Ribs / Chest Wall
Rib Fracture
늑골 골절
Cortical disruption of rib from trauma or severe cough
- How common
- Common (10% of chest trauma)
- Typical age
- All ages (severe in elderly)
What is it?
Cortical disruption from trauma or repetitive stress; severe pain causes shallow breathing, atelectasis, and pneumonia risk.
Commonly affected: Ribs 4–9 lateral most common; 1–2 = high-energy, 10–12 = consider abdominal injury
How it develops
- Traumatic ImpactFall, MVC, or direct blow
- Cortical BreakLocal hematoma and soft tissue bleed
- Splinting RespirationPain triggers shallow breathing
- Pulmonary ComplicationsAtelectasis, pneumonia, hemopneumothorax risk
Symptoms
- Focal sharp painSevere pain at fracture site
- Worse with breathingTearing pain with deep breath or cough
- Tenderness/crepitusPalpable crepitus possible
- Shallow breathingTachypnea/hypoventilation from pain avoidance
- Positional painPain when lying or rolling
How it is examined
- Focal tendernessExquisite tenderness at fracture level
- Rib compression testAP/lateral compression reproduces pain
- CrepitusBony crepitus may be palpable
- Breath sound evaluationDiminished sounds suggest pneumothorax/hemothorax
Imaging
Dedicated rib views show cortical disruption; CT more sensitive for non-displaced and posterior fractures.
- Cortical discontinuity
- Displaced or non-displaced fracture line
- Evaluate for pneumothorax/hemothorax
CT is standard for detailed fracture and organ evaluation; MRI reserved for occult fracture.
- CT: subtle fracture lines
- Soft tissue hematoma
- MRI: marrow edema
Non-surgical care
- Pain controlNSAIDs/acetaminophen; opioids if needed
- Deep breathing/incentive spirometryPrevent atelectasis and pneumonia
- Intercostal nerve blockMultiple fractures for pain control
- Activity modificationAvoid binders — they restrict breathing
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Flail chest, ≥3 displaced fractures, severe deformity
Procedures that may be discussed
- Open reduction internal fixation
- Rib plating
Outlook
Most heal in 6–8 weeks; elderly and multiple fractures have higher complication risk.