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Inpatient management of traumatic rib fractures

Eileen M Bulger, MD, FACS
Section Editor
Joseph S Friedberg, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Multiple rib fractures are the consequence of significant forces impacting the chest wall and are most commonly due to blunt injuries (eg, motor vehicle crash, falls, assault), but penetrating injuries (eg, gunshot) can also fracture multiple ribs. Rib fractures are present in 10 percent of all trauma patients and about 30 percent of patients with significant chest trauma. The presence of intrathoracic injury correlates directly with the number of fractured ribs [1,2]. Fracture of multiple ribs in more than one location can lead to flail chest (or open chest wound) significantly compromising respiratory function [3]. The main goals in the treatment of multiple rib fractures are control of pain, support of respiratory function, and stabilization of the chest wall either through mechanical ventilation or surgical fracture fixation.

This topic review will discuss inpatient management of multiple traumatic rib fractures. The general approach to blunt chest trauma and general considerations for single or nontraumatic rib fractures are discussed elsewhere. (See "Initial evaluation and management of blunt thoracic trauma in adults" and "Initial evaluation and management of rib fractures".)


The initial resuscitation, diagnostic evaluation, and management of the patient with blunt or penetrating injury is based upon protocols from the Advanced Trauma Life Support (ATLS) program, established by the American College of Surgeons Committee on Trauma. (See "Initial management of trauma in adults".)

The initial resuscitation and evaluation of the patient with blunt or penetrating abdominal or thoracic trauma is discussed in detail elsewhere. (See "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults" and "Initial evaluation and management of blunt thoracic trauma in adults" and "Initial evaluation and management of penetrating thoracic trauma in adults".)

Because an increasing number of rib fractures are clearly associated with increased morbidity and mortality, the presence of three or more rib fractures suggests the need for hospitalization or transfer to a regional trauma facility [1,4-8]. The presence of six or more rib fractures is associated with significant increases in mortality, usually due to associated injuries. Elderly patients (age >65 years) are at increased risk of complications associated with rib fracture, and thus hospital admission should be considered for any elderly patient. (See 'Associated injuries' below and 'Morbidity and mortality' below.)


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Literature review current through: Mar 2017. | This topic last updated: Aug 15, 2016.
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