ABSTRACT
Diagnosis of rib fractures is largely on clinical grounds and should be suspected in any patient with localized chest wall tenderness following blunt thoracic trauma. A negative chest radiograph does not rule out rib fracture, as up to 50% of rib fractures are not visualized on anterior-posterior (AP) chest radiographs 10. Chest radiographs in patients with suspected rib fractures are obtained to search for hemoor pneumothorax, lung contusion or other injuries. Treatment of rib fractures is largely supportive, emphasizing adequate analgesia and chest physiotherapy. Intercostal nerve blocks or epidural analgesia may be appropriate in patients with severe pain from multiple fractures or in the elderly. Epidural catheters provide the most effective pain control with minimal adverse effects. This method is the treatment of choice in patients with significant pain from multiple fractures and who are at high risk for respiratory complications. Strapping of the chest is not advocated because it can promote atelectasis and reduce vital capacity. Operative repair of rib fractures with plates and wires is indicated only if the bony chest wall injury is the primary reason for prolonged mechanical ventilation. Repair would be of no benefit if the mechanical ventilation were used to support the underlying pulmonary parenchymal contusion.
