Rib fractures result from trauma to the chest and can be life-threatening if left untreated.

Ribs are long, thin bones that are prone to breaking from direct trauma to the chest (such as a car crash, fall, or assault) or repetitive trauma (such as forceful coughing or sports). Rib fractures can occur at any age, but elderly patients are at higher risk because of osteoporosis (brittle bones). Sometimes the ribs crack, and other times they completely break into 2 or more pieces. The more rib fractures a patient has, the more dangerous they can be. In patients older than 65 years, each additional rib fracture increases the risk of pneumonia by 27% and the risk of death by almost 20%. As such, prompt evaluation by a doctor is crucial.

The most common symptom of rib fractures is pain with touch, taking a deep breath, sneezing, or coughing. Because these fractures are quite painful, patients splint when they breathe, meaning that they take short shallow breaths, and minimize movement. This can lead to collapse of the air sacs in the lungs, which makes breathing even harder and can subsequently lead to pneumonia. Chest x-ray is a useful first test in determining if a patient has rib fractures. However, a normal x-ray result does not rule out a fracture, and if the suspicion is high enough, a computed tomography scan should be obtained. Often, the initial trauma that caused the rib fractures can also lead to other chest injuries such as bruising of the lungs, bleeding in the chest, or air leaking from the lung (pneumothorax). Flail chest occurs when 2 or more consecutive ribs are broken in at least 2 places, making that segment of the chest move paradoxically (opposite from the rest of the chest wall), and is often associated with more severe underlying lung injury.

Multidisciplinary management of patients with rib fractures is important and may include trauma surgeons, pain specialists, pulmonologists, and physical and occupational therapists. The key to rib fracture treatment is pain control, breathing exercises to maintain the lungs fully inflated, and physical therapy. Because the risk of complications increases with age, older patients may require hospitalization, sometimes in an intensive care unit. In general, many different types of pain medications are used at the same time for pain control. Some of these include nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentin, lidocaine, narcotics, and muscle relaxers. If these are not sufficient, then a nerve block or an epidural catheter may be used to provide pain control in the region of the fractures. Treatment of rib fractures is considered completed when a patient can take deep breaths, cough effectively, and walk without significant discomfort. If the broken ribs are bent or displaced in such a way that they puncture the lungs, surgery might be needed to put the ribs back together using thin steel plates (called rib plating). Similarly, flail chest may require surgical rib fixation. Rib fractures can take up to 3 months to fully heal.