Rib Fracture (Broken Ribs): Symptoms, Treatment, Healing Time | medical society (2023)

Description of the broken rib

A fractured rib (rib fracture) is the most common injury to the rib cage, particularly the 4th through 9th ribs (source). If one and the same rib isbroken not only in one place, but also in another place at the same time, it's a breakpieces (break into pieces). If the doctor diagnoses aserial rib fracture, someone has broken three or more ribs on the same side of their chest.

First aid for broken ribs

In general, first aid for a broken rib is recommended to immobilize the injured body part. In the case of a broken arm or leg, this is relatively easy to do. It's more difficult with a broken rib (fractured rib)—the sufferer has to keep breathing, and each time the broken rib (fractured rib) is moved slightly. However, as a first responder, there is something you can do to prevent a broken rib (rib fracture):

• Calm the affected person down.
• Place the affected person's arm in a sling (such as a triangle sling) on ​​the injured side. If necessary, you can secure the sling with another cloth that wraps around the injured person's upper body.
• Alternatively, you can gently wrap an elastic bandage around the victim's chest at the level of the fracture.
• What else you can (and should) do if you have a broken rib: Take the injured person to a hospital or call an ambulance.

Causes of rib fractures

A broken rib (rib fracture) is usually the result of a direct or indirect trauma, i.e. an external force. This happens, for example, when someone slips in the bathroom and hits their ribs on the sink or the edge of the bathtub. Falling down stairs is also a common cause of broken ribs.

More rarely, a broken rib is a disease-related fracture. For example, bone metastases (tumors that develop from a tumor in the bone) and osteoporosis (bone loss) can be the cause of a broken rib (rib fracture).

symptoms

Typical broken ribsThe symptoms are painon the affected side, which increases with deep inhalation and exhalation, coughing, sneezing, and exercise. Also, pressing on the broken rib hurts. You may also hear a noise (such as a crunch) and feel a build-up of air (emphysema). In some cases, you can feel the broken rib on the outside like a kick in the skin. This applies to a closed fracture. An open fractured rib has a bone fragment protruding from the skin.

It is not possible to distinguish with the naked eyerib bruise(intact bone) and broken rib (broken bone). Even the symptoms are similar. Only a doctor can then make the correct diagnosis.

scratch

It usually becomes dangerous when the broken rib is accompanied by other injuries or complications:

• Serial rib fractures in particular can allow air or blood to enter the space between the pleura and the lungs (the pleural space) - a pneumothorax (abnormal accumulation of air in the chest) or hemothorax (a buildup of blood in the chest). ) developed.
• If air collects in the mediastinum, this is called a pneumomediastinum.
• A serial rib fracture can limit breathing, not only because of the pain, but also because of the unstable chest wall.
• In an accident, in addition to a broken rib (rib fracture), the lungs can also be crushed or injured.
• If the first or second rib is fractured in an accident, large vessels can be injured (e.g., subclavian and venous arteries and aorta).
• The accident can also cause bruising in the lungs.
• Injuries to the trachea, heart muscle, surrounding nerves, and (if the lower ribs are fractured) the liver, spleen, kidneys, and diaphragm are also possible.
• If not only a rib but also the breastbone is broken, the heart and lungs can also be crushed. The thoracic spine can also be damaged.

When to the doctor?

If you suspect a broken rib, you should always see a doctor. The specialist for such an injury is a specialist in orthopedics and trauma surgery.

Medical help is particularly urgent when the injured person has increasing difficulty breathing and circulatory problems. Both indicate a complex chest injury.

Diagnosis and Tests

The doctor treating you will first ask you or the injured person exactly how the broken rib (rib fracture) came about, what symptoms occur and whether there are previous illnesses (e.g. osteoporosis) (anamnesis). Possible questionsIntervieware for example

• Did an accident cause the injury? If yes, how did it happen?
• Where exactly does it hurt?
• Can you describe the pain in more detail (stabbing, dull, etc.)?
• Are there other symptoms?
• Has there been any previous injury or damage in this area?

After the conversation, the doctorexamine physicallythe patient. He will examine the injured area, looking for abnormalities such as poor positioning or swelling. By applying gentle, targeted pressure to the chest, he can pinpoint the location of the possible rib fracture more precisely. The doctor also palpates and auscultates the lungs for signs of possible concomitant injuries (e.g. accumulation of air or blood in the pleural space).

Imaging tests can confirm a suspected rib fracture (broken ribs) and provide information about the type and extent of the injury. Essentially, this involves arib x-rayCage (X-ray).

If no fracture is visible on the first x-ray, this does not necessarily rule out a rib fracture. A fractured rib can often only be seen on an x-ray several weeks later, when callus (newly formed bone tissue) is visible.

Sometimes doctors also order a computed tomography (CT) scan, for example when the X-rays are unclear or other lesions (for example in the lungs) are suspected.

In the case of a deep rib fracture (fracture of the ninth to twelfth ribs), the doctor should check whether the liver (right side) or spleen (left side) is also injured. This usually happens during aultrasound examination.

Treatment of fractured ribs (broken ribs)

Rarely does a doctor have to operate on a broken rib. In most cases, conservative treatment is sufficient.

A tape or tile bandage may be applied to young athletic patients with an isolated rib fracture (broken ribs). However, a broken rib (broken ribs) is usually not fixed with a bandage, otherwise there is a risk that the patient will get pneumonia - with a bandage on the chest, some patients breathe very shallowly, so that the lungs are not sufficiently ventilated.

The conservative treatment of a broken rib (rib fracture) essentially consists of pain therapy and respiratory therapy.

pain management

The pain of a broken rib can be relieved in a number of ways:

• With moderate to moderate pain, the patient can takenonsteroidal analgesics(including diclofenac and ibuprofen).Opioids(very strong painkillers) are needed for severe pain.
• Fornerve blockthe doctor injects a local anesthetic into the lower edge of the affected rib. This numbs the intercostal nerves, leaving the patient pain-free for about six to eight hours.
• Emthorakale Epiduralanästhesiethe doctor injects painkillers or local anesthetics into the epidural space in the spinal canal. As a result, pain-conducting nerve fibers are inhibited for some time.

Thoracic epidural anesthesia is used in particular for severe pain, serial rib fractures (rib fractures) and bilateral fractures.

Respiratory therapy for broken ribs

Chest physiotherapy is the second line of treatment for rib fractures (broken ribs). Here the patient is instructed to breathe more deeply. In addition, certain breathing techniques and inhalations help to cough up bronchial secretions (pneumonia prophylaxis!). Respiratory therapy can be performed on an outpatient basis.

inpatient treatment

Some patients with fractured ribs (broken ribs) should be hospitalized as inpatients. This may be necessary, for example, in the case of a serial rib fracture (broken ribs) or a fracture of the first to third ribs. Patients can be carefully monitored and treated in the hospital.

Even with severe accompanying complications and injuries, inpatient treatment is usually required.

forecast

A broken rib is usually harmless and heals without complications.

In a serial rib fracture (ribs fractured in series, i.e. fracture of three or more ribs), respiratory mechanics may be compromised. Less commonly, a fractured rib causes an injury to the pleura that results in a pneumothorax (air chest). Left untreated, these complications of a broken rib can become life-threatening. With early treatment, however, they are easily manageable and heal without consequences.

Cracked Ribs (Broken Ribs): Healing time

For broken ribs, the length of recovery depends mainly on whether there are any complications. A fractured rib usually heals without complications in four to six weeks. If symptoms persist beyond this period, the cause may be delayed bone healing or, in rare cases, painful nonunion (no new bone tissue forming to fill the fracture site).