Fractured Rib

Topic Overview

What is a fractured rib?

A rib fracture is a crack or break in one of the bones of the rib cage. A break in the thick tissue (cartilage) that connects the ribs to the breastbone may also be called a fractured rib, even if the bone itself is not broken.

The most common cause of a fractured rib is a direct blow to the chest, often from a car accident or a fall. Coughing hard can also fracture a rib. This is more likely to happen if you have a disease that has made your bones weak, such as osteoporosis or cancer.

It is important to see a doctor after a rib injury. A blow that is hard enough to fracture a rib could also injure your lungs, spleen, blood vessels, or other parts of your body.

What happens when you break a rib?

Your ribs have two main jobs:

  • They protect the organs in your chest.
  • They help you breathe by keeping space open inside your chest while the muscles you use to breathe squeeze in, or contract. This leaves plenty of space for your lungs to fill up with air.

The muscles used for breathing pull on the ribs, so breathing may be very painful when you have a fractured rib.

Flail chest is a serious problem that happens when three or more ribs are broken in more than one place. If you have flail chest, the broken area can't hold its shape when you take a breath. This leaves less space in your chest for your lungs to open and air to flow in. It also makes it harder for the muscles to work well, so it's harder to take a breath.

What are the symptoms?

A fractured rib may cause:

  • Mild to severe pain in the injured area.
  • Pain when you breathe.
  • Pain around the fracture when someone pushes on your breastbone.

If you can't breathe normally because of pain or flail chest, you may:

  • Feel short of breath.
  • Feel anxious, restless, or scared.
  • Have a headache.
  • Feel dizzy, tired, or sleepy.

How is a fractured rib diagnosed?

Your doctor will ask questions about your injury and do a physical exam. The doctor may:

  • Push on your chest to find out where you are hurt.
  • Watch you breathe and listen to your lungs to make sure air is moving in and out normally.
  • Listen to your heart.
  • Check your head, neck, spine, and belly to make sure there are no other injuries.

You may need to have an X-ray or other imaging test if your doctor isn't sure about your symptoms. But rib fractures don't always show up on X-rays. So you may be treated as though you have a fractured rib even if an X-ray doesn't show any broken bones.

How is it treated?

If your doctor thinks you have internal injuries along with a fractured rib, you may need to be treated or watched in the hospital. You may be given strong medicine to control your pain.

But most fractured ribs are treated at home and will heal on their own over time. Home treatment will help you manage the pain while you heal. Pain relief can help you feel better and let you take deeper breaths.

A fractured rib usually takes at least 6 weeks to heal. To help manage the pain while the fracture heals:

While you are healing, it is important to cough or take the deepest breath you can at least once an hour. This can help prevent pneumonia or a partial collapse of the lung tissue.

If you have fractured your ribs and you have not injured your neck or back, it is a good idea to lie on your injured side. This may seem odd at first, but it will let you take deeper breaths.

In the past, it was common to tape or tightly wrap the injured rib area. But you should not do this, even if it eases your pain. It can keep you from taking deep breaths, and it could cause parts of your lung to collapse or could increase your risk for pneumonia.

References

Other Works Consulted

  • Buchman TG, et al. (2004). Thoracic trauma. In JE Tintinalli, ed., Emergency Medicine: A Comprehensive Study Guide, 6th ed., pp. 1600–1601. New York: McGraw-Hill.
  • Collier BR, et al. (2007). Injuries to the thorax section of Wilderness trauma, surgical emergencies, and wound management. In PS Auerbach, ed., Wilderness Medicine, 5th ed., pp. 488–489. Philadelphia: Mosby Elsevier.
  • Consoli RJM (2007). Trauma section of Emergency Medicine. In RE Rakel, ed., Textbook of Family Practice, 7th ed., pp. 807–833. Philadelphia: Saunders Elsevier.
  • McGillicuddy D, Rosen P (2007). Diagnostic dilemmas and current controversies in blunt chest trauma. Emergency Medicine Clinics of North America, 25(3): 695–711.
  • Tzelepis GE, McCool FD (2005). Flail chest section of The lungs and chest wall disease. In RJ Mason et al., eds., Murray and Nadel's Textbook of Respiratory Medicine, 4th ed., vol. 2, pp. 2321–2325. Philadelphia: Elsevier Saunders.

Credits

Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Updated July 28, 2008

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