Rib fracture 3634070 222795624 2008-07-01T04:04:40Z Delldot 476500 see also [[pulmonary toilet]], copyedit using [[Project:AutoWikiBrowser|AWB]] {{Infobox_Disease | Name = Rib fracture | Image = | Caption = | DiseasesDB = 11553 | ICD10 = {{ICD10|S|22|3|s|20}}-{{ICD10|S|22|4|s|20}} | ICD9 = {{ICD9|807.0}}, {{ICD9|807.1}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = emerg | eMedicineTopic = 204 | }} A '''rib fracture''' is a break or [[bone fracture|fracture]] in one or more of the [[bone]]s making up the [[rib cage]]. The ''[[first rib]]'' is rarely fractured because of its protected position behind the [[clavicle]] (collarbone). However, if it is broken serious damage can occur to the [[brachial plexus]] of [[nerve]]s and the [[subclavian]] vessels. Fractures of the first and second ribs may be more likely to be associated with [[head injury|head]] and facial injuries than other rib fractures.<ref name="Hwang96"/> The ''middle ribs'' are the ones most commonly fractured. Fractures usually occur from direct blows or from indirect crushing injuries. The weakest part of a rib is just anterior to its angle, but a fracture can occur anywhere. The most commonly fractured ribs are the 7th and 10th.<ref name="Hwang96"> {{ cite journal |author= Hwang JCF, Hanowell LH, Grande CM |title=Peri-operative concerns in thoracic trauma |journal= Baillière's Clinical Anaesthesiology |volume = 10 |issue = 1 |page=123–153 |doi= doi:10.1016/S0950-3501(96)80009-2 | date=1996 }} </ref> A ''lower rib'' fracture has the complication of potentially injuring the [[diaphragm (anatomy)|diaphragm]], which could result in a [[diaphragmatic hernia]]. Rib fractures are usually quite painful because the ribs have to move to allow for [[breath]]ing. Even a small crack can inflame a tendon and cripple an arm. When several ribs are broken in several places a [[flail chest]] results, and the detached bone sections will move separately from the rest of the chest. ==Causes== Rib fractures can occur without direct trauma and have been reported after sustained [[cough]]ing and in various [[sport]]s &ndash; for example, [[rowing (sport)|rowing]] and [[golf]] &ndash; often in elite [[sportsperson|athlete]]s. They can also occur as a consequence of diseases such as cancer or infections ([[pathological fracture]]). [[Fragility fracture]]s of ribs can occur due to diseased bone structure, e.g., [[osteoporosis]] and [[metastasis|metastatic]] deposits. == Diagnosis == Broken ribs are often indicated by the following [[symptom]]s: * Pain when breathing or with movement * A portion of the chest wall moving separately from the rest of the chest (flail chest) * A grating sound with breathing or movement * Where the [[mechanism of injury]] would indicate substantial force to the ribs Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe [[thorax|thoracic]] injuries such as [[pulmonary contusion]].<ref name="Wanek04"> {{ cite journal |author=Wanek S, Mayberry JC |title=Blunt thoracic trauma: Flail chest, pulmonary contusion, and blast injury |journal=Critical Care Clinics |volume=20 |issue=1 |pages=71–81 |year=2004 |month=January |pmid=14979330 |doi=10.1016/S0749-0704(03)00098-8 |url= }} </ref> Rib fractures are also a sign of more serious injury in elderly people.<ref name="Wanek04"/> ==Treatment== There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Adequate [[analgesic|analgesia]] can avoid this. Flail chest is a potentially life-threatening injury and will often require a period of [[mechanical ventilation|assisted ventilation]]. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying [[viscus|viscera]] (e.g., lung [[bruise|contusion]]) or remotely (e.g., C spine injury). Spontaneous fractures in sportspeople generally require a cessation of the cause, e.g., time off rowing, whilst maintaining cardiovascular fitness. ==See also== *[[Pulmonary toilet]] ==References== <references/> {{Fractures}} {{Chest trauma}} [[Category:Chest trauma]] [[Category:Bone fractures]] [[de:Rippenfraktur]] [[ru:Переломы рёбер]]