Content Reviewers:Antonia Syrnioti, MD, Ashley Mauldin MSN, APRN, FNP-BC, Lisa Miklush, PhD, RNC, CNS, Gabrielle Proper, RN, BScN, MN
Contributors:Abbey Richard, Mathew Pietri, Evan Debevec-McKenney, Ahmed A. Abu Ajeene, Katherine May, BSN, RN
Now, there are 12 ribs on each side of the chest, with each rib attaching posteriorly to the thoracic vertebrae, and ending anteriorly as costal cartilage. There are three types of ribs: true, false, and floating ribs. The first seven pairs of ribs are true ribs, and they attach directly to the sternum through costal cartilages. The 8th, 9th, and 10th pairs of ribs are false ribs, and they attach indirectly to the sternum through the costal cartilage of the 7th rib. The last two pairs of ribs are called floating ribs because they don’t attach to the sternum at all.
Now, the ribs form the side component of the thoracic cage, which provides support and protection for the thoracic structures, such as the heart, lungs, and blood vessels. Other functions of ribs include increasing or decreasing the thoracic volume to facilitate breathing, in addition to providing attachment points for muscles.
The main cause of rib fractures is direct trauma to the chest, which can be caused by falls, child abuse, and car crashes. Rib fractures can also be caused by repetitive chest trauma, which might be due to recurrent cough or engagement in certain sports, such as golf or tennis.
Risk factors for rib fractures include modifiable ones, such as osteoporosis, engagement in contact sports, and malignant bone tumors involving the ribs; as well as non-modifiable ones, such as advanced age.
Regardless of the cause, fractures typically happen in ribs four through ten, and can be associated with several complications. A fractured rib that’s sharp, splintered, or displaced may damage or pierce nearby organs and tissues, such as the pleura or lungs, leading to pneumothorax, which is when there’s air from the injured lung leaking into the pleural cavity, and that doesn’t allow the lung on that side to expand properly. This may lead to atelectasis or collapse of the alveoli in the lung.
Since clients with rib fractures have trouble breathing or coughing up airway secretions, they are also at an increased risk of developing pneumonia. In severe cases, the broken rib can tear the aorta, injure internal organs, such as the spleen, liver, or kidneys or damage the diaphragm. Another complication is a flail chest, which is when three or more ribs fracture in two or more places, which can allow a big segment of the thoracic wall to move freely. This is an extremely painful injury that impairs ventilation, and, as a consequence, blood isn’t properly oxygenated.
Clients with rib fractures typically present with pain at the site of the fracture, which intensifies with breathing, moving, coughing, or even sneezing. Some clients also splint, meaning that they support the area when deep breathing or coughing in an effort to limit chest movement and reduce pain.
The diagnosis of rib fractures starts with the client's history and physical assessment, followed by a chest X-ray. This can help look for complications, particularly pneumothorax, and sometimes also shows the site of fracture. A CT scan can also help detect the fractures missed on X-ray. In cases of fractures resulting from repetitive trauma, a bone scan might also be useful. This is where a nuclear substance is injected into the body and then taken up by bones at the site of the fracture.
All right, now the treatment of rib fractures typically involves pain management, supplemental oxygen, as well as chest physiotherapy to prevent pneumonia. With these measures, rib fractures typically heal on their own within six weeks. Clients with a complex fracture can be treated with rib-stabilization surgery, where plates and screws are used to stabilize the ribs while they heal. Lastly, clients with severe or chronic pain may benefit from intercostal nerve block, where a local anaesthetic is injected around a nerve to temporarily block the sensation of pain