there is a significant increase in the risk of hemothorax associated with more rib fractures and specifically more posterior rib fractures. […] We discovered that the displacement of even a single rib fracture significantly increased the risk of hemothorax.

• #2

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #2 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  Fractures of the first rib are rare. The significance of a first rib fracture is the association with cervical spine trauma, multiple rib fractures, or life-threatening vascular injuries. […] Fractures of the first rib imply a violent force; this pattern of fractures may signify injury to the adjacent subclavian vein and brachial plexus. Isolated first rib fractures are seen in association with cranial and maxillofacial injuries and are probably secondary to avulsion of the first rib by its muscular attachment rather than direct trauma to the rib, which is relatively protected. […] Fractures of the fifth to ninth ribs can be single or multiple. Multiple fractures can present as flail chest, which is present when paradoxical respiratory movement occurs in a segment of the chest wall. […] An inward displacement of the rib fracture fragments at the time of the injury may lacerate the lung parenchyma and produce a pneumothorax, with a possible hemothorax.

• #2 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  A broken rib occurs when one of the bones in the rib cage breaks or cracks. […] A broken rib can harm blood vessels and internal organs. Having more than one broken rib increases the risk. […] Complications depend on which ribs break. Possible complications include: […] A sharp end from a break in one of the first three ribs at the top of the rib cage could pierce a major blood vessel, including the aorta. […] The jagged end of a broken middle rib can punch a hole in a lung and cause it to cave in. […] The ends of a broken lower rib can cause serious harm to the spleen, liver or a kidney.

• #2 Rib Fractures – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/chest-injuries/rib-fractures

  Because of the pain, people may breathe less deeply, increasing the risk of complications, such as collapse of parts of the lung (atelectasis) and pneumonia. […] People with flail chest often need to have their breathing supported with a ventilator until the injuries heal. Some people with flail chest may need surgery to stabilize the ribs and reduce the risk of complications, including pneumonia, lengthy hospital stays, and death.

• #2 Rib Fracture and Pneumothorax Complication | SportsMD

  https://www.sportsmd.com/sports-injuries/chest-rib-injuries/rib-fracture-pneumothorax-complication/

  A rib fracture or broken rib is one of the more common injuries to the chest with rib fractures as the most common thoracic injury from blunt force trauma (i.e. automobile accidents, falls, or contact sports). […] However, displaced multiple fractures can be life-threatening. Displaced multiple fractures can leave sharp bony fragments that may puncture the pleural sac surrounding the lungs. This can lead to a pneumothorax or a collapsed lung. These types of injuries are the most serious with the athlete needing immediate emergency medical treatment. […] The most severe and critical complication of displaced rib fractures is a pneumothorax. A displaced rib fracture can puncture the lungs and the pleural sac surrounding the lungs effectively deflating the lung on the side of the pleural puncture. As the lung deflates, the athlete will have increasing pain and difficulty breathing.

• #2 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Intrathoracic injury, such as pneumothorax or pulmonary contusion, can occur in association with rib fractures at any level. The risk of intra-abdominal or intrathoracic injury increases if two or more rib fractures are present at the same level. […] First rib fractures are associated with greater overall injury severity and life-threatening internal injury (including injuries to the brain, spine, lungs, and pelvis), while isolated first rib fractures from playing sports do not carry the same risk. […] Displaced rib fractures increase the risk of injury to the lung and proximate intercostal blood vessels (common cause of hemothorax). A delayed hemothorax can occur days to weeks after the rib fracture, and can occur without a hemothorax initially or may start as a trace hemothorax that gradually progresses.

• #2 Diagnosis and management of a trapped lung or diaphragm by fractured ribs: analysis of patients undergoing rib fracture repair | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-019-0581-x

  There are few reports regarding a lung or diaphragm trapped by a fractured rib. This study aimed to describe the clinical presentations, diagnosis, and management of these intrathoracic pathologies. […] A total of 38 consecutive patients who underwent SSRF were analyzed. Three patients had a trapped lung and one had a trapped diaphragm. […] As per our analysis, the incidence of a trapped lung or diaphragm was 10.5%. If a patient presents with persistent intractable dynamic pain, thoracoscopic exploration with concurrent SSRF may be a feasible and effective treatment option. […] The aim of the study was to describe cases with a trapped lung or diaphragm, including the mechanism of trauma, diagnosis, surgical approaches and outcomes, development of the condition over time, and presentation.

• #2 Broken or Bruised Ribs – Types, Causes, Symptoms, Risks, Complications, Diagnosis, Treatment, Prevention

  https://www.medindia.net/health/conditions/broken-or-bruised-ribs.htm

  The jagged or broken end of a rib can injure the lung and cause it to collapse. When the membrane around the lung gets damaged due to the broken rib, air leaks into the space between the lung and chest wall. This leaked air pushes on the outside of the lung making it collapse. […] Pneumothorax can become life-threatening if the air is trapped under pressure; this is known as tension pneumothorax. This causes increased breathing difficulty by compressing the lungs. It is a medical emergency. […] Fracture of the first three ribs can rupture the aorta or any other major blood vessel. […] Fractures to the lower ribs can injure some abdominal organs like spleen, liver or kidneys. Symptoms include pain in the abdomen or back. If there is internal bleeding associated with organ rupture, the patient may feel faint and extremely unwell. It warrants immediate medical attention.

• #2

  https://www.orthobullets.com/knee-and-sports/12108/rib-stress-fracture

  A rib stress fracture in an uncommon site of stress fracture that typically occurs due to repetitive contraction of the chest wall muscles. […] Pathophysiology […] stress placed on a rib during repetitive contraction of an attached muscle. […] accentuated during training because muscles strengthen more rapidly than bone. […] muscle fatigue during prolonged activity places a bone at risk for fracture by lessening the ability of a muscle to absorb and dissipate opposing forces. […] anatomic sites of weakness […] first rib stress fx […] groove for subclavian artery is site of weakness due to superiorly directed forces from the scalene muscles and inferiorly directed forces from the serratus anterior and intercostal muscles.

• #2 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?lang=en&id=3765

  Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. […] The mechanism of CIRF can be explained in several ways. First of all, CIRF is accepted as a specific and less common type of stress fracture; thus, repetitive mechanical stress on the ribs with adaptive bone remodeling and muscle fatigue is thought to play a role in the development of the CIRF. […] Repeated trauma due to repetitive cough may cause inelastic deformation of the middle third of the ribs between the fifth and 10th ribs, which is the most vulnerable part of the rib, as well as of the costochondral junctions. […] The second mechanism is thought to be linked with contrary muscle forces acting on the ribs. […] Several risk factors for the development of CIRF have been reported. Osteoporosis, COPD, prolonged use of high dose steroids, and asthma are among them. […] In summary, 22% of our patients had COPD and patients with COPD were significantly older. […] In conclusion, one should be aware of that cough may cause rib fracture and should be suspected, when localized chest pain develops following coughing.

• #2 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  A spontaneous fracture of a midthoracic rib should alert the clinician for an underlying metastasis, multiple myeloma, or hyperparathyroidism. […] Hemorrhage around and within the adrenal glands represents a risk that is associated with fractures of the lower ribs. Fractures of the lower ribs are also commonly associated with visceral injury to the kidneys and the spleen. […] A pneumothorax is a common sequela of blunt trauma. Fracture fragments that lacerate the lung parenchyma can cause bleeding into the pleural cavity and result in a pneumothorax. […] The incidence of a pneumothorax is not as high with one rib fracture, but the risk increases as the number of broken ribs increases. […] The incidence of hemopneumothoraces in patients with rib fractures is 30%. A hemothorax is usually the result of a lacerated intercostal artery; however, bleeding from broken ribs usually stops before a sufficient volume is lost and before emergency thoracotomy is required.

• #2 Care options for patients with rib fracture – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/trauma/news/care-options-for-patients-with-rib-fracture/mac-20578996

  While Dr. Kim explains he has treated patients with organ damage such as to the diaphragm or spleen caused by a floating piece of a fractured rib, he calls this scenario uncommon. More commonly, displaced rib fractures may also be associated with intercostal damage, either muscular, vascular or both. […] The typical healing time of a nondisplaced rib fracture in an otherwise healthy individual ranges from 6 to 12 weeks. […] Most fractured ribs heal without surgical intervention. […] Dr. Kim indicates that a multimodal pain management regimen and commonsense activity reduction can assist with pain relief. […] A patient with a rib fracture not only experiences pain but also is at risk of pneumonia, as poorly controlled pain can affect respiratory mechanics, says Dr. Kim. […] He notes that avoiding deep breaths then leads to poor secretion clearance and low tidal volume breathing.

• #2

  https://www.aast.org/resources-detail/rib-fractures

  The most common symptom of rib fractures is pain. Pain is typically elicited with breathing or coughing. If the fractures are complex, the patient may suffer from additional damage to underlying structures. The sharp fractured end of the rib can puncture the lung, causing air leakage, a condition called a pneumothorax, which is potentially life threatening. In addition to pain, shortness of breath and decreased oxygen content in the blood can result from these injuries. A flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can result in a clinical entity called acute lung injury. In its most severe form, acute lung injury can lead to a life threatening entity called adult respiratory distress syndrome (ARDS). Respiratory failure is usually caused by the underlying pulmonary contusion but not by the anatomic flail chest itself. In addition, the flail segment moves in the opposite direction as the rest of the chest wall because of the ambient pressure in comparison to the pressure inside the lungs. This so-called „paradoxical motion” can increase the work and pain involved with breathing.

• #2 Rib Injury | Rib Injury Clinic

  https://www.ribinjuryclinic.com/conditions/rib-injury/

  Rib injuries vary significantly from a minor injury with associated pain and bruising to severe, multiple broken ribs and associated internal injuries. […] The classification of rib fractures is often based on the appearance of rib fractures on chest x-ray or commonly on Chest CT scan. […] Rib fractures or any bone that fails to heal properly can lead to conditions called mal-union, delayed healing or non-union. […] Symptoms of a fracture that is not healing normally include tenderness, swelling, and an aching pain that may be felt deep within the affected bone. […] Breathlessness: Shortness of breath acutely is usually caused by the chest wall pain not allowing deep breaths to be taken, occasionally it can be associated with the lung collapsing after the injury; a build-up of fluid in the chest cavity (effusion) or even a developing chest infection (pneumonia).

• #2 Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank | Trauma Surgery & Acute Care Open

  https://tsaco.bmj.com/content/5/1/e000441

  Traumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. […] Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. […] Worse outcomes were predominantly observed among patients with polytrauma and flail chest. […] Traumatic rib fractures must be considered as a surrogate marker of severe injury, as about half of our cohort consisted of patients with polytrauma. […] Among these patients, significant worse outcomes were observed with respect to mortality, number of complications and other in-hospital outcomes, such as admission to the ICU and need for mechanical ventilation. […] The highest mortality rate was observed among patients with flail chest (13.0%), followed by patients with polytrauma (10.6%) and elderly patients (7.6%).

• #2 Rib fracture – WikEM

  https://wikem.org/wiki/Rib_fracture

  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 […] Ribs more flexible in children, so fractures require extreme force.

• #2 Rib Fractures – Parents Accused

  https://www.parentsaccused.co.uk/rib-fractures/

  When a rib fracture is identified in an infant, doctors are likely to have concerns and care proceedings may be initiated. […] The mechanism to fracture a rib is usually thought to be squeezing or compression of the chest. The amount of force needed to cause a rib fracture is not known but it is thought that normal handling or rough play would not cause a fracture in a child with normal bones. The ribs of an infant are soft and pliable/bendy so it is thought that considerable force is necessary to break them. […] Direct research on force is lacking due to the limits on experimentation, however, literature often considered to back up this theory includes a 50 year review of CPR carried out on children (where the chest is pushed hard – by a third – to resuscitate) in which very few children sustained rib fractures and a review of rib fractures during the birthing process (although babies have their rib cage squeezed during childbirth, there are very few reported cases of fractures as a result of birth).

• #2 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  A recent American multicentre, prospective, controlled clinical trial revealed that there might be an answer in costal-fixation surgery for uncomplicated rib fractures, especially since it showed an improvement in pain-intensity levels within the operative group, as compared with the non-operative group. […] Since the only predictive factor for ongoing pain and disability identified so far is the pain intensity during the first few days after injury, it has been suggested that the possible mechanism leading to the chronicity of the pain after rib fractures is that the initial high-intensity pain might be sensitising the central nervous system to pain perception. […] Therefore, an early interventional approach to reduce acute pain after rib fractures might improve the outcomes for these patients.

• #2 Diagnosis and management of a trapped lung or diaphragm by fractured ribs: analysis of patients undergoing rib fracture repair | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-019-0581-x

  The median duration between injury and surgery was 25 days. The patients with trapped lungs underwent repair and resection. The patient with a trapped diaphragm underwent thoracoscopic release. […] A definitive diagnosis can made by VATS exploration. […] The incidence was 10.5% (4/38). […] Lung atelectasis with intercostal extension of the parenchyma or loss of the double-domed contour of the diaphragm is a common radiographic abnormality that was observed in 50% of cases. […] We prefer repair and resection for management of a trapped lung. […] Repair and resection for a trapped lung and surgical release for a trapped diaphragm are both feasible and safe.

• #2 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  The rationale behind this hypothesis is that costal fixation could lead to reduced inflammation and nerve injury by restricting and preventing further fracture movement and thus reducing pain. […] Rib fractures are a very common injury often associated with immense levels of persistent pain and disability, which have a large psycho-socio-economic impact on patients and our healthcare systems. […] Although there are many challenges when it comes to the treatment of rib fractures, including the lack of clinical research and evidence, it is quite obvious that the current conservative treatment of rib fractures does not efficiently facilitate pain relief or even a prompt return to everyday activities. […] New methods for treating rib-fracture patients that alleviate pain and reduce disability are urgently required and are expected to have a positive impact not only on individual patients but also on the wider community. […] It therefore doesn’t come as a surprise that the surgical treatment of rib fractures in the absence of a flail chest is drawing increased surgical attention lately.

• #3 Rib Fractures – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/chest-injuries/rib-fractures

  Rib fractures usually result from strong blunt force, such as a fall from a height, a motor vehicle crash, or a hit with a baseball bat. However, sometimes in older adults who have osteoporosis, only a slight force (as occurs in a minor fall) is required. […] The fracture itself is rarely serious, although the force that caused the fracture occasionally causes other problems, such as a bruised lung (pulmonary contusion) or a collapsed lung (pneumothorax). An injury that fractures the lower ribs sometimes also damages the liver or spleen. The more ribs that are broken, the more likely lungs or other organs are to be damaged. […] In flail chest, a segment of the chest wall separates from the rest and moves in the opposite direction from the rest of the chest wall when a person breathes. Breathing becomes more difficult and tiring. Usually, a blow strong enough to cause flail chest also bruises the lung beneath the injured area (called pulmonary contusion).

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