Rib fracture management

Abstract

### Key points Trauma is a major cause of morbidity and mortality worldwide, and the leading cause of death in the first four decades of life. Rib fractures are very common and are detected in at least 10% of all injured patients, the majority of which are as a consequence of blunt thoracic trauma (75%) with road traffic collisions being the main cause. The remaining 25% are due to penetrating injuries. Rib fractures are associated with significant morbidity, with patients frequently requiring admission to the intensive care unit (ICU), and mortality rates as high as 33%.1 This morbidity and mortality associated with rib fractures is caused by three main problems: hypoventilation due to pain, impaired gas exchange in damaged lung underlying the fractures, and altered breathing mechanics. Pain associated with rib movement reduces the tidal volume and predisposes to significant atelectasis. This can further lead to retention of pulmonary secretions and pneumonia. An injury severe enough to fracture ribs, especially if so significant as to cause a flail segment, will invariably cause a substantial contusion to the underlying lung. The lung becomes oedematous with varying degrees of haemorrhage and necrosis. The damaged lung is poorly compliant and will not take part in gas exchange, leading to intrapulmonary shunting and a decrease in P a O 2 . In the presence of a flail segment, the generation of negative intrapleural pressure produces paradoxical movement of the flail, causing it to move inward, while the rest of …