(See also Introduction to Chest Injuries.)
Rib fractures usually result from strong blunt force, such as a fall from a height, a motor vehicle crash, or a hit with a baseball bat. However, sometimes in older people who have osteoporosis, only a slight force (as occurs in a minor fall) is required.
The fracture itself is rarely serious, although the force that caused the fracture occasionally causes other problems, such as a bruised lung (pulmonary contusion) or a collapsed lung (pneumothorax). An injury that fractures the lower ribs sometimes also damages the liver or spleen. The more ribs that are broken, the more likely lungs or other organs are to be damaged.
Flail chest can result if several adjacent ribs are broken in more than one place. In flail chest, a segment of the chest wall separates from the rest and moves in the opposite direction from the rest of the chest wall when a person breathes. Breathing becomes more difficult and tiring. Usually, a blow strong enough to cause flail chest also bruises the lung beneath the injured area (called pulmonary contusion).
Rib fractures cause severe pain, particularly when people breathe deeply. The pain lasts for weeks.
Because older people are more likely to develop these complications, they also have a higher risk of death due to a rib fracture than do younger people.
Doctors suspect rib fracture when one or more ribs are very tender in one particular spot. Sometimes doctors can feel the broken ribs when they gently push the injured area. Doctors do not always need to confirm rib fractures with an x-ray because the presence of rib fractures does not change the way a chest injury is treated. Nonetheless, doctors usually do a chest x-ray to detect serious problems that can accompany rib fractures, such as a bruised or collapsed lung. Not all rib fractures can be seen on a chest x-ray.
Regardless of whether rib fractures are identified, people are given pain relievers (analgesics). Those with severe pain are usually given opioid pain relievers such as oxycodone or hydrocodone. Sometimes hospitalized people who have severe pain are treated by numbing the nerve to the affected ribs or with injection of drugs around the spinal cord (epidural analgesia).
People with a rib fracture are asked to cough or breathe deeply about once an hour while they are awake to keep the air sacs in the lung open and prevent pneumonia.
People with several rib fractures may need to be treated in the hospital.
People with flail chest often need to have their breathing supported with a ventilator until the injuries heal. Some people with flail chest may need surgery to reduce the risk of complications, including pneumonia, lengthy hospital stays, and death.