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Definition A rib fracture is disruption in any of the 12 rib bones that form the rib cage.

The disruption may be a single fracture of one rib, a single fracture of multiples ribs, or a rib or ribs may be broken into several pieces (comminuted fracture). The fractures are classified by location (i.e., rib number, right or left side of the body) and whether the ends of the broken rib are aligned (nondisplaced) or not (displaced). The fourth through ninth ribs are the most commonly fractured, and fractures of the eighth through twelfth ribs are often a marker for abdominal organ injuries. "Flail chest" occurs when three or more neighboring ribs are fractured in two or more places, or when the ribs separate from the costal cartilage (costochondral separation) that attaches the ribs to the breast bone (sternum). This creates an unstable section of chest wall that moves in the opposite direction with respect to the rib cage. For example, when the individual breathes in and the rib cage rises, the portion of the rib cage is part of the flail chest will actually fall.) This paradoxical respiratory movement compromises respiratory efficiency. Rib fractures are the most common type of chest injury. They are caused by blunt or open trauma to the chest. Rib fractures often result from motor vehicle accidents, crush injuries, and recreational or athletic injuries. In the elderly, diseases that weaken the bones (osteoporosis, osteopenia) make an individual more susceptible to rib fractures from a fall. An increased risk for rib fracture has been associated with hyperparathyroidism. Stress fractures of the ribs may be caused by prolonged paroxysms of coughing that increase pressure and motion of the chest wall (e.g., chronic obstructive pulmonary disease [COPD], pneumonia, whooping cough [pertussis]), or less commonly by repetitive movement of the upper extremities (e.g., rowing, golf, discus throwing). Risk: Individuals at risk for chest trauma from work, recreational or athletic pursuits are more likely to sustain a rib fracture. An increased risk for rib fracture has been associated use of steroid drugs (Nadalo). Seventy-two percent of rib fractures occur in men, possibly due to job requirements for heavy labor or participation in sport activities that create a greater risk for blunt trauma (Holcomb). Postmenopausal women are at higher risk for osteoporosis and thus at higher risk for rib fracture. Incidence and Prevalence: Rib fractures are common and often go unreported. They account for 10% of traumatic injuries and 14% of all chest wall injuries in the US. The incidence of flail chest is 10% to 15% of severe chest traumas (Nadalo). Rib fractures are common in individuals who survive cardiopulmonary resuscitation, especially in older adults. Source: Medical Disability Advisor Diagnosis

reaching. Cardiac and respiratory function are assessed with a stethoscope.History: Often. or corset helps to decrease pain. spine. Full arterial blood gas analysis may be used. Candidates for hospitalization include those individuals who are cannot manage their secretions. but this requires removal of a sample of blood directly from the artery and can be uncomfortable. a fall. or violent coughing. Ice may be placed over the tender area to decrease swelling. and extremities. Support from a rib belt. especially when there is evidence of poor breathing (hypoventilation). individuals with abdominal injuries. analgesics. Suppression of a cough. or using chest wall muscles. A comprehensive health history should be obtained. Source: Medical Disability Advisor Treatment Uncomplicated rib fractures with no associated injuries are treated symptomatically on an outpatient basis. Individuals with severe trauma may complain of the inability to breathe normally. Other signs of respiratory insufficiency including rapid. such as nonsteroidal anti-inflammatory agents. heart and blood vessels. abdominal organs. Tests: Chest and rib x-rays are ordered to locate the fracture(s) and to determine if there are other injuries to the lungs. and abnormal movement of the chest wall (flail chest) may be noted. Pulse oximetry is a non-invasive method that allows rapid determination of an individual’s ability to get enough oxygen. Tenderness over a portion of the chest and displacement of ribs may be noted with palpation. and the elderly. or pneumonia. a motor vehicle accident. shallow breathing. and anxiety. their use is seldom recommended. if present. CT and MRI are performed to evaluate soft tissue injury. Changes in breath sounds may be heard (auscultated). including recent and prior illnesses and related treatment. increased carbon dioxide levels in the blood (hypercapnia). binder. a bluish color to the skin (cyanosis). and narcotics. Individuals may report feeling a lump over the injured area or feeling a rib(s) move abnormally. An intercostal nerve block may be an option for severe pain. therefore. but individuals who use these devices cannot breathe deeply. This includes medications to decrease pain. coughing. . atelectasis. This leads to higher risk of pneumonia or partial lung collapse (atelectasis). will decrease pain. agitation. In severe trauma cases. Individuals may complain of pain when breathing. crunching (crepitus) may be felt in the soft tissue around the fracture site (signifying air that has leaked out of the chest cavity and is trapped in the tissue). The physician will determine if there are other injuries involving the lungs. the use of accessory muscles in breathing. Physical exam: Bruises (contusions) and cuts (lacerations) may be observed. shoulders. Other laboratory tests may be performed to evaluate an individual’s health status. there is a history of blunt force trauma to the chest.

functional shoulder mobility. The physical therapist should instruct patients in deep-breathing exercises to promote full lung expansion. . the rib should heal in approximately 6 weeks if there are no underlying conditions affecting bone healing.Rib fractures rarely require surgical management. crush injury) to the chest with multiple vascular and neurological complications. The goal of rehabilitation is to decrease pain. and mobilize lung secretions. and improved posture. In multiple trauma cases. Finally. shoulder and trunk gentle stretching exercises may relieve discomfort and promote chest expansion. When surgical intervention (ORIF) is required. unless they are part of a major trauma (e. relieve intercostal muscle spasm. complete recovery will include resolution of other injuries. Source: Medical Disability Advisor Rehabilitation Physical therapy is indicated in those individuals with a fractured rib who present with a compromised respiratory system. prevent respiratory complications and restore function. Source: Medical Disability Advisor Prognosis Rib fractures treated with nonsurgical methods (conservative treatment) will heal in 6 to 10 weeks but may be quite painful during that period. Associated conditions such as injury to the major organs and vessels in the chest may take longer to heal than an isolated rib fracture. or functional limitations associated with postural muscles. Surgical procedures include removal of bone fragments (rib resection) or use of fixation devices for rigid stabilization during healing such as open reduction-internal fixation (ORIF). advanced age. It provides a framework based on the duration of tissue healing time and standard clinical practice. in conjunction with pharmacological treatment. Local application of heat or cold may provide temporary relief of discomfort. FREQUENCY OF REHABILITATION VISITS Nonsurgical Specialist Fracture. There is evidence to support the use of a transcutaneous electrical nerve stimulator (TENS) for pain management in patients with uncomplicated minor rib fractures (Oncel). Rib Physical Therapist Up to 6 visits within 3 weeks The table above represents a range of the usual acceptable number of visits for uncomplicated cases.g..

and spleen injury is 11. These types of complications may require chest surgery (thoracotomy). Individuals with chronic underlying respiratory illnesses such as COPD. liver. heart. often from a lacerated artery. major blood vessels. resulting in pericardial or aortic hemorrhage. and overhead work. or bones in the chest cavity. emphysema. Although rare. Though rare. and the incidence of liver injury associated with rib fracture is 10.3% (Nadalo). lifting. nonunion (failed union) of the fracture may occur. introduction of air into the pleural cavity surrounding the lungs (pneumothorax). Individuals with rib fracture(s) may not be able to tolerate heavy aerobic exertion in any position because of difficulty breathing. Pulmonary complications may include laceration of the lung tissue (parenchyma) by fracture fragments. or asthma may need to be hospitalized for respiratory support and management.7%. penetration of the heart has been reported. and bleeding into the pleural cavity surrounding the lungs (hemothorax). Pulmonary contusions occurs in 20% to 40% of individuals with rib fractures. twisting. .Source: Medical Disability Advisor Complications Individuals over age 45 with more than four rib fractures are at increased risk for pulmonary complications or spleen or liver lacerations sustained in conjunction with traumatic rib fracture. Other complications of severe rib fractures with multiple trauma include damage to organs such as the spleen. carrying. Source: Medical Disability Advisor Return to Work (Restrictions / Accommodations) Return to work will require job modification for upper body activities involving reaching.