rib fracture


Complications of rib fractures
Rib fracture complications. Structurally, each rib is located above the intercostal arteries, veins, and nerves. Therefore, the most critical issue with rib fractures is that they can cause severe pain for the patient. Thus, the main complication of a rib fracture is pain. This pain persists 24 hours a day, especially when the patient takes deep breaths, coughs, or turns over while sleeping during the night, which can awaken them due to the severe pain. Additionally, because of this pain, the patient is unable to cough effectively. Therefore, a large amount of phlegm, especially in smokers, accumulates in the lungs, leading to complications such as lung infections and pneumonia. Besides pain, another complication of rib fractures is the potential puncture of intercostal arteries or veins, which can cause hemothorax. This condition can result in a significant accumulation of blood in the pleural cavity, and a severe hemothorax can be life-threatening, especially a progressing hemothorax. Therefore, for patients with fractures of three or more ribs, it is recommended, according to the 2017 US guidelines for the treatment of internal fractures and the 2018 consensus from Chinese experts on internal fracture treatment, to actively proceed with surgical interventions. Studies have found that active surgical intervention for fractures of more than three ribs can significantly reduce the patient's pain, shorten hospital stays, and improve quality of life. In summary, the main complications of rib fractures include pneumothorax, hemothorax, pain, and resultant lung infections and pneumonia. These complications are crucial in the treatment of rib fractures and need to be actively addressed.


How to treat rib fractures well?
Rib fractures are very common. We consider fractures of three or fewer ribs to be stable fractures, which generally only require local external fixation using a rib belt or chest wrap to stabilize the fracture and alleviate pain. Additionally, treatments can include drugs that activate blood circulation and reduce stasis, anti-swelling and pain relief drugs, or non-steroidal anti-inflammatory drugs. Then, the fractures can heal on their own. However, if more than three ribs are fractured, we consider it an unstable fracture, which may need to be fixed. Such cases might require surgery to reposition and stabilize the fractured bones. Rib fractures themselves are not very concerning; what is concerning are the complications, such as hemothorax or pneumothorax. If conditions like pleural effusion or pneumothorax occur, it is advised to perform closed chest drainage by inserting a drainage tube to release the accumulated blood and air to avoid severe complications. Rib fractures do not require special treatment; with effective stabilization and treatment, most can fully recover.


Common sites of rib fractures
The most common sites for rib fractures are the fourth to tenth ribs, as they are more prone to fractures. The first to third ribs are relatively short and are protected by the scapula and clavicle. Additionally, the 11th and 12th ribs are quite mobile, making them less likely to fracture when subjected to external forces. Among the fourth to tenth ribs, the fourth to seventh ribs are the most susceptible to fractures, because their internal cartilage is relatively short, making these ribs the most likely to break when impacted.


How to care for a rib fracture
For a rib fracture, first, the patient should pay attention to rest. Local effective and secure external fixation should be done. You can tie a chest band or a rib fixation band on the affected area to stabilize the fracture, which can effectively relieve pain and is beneficial for the healing and growth of the fracture. Then, in terms of diet, it is important to consume high-protein, high-energy, high-nutrient, low-fat, and easily digestible food, such as fish, milk, eggs, lean meat, shrimp shells, and some fresh vegetables. These foods are rich in nutrients and also contain a lot of calcium, which helps the healing of fractures. This is the method of recuperation for a rib fracture.


How to recuperate from a rib fracture
After a rib fracture, it is suggested to pay attention to the following aspects in terms of care: Firstly, after a rib fracture, it is advisable to use a chest binder for protection, which generally needs to be fixed for about four to six weeks. Secondly, in terms of diet, it is important to enhance nutrition. Foods rich in high-quality protein, calcium, and vitamins should be consumed more frequently. These foods help provide nutrients for the recovery of the fracture and promote healing. At the same time, symptomatic medication treatment can be used. For example, anti-inflammatory and analgesic drugs, and traditional Chinese medicines that promote blood circulation and remove blood stasis can facilitate recovery. During the recovery period of the fracture, it is recommended to start rehabilitative exercises as soon as possible and encourage activities like coughing and expectorating to avoid complications such as obstructive pneumonia and lung collapse.


Can you move with a rib fracture?
After a rib fracture, the patient's limbs can still move, and movement of the limbs should generally not pose major problems. However, excessive movement can sometimes cause pain, as well as movement and displacement at the fracture ends. Therefore, it is generally advised that after a rib fracture, the patient should primarily rest and minimize movement, especially within the first two weeks of the acute phase, where bed rest is strongly recommended. Avoid strenuous activities, although some gentle exercise can be appropriate, but vigorous physical labor is not advised.


Is a rib fracture serious?
Whether a rib fracture is serious depends mainly on the extent of the fracture and the damage to the surrounding tissues. Generally, a single rib fracture or a non-displaced rib fracture is not serious and requires conservative treatment. However, if there are multiple rib fractures occurring at once, breaking several ribs, including possibly the sixth rib, the consequences can be very serious because it may result in a flail chest. Secondly, a rib fracture can potentially damage surrounding structures such as the pleura, lung tissue, and blood vessels, resulting in conditions such as pneumothorax, pleural effusion, and even active hemothorax, which must be promptly treated to avoid life-threatening situations. Thirdly, if a rib fracture heals in a deformed manner and is not treated, it can compress blood vessels and nerves, causing a persistent type of intercostal neuralgia even after healing. Apart from the local deformity, this situation often stimulates the intercostal nerves and may require surgical intervention. Therefore, the severity of a rib fracture depends mainly on the degree of the fracture and its aftermath, and typically requires assessment by a professional doctor.


How to treat rib fractures?
For the treatment of rib fractures, if it is a single or multiple closed fractures, and if there are no internal organ injuries, and the fracture alignment is good, non-surgical treatment can generally achieve good results. For example, using a chest bandage to secure and protect the area, generally immobilizing it for about 4 to 6 weeks, can effectively aid recovery. For multiple rib fractures, especially those accompanied by abnormal breathing, open fractures, or concurrent internal organ injuries, surgical treatment is primarily adopted. During the recovery period from the fracture, rest is important. If there is pain, some non-steroidal anti-inflammatory pain relief medications can be used to alleviate the pain. Additionally, during the recovery period, coughing should be encouraged to prevent complications such as lung infections or atelectasis. (Please use medication under the guidance of a doctor)


Symptoms of rib fracture and pneumothorax
Patients who have suffered a rib fracture typically experience localized pain which affects their ability to turn, bend, or perform normal movements such as breathing and coughing. If the rib fracture is accompanied by a pneumothorax, symptoms like chest tightness and breathlessness often occur. Diagnosing a rib fracture with pneumothorax requires an assessment of the patient's clinical symptoms along with various supportive examinations. For example, a chest CT scan can confirm the presence of a pneumothorax and determine the severity of the condition. In cases where the pneumothorax is severe and the lung compression exceeds one-third, it is necessary to actively pursue thoracic closed drainage surgery as treatment.


Will rib fractures swell?
Generally, swelling after a localized fracture is due to damage to the blood vessels in the area of the fracture. The bleeding that follows accumulates under the skin at the fracture site, causing obvious swelling. However, rib fractures are somewhat unique because after a rib fracture, the bleeding generally occurs internally, meaning the blood enters the chest cavity, leading to accumulation of blood and fluids within the chest. Generally, the blood does not accumulate under the skin. Therefore, rib fractures typically do not exhibit obvious swelling. There might be some local swelling, but it is usually not prominent. If not examined closely, it is generally not noticeable that there is significant swelling at the site of a rib fracture.