SIMPLE RIB FRACTURES

This is a break in the continuity of a rib(s). Could be traumatic or pathological.

Types of fractures

  • Crack fracture(s)
  • Single
  • Multiple fractures with fragment displacement
  • Segmental fracture(s).

Clinical Features

  • 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.

Caution:

The chest injury may be associated with splenic or liver injury, especially with higher and lower rib fractures.

Investigations

  • Physical examination
  • Chest radiograph; oblique views may be necessary

Management

  • 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
    250mg TDS.
  • Manage associated conditions.
  • Initiate chest physiotherapy.