Rib Fracture

1. See Also
   1. Flail Chest
2. Red Flags: High risk Rib Fractures (Injuries suggestive of high energy injury)
   1. Rib Fracture of ribs 1 to 3
   2. SternumFracture
   3. Scapular Fracture
   4. Young patient with more than one Rib Fractured
3. Imaging
   1. Avoid rib xray
   2. Chest XRay
      1. Rib Fracture
      2. Pneumothorax
         1. Especially with Rib Fractures at 4-9
   3. Consider CT Chest
      1. Indicated for high risk injury as listed above under red flags
   4. CT Abdomen
      1. Indicated for Rib Fracture at 10-12 and abdominal exam suggestive of injury
      2. Evaluate for liver Laceration and splenic rupture
4. Management
   1. Trauma surgeon consult if high risk, high energy injury (see red flags above)
   2. Pain management to decrease Splinting and improve ventilation
      1. Narcotic Analgesics
      2. Intercostal block
      3. Epidural Anesthesia
   3. Admit older, debilitated patients with Rib Fractures
      1. Higher risk of Atelectasis and secondary Pneumonia
5. Complications
   1. Pain induced Splinting complications
      1. Atelectasis (due to Splinting)
      2. Pneumonia
   2. Rib Fracture at ribs 4-9
      1. Pneumothorax
   3. Rib Fracture at ribs 10-12
      1. LiverLaceration
      2. Splenic rupture
   4. High energy injury (Rib Fracture 1-3, SternumFracture, Scapula Fracture)
      1. Lung Contusion
      2. Cardiac Contusion
      3. High mortality risk