A rib fracture is a fairly common musculoskeletal injury caused by impact trauma (a fall, car accident or collision during a football match), excessive fatigue (continuous swing movements while playing golf) or a severe coughing fit. There are different levels of severity, from stress micro-fractures to more complex ones in which the bone has shattered into sharp-edged pieces; consequently, the associated complications can also be more or less painful and become life-threatening, such as pneumothorax (perforation of the lung). By learning to evaluate a potential injury of this type at home, you can decide whether to go to the emergency room; however, remember that only a doctor can confirm the diagnosis. If in doubt about a painful injury involving the rib cage, err on the side of caution and go to the hospital.
Steps
Part 1 of 2: Assessing the Fracture at Home
Step 1. Understand the basic anatomy
The human being has twelve ribs, whose function is to protect the internal organs and provide support to the numerous muscles that allow breathing and movement. The ribs are joined to the twelve thoracic vertebrae and most converge towards the sternum, the frontal bone of the chest. The few "floating" ribs at the bottom protect the kidneys and do not join the breastbone; the upper ones are located near the neck (below the collarbones), while the lower ones are located a few centimeters above the pelvis. Typically, you can feel them through the skin, especially in thin people.
- The ribs that fracture most frequently are the central ones (from the fourth to the ninth); usually, they break at the point where they receive the impact or at the point of maximum curvature, which is also the weakest and most vulnerable.
- This type of trauma is less common among children, because their bones are more elastic (the cartilage content is greater than that of adults) and therefore a great deal of strength is required to be able to break them.
- Osteoporosis is a risk factor for rib fracture; it is a common disease among the population over 50, characterized by the loss of bone minerals.
Step 2. Look for swollen deformities
Take off your shirt and look at the area of your torso where the pain is coming from. Stress microfractures do not cause any deformation, but you should be able to identify the area that is painful to the touch and you may notice some swelling, especially if you have suffered an impact. In severe cases (multiple fractures involving multiple ribs or bones that have separated from the chest walls), you may notice a rib volet; this term indicates the phenomenon whereby the fractured chest wall moves in the opposite direction to the intact half during breathing. This is a serious trauma, because the bones move closer to the lungs when the person inhales, while the rest of the chest expands and then moves away on exhalation when the chest contracts. The most severe fractures are very painful, generate more significant edema (inflammation) and are accompanied by the rapid formation of a hematoma due to the ruptured blood vessels.
- Generally, it is easy to recognize a costal volet when the victim is supine and bare chest; just observe while he breathes and listen to lung noises.
- Intact ribs are quite elastic when subjected to pressure; the fractured ones are rather unstable and maintain the position after being crushed, causing intense pain.
Step 3. Notice if the pain increases with deep breathing
Another typical sign of this injury, including microfractures, is greater pain or pain during deep breaths; the ribs move with each breath, so it hurts to inhale deeply. In severe cases, even a superficial movement can be very difficult and extremely painful; consequently, the victim breathes quickly and superficially, triggering hyperventilation and also cyanosis (bluish color of the skin due to lack of oxygen).
Step 4. Check the range of motion
Another symptom of a rib fracture is a reduction in torso movements, especially lateral movements. Patients who have suffered this trauma are unable or hesitant to twist and flex the trunk laterally. The fracture and related muscle spasm prevent movement or the pain is so intense that the person gives up. Again, small stress injuries (microfractures) are less disabling than more severe ones.
- Fractures in which the cartilage joint that secures the ribs to the breastbone breaks is particularly painful, especially during rotational movements of the torso.
- Even in cases of microfractures, the combination of reduced motility, impaired respiratory capacity and pain largely limits the ability to exercise and be active; practicing sports is virtually out of the question during the healing period.
Part 2 of 2: Getting a Medical Diagnosis
Step 1. Go to the family doctor
If you or a family member have suffered a trauma that causes persistent pain in the trunk, you should go to the doctor for a thorough examination and evaluate a plan of action; even if the suffering is relatively mild, it is worth going to a professional.
Step 2. Know when to go to the emergency room
Emergency care is essential for life-threatening complications, such as pneumothorax. The signs and symptoms of pulmonary perforation are: severe difficulty in breathing, sharp or piercing pain in the chest (in addition to that related to the fracture), cyanosis, shortness of breath and severe distress.
- Pneumothorax is a situation in which air gets trapped between the rib cage and lung tissue and one of its causes includes a fractured rib that tears the lung.
- Other internal organs can also be damaged or pierced by a broken stump of bone, such as the kidneys, spleen, liver and, although rarely, the heart.
- If you suffer from any of the symptoms described above, go to the nearest emergency room or call 911.
Step 3. Get an X-ray
Together with the physical exam, radiography allows for visualization of the bone and is an effective diagnostic tool for assessing the presence and severity of most rib fractures. However, stress ribs (which are often referred to as "cracked" ribs) are difficult to recognize through the plates, because they are very thin; consequently, a second X-ray is done once the edema has subsided (within a week or so).
- Chest x-rays are useful in diagnosing pneumothorax because fluids and air can be seen in the x-ray.
- They are also able to show bone bruises which are sometimes mistaken for fractures.
- If the doctor has established the fracture site within a certain margin of safety, he may order an even more localized x-ray to obtain an enlarged image.
Step 4. Get a computed tomography scan
Microfractures are not serious injuries and usually resolve spontaneously with short-term use of pain relievers or anti-inflammatories. This test is often able to reveal undiagnosed lesions with X-rays, and also makes it easier to view damaged organs and blood vessels.
- During the exam, numerous x-rays are taken from different angles and a computer combines the images to show cross sections of the body.
- Computed tomography is a more expensive exam than x-rays, so doctors only do this if the x-rays are inconclusive.
Step 5. Get a bone scan
During the examination, a small amount of radioactive material (radiopharmaceutical) is injected into a vein. The substance "travels" through the blood to bones and organs. When disposed of, the radiopharmaceutical leaves a small residual radiation which is picked up by a special video camera that slowly examines the whole body. Since fractures show up as brighter areas, stressful fractures can also be seen better, although the area is still inflamed.
- Bone scan is effective for visualizing microfractures; however, these lesions are not clinically significant and the potential side effects of the procedure may not be justified.
- The main negative reactions include allergic reactions to the radiopharmaceutical that is injected before the examination.
Advice
- In the past, doctors usually used compression bandages to immobilize fractured ribs; this procedure is no longer recommended because it reduces the ability to breathe deeply and increases the risk of pneumonia.
- In most cases, treatment involves resting, applying cold packs, and using painkillers or anti-inflammatories for a short time; ribs cannot be cast like other bones.
- When you have broken ribs, the supine position is the most comfortable for sleeping.
- It is recommended that you perform deep breathing exercises several times a day to reduce the risk of pneumonia.
- Supporting the chest wall by applying a little pressure to the broken ribs reduces the acute pain caused by coughing, straining, and so on.
