This is a break in the continuity of a rib(s). Could be traumatic or pathological.
Types of fractures
- Crack fracture(s)
- Multiple fractures with fragment displacement
- Segmental fracture(s).
- There is history of trauma.
- Pain on breathing or movement.
- Evidence of chest trauma.
- Crepitus at the fracture site or tenderness.
- May have signs of associated haemo-pneumothorax
- Subcutaneous emphysema.
The chest injury may be associated with splenic or liver injury, especially with higher and lower rib fractures.
- Physical examination
- Chest radiograph; oblique views may be necessary
- Oxygen: Supplement if signs of respiratory distress are present.
- Analgesia: Administer pethidine and 2% lidocaine 2–5ml directly into fracture site; repeat once daily or after 3 days.
- Chest drainage: Insert tube as indicated. Admit patient for observation if fractures of the first rib and those of the 8th rib and below are present.
- Antibiotics: Give flucloxacillin 500mg QDS. For children less than 2 years give quarter adult dose; for older children, half adult dose. Antibiotics given because of the associated atelectasis. Mucolytic drugs, e.g., carbocisteine 750mg TDS for adults; children 2–5 years 62.5–125mg QID, while 6–12 years
- Manage associated conditions.
- Initiate chest physiotherapy.