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Inpatient management of traumatic rib fractures

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


Traumatic 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 ribs. Rib fractures are present in 10 percent of all trauma patients and approximately 30 percent of patients with significant chest trauma. The number of fractured ribs also directly correlates with the presence of intrathoracic injury [1,2].

Multiply fractured ribs or flail chest can significantly compromise respiratory function. Pneumonia is often the common pathway to acute respiratory failure resulting from rib fractures, and prevention offers the best means to avoid potentially preventable deaths [3]. The main goal of treatment is to prevent pneumonia and other complications of rib fractures (eg, nonunion), and conservative treatment includes pain control and aggressive supportive pulmonary care to avoid the need for intubation. For some patients in whom these conservative measures are not adequate, rib fracture stabilization may be beneficial.

Although less common, chronic, forceful coughing, as may be seen in patients with severe asthma, cystic fibrosis, or poorly controlled emphysema, can also result in rib fractures [4]. General considerations for single or nontraumatic rib fractures are discussed separately. (See "Initial evaluation and management of rib fractures".)

This topic review will discuss inpatient management of multiple traumatic rib fractures. Specific techniques for surgical stabilization of rib fractures are reviewed separately. (See "Surgical management of severe 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. The initial resuscitation and evaluation of the patient with blunt or penetrating thoracic trauma is discussed in detail elsewhere.


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Literature review current through: May 2017. | This topic last updated: May 30, 2017.
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