Rib fracture

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Contributors: Michael W. Winter MD, Benjamin L. Mazer MD, MBA

Alerts and Notices

Synopsis

Rib fracture is a common injury of the thoracic cage. It may be traumatic or pathologic. Depending on location and number of ribs involved, be alert for possible internal injuries, pulmonary contusions, pneumothorax, liver or splenic rupture, or vascular injury. Common signs and symptoms include chest tenderness or pain, decreased breath sounds, bony crepitus, pain on inspiration, dyspnea, and tachypnea.

In children, certain fractures should increase suspicion for nonaccidental trauma, including rib fracture, often in the context of delay to seek medical care or temporal or factual inconsistencies in patient history.

Depending on the location and number of fractured ribs, treatments include body repositioning, medication for pain and inflammation control (topical NSAIDs may be especially effective; resources for opioid prescribing guidelines, as well as nonopioid alternatives, can be found here), ventilation, and incentive spirometry. Elderly patients and those with pulmonary disease require close monitoring for complications due to secretions, including pneumonia, hypoventilation, and atelectasis.

Codes

ICD10CM:
S22.39XA – Fracture of one rib, unspecified side, initial encounter for closed fracture
S22.39XB – Fracture of one rib, unspecified side, initial encounter for open fracture

SNOMEDCT:
33737001 – Fracture of rib

Differential Diagnosis & Pitfalls

• Esophagitis
• Pneumothorax
• Pulmonary embolism
• Acute coronary syndrome
• Coronary artery disease
• Aortic dissection

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