Rib Fracture

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A fracture is any break in the continuity of bone. Fractures are named according to their severity, the shape or position of the fracture line, or even the physician who first described them. It is defined according to type and extent. In some cases, a bone may fracture without visibly breaking. Fractures occur when the bone is subjected to stress greater than it can absorb. It can be caused by a direct blow, crushing force, sudden twisting motion, or even extreme muscle contraction. When the bone is broken, adjacent structures are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels. Body organs may be injured by the force that caused the fracture or by the fracture fragments. Among the common kinds of fractures are the following:

§ Open (compound) fracture: The broken ends of the bone protrude through the skin. Conversely, a closed (simple) fracture does not break the skin.

§ Comminuted fracture: The bone splinters at the site of impact, and smaller bone bone fragments lie between the two main fragments.

§ Greenstick fracture: A partial fracture in which one side of the bone is broken and the other side bends; occurs only in children, whose bones are not yet fully ossified and contain more organic material than inorganic material

§ Impacted fracture: One end of the fractured bone is forcefully driven into the interior of the other.

§ Pott’s fracture: A fracture of the distal end of the lateral leg, with one serious injury of the distal tibial articulation.

§ Colles’ fracture: A fracture of the distal end of the lateral forearm in which the distal fragment is displaced posteriorly.

Fractures may also be described according to anatomic placement of fragments, particularly if they are displaced or nondisplaced.

Causes

Rib fracture is any break in a rib. There may be one or more breaks. An injury, such as a blow to the chest or a fall, forces the broken rib inward. The jagged edges of the broken rib could cut or tear the lung. This could cause bleeding inside the chest or could cause one of the lungs to collapse (deflate). Hard coughing or hard sneezing can also fracture a rib but the broken rib is forced outward. With this kind of fracture there is less chance of injury to the lungs. Rib fractures usually heal on their own without treatment in about 3 to 6 weeks.

Rib fractures are the most common type of chest trauma, occuring in more than 60% of patients admitted with blunt chest injury. Most rib fractures are benign and are treated conservatively. Fractures of the first three ribs are rare but can result in a high mortality rate because they are associated with laceration of the subclavian artery or vein. The fifth through ninth ribs are the common sites of fractures. Fractures of the lower ribs are associated with injury to the spleen and liver, which may be lacerated by fragmented sections of the rib.

Signs & Symptoms

Patients with rib fractures have clinical manifestations such as severe pain, point tendernessa and muscle spasm over the area of the fracture, which is aggravated by coughing, deep breathing and movement. The area around the fracture may be bruised. To reduce the pain, the patient splints the chest by breathing in a shallow manner and avoids sighs, deep breaths, coughing, and movemnet. This reluctance to move or breathe deeply results in diminished ventilation, collapse of unaerated alveoli (atelectasis), pneumonitis, and hypoxemia. Respiratory insufficiency and failure can be the outcomes of such a cycle.

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