Rib fracture: Difference between revisions
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*May have chest wall crepitus or ecchymosis | *May have chest wall crepitus or ecchymosis | ||
*Pain on inspiration | *Pain on inspiration | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**May only pick up 24% of fractures<ref>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.</ref> | **May only pick up 24% of fractures<ref>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.</ref> | ||
*CT chest has much better sensitivity (63%) and specificity (97%)<ref>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.</ref> | *CT chest has much better sensitivity (63%) and specificity (97%)<ref>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.</ref> | ||
*Consider [[flail chest]], if multiple ribs are fractured in 2 or more places and paradoxical chest wall movement | |||
==Management== | ==Management== | ||
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*Consider admission for: | *Consider admission 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> | ||
**Flail segment | **[[Flail chest|Flail segment]] | ||
**Significant associated injury | **Significant associated injury | ||
**Pre-existing pulmonary disease | **Pre-existing pulmonary disease | ||
Revision as of 18:30, 13 June 2020
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
- CXR
- May only pick up 24% of fractures[1]
- CT chest has much better sensitivity (63%) and specificity (97%)[2]
- Consider flail chest, if multiple ribs are fractured in 2 or more places and paradoxical chest wall movement
Management
- Adequate analgesia is paramount to management of rib fractures
- Rib belts or other chest wall wrapping has no place in treatment and should be discouraged
- Incentive spirometry
- If flail segment is present, positive pressure ventilation may be required to allow for adequate ventilation
Disposition
- Consider discharge for:
- Isolated rib fractures
- Young, otherwise healthy patient
- Good respiratory effort and cough (able to clear respiratory secretions)
- Pain controlled with PO medications
- Consider admission for:
- Elderly patient with multiple rib fractures, hypotension, pulmonary contusion, hemothorax, pneumothorax, or age >85[3]
- Flail segment
- Significant associated injury
- Pre-existing pulmonary disease
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.
- ↑ 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.