Symptoms of rib fracture and pneumothorax

Written by Cheng Bin
Orthopedics
Updated on September 05, 2024
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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.

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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.

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Do rib fractures require surgery?

If there is a fracture of a single rib or a single spot with minor displacement, conservative treatment can be chosen without the need for surgery. However, if multiple ribs are fractured in multiple sections, it affects breathing, clinically known as flail chest. This condition can cause severe pain and breathing difficulties, and possibly fluid accumulation in the chest cavity. In such cases, surgery is required to reposition and stabilize the fractures, facilitating recovery. Therefore, whether surgery is needed should be based on the analysis of the injury.

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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.

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What are the symptoms of a rib fracture?

When a rib fracture occurs, there is initially localized pain, particularly exacerbated during breathing, and increased pain during pressing on the ribcage. Early on, there may be no respiratory or pulmonary inflammation, but if there is no systematic treatment and no rest, this could lead to breathing difficulties and signs of inflammation in the chest cavity. Additionally, if multiple ribs are fractured at multiple sites, a condition known as flail chest may occur.

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How to sleep with a rib fracture

For rib fractures requiring bed rest, wearing a chest brace for protection is advisable. During the initial 2 to 4 weeks, sleeping positions should be such that they do not cause pain. In cases of multiple rib fractures, pain might occur irrespective of whether the patient is lying on their back or side. Therefore, there are no special requirements for sleeping positions; it should be whatever position causes the least pain locally. A chest brace can also be used to help minimize the pain caused by friction between the fractured ends of the bones. In addition, it is recommended to consume foods rich in calcium and take oral bone-healing calcium supplements to promote fracture healing, as this is the fundamental way to alleviate pain.