Skip to main content

Medical Management of Rib Fractures

  • Chapter
  • First Online:
Rib Fracture Management
  • 1272 Accesses

Abstract

Rib fractures are reported in at least 10% of all trauma admissions. The associated morbidity and mortality worsen with advanced age and increasing number of rib fractures. In this population, the risk of nosocomial pneumonia has been documented to be as high as 29%. The utilization of clinical care pathways results in favorable outcomes. Despite this evidence, the medical management of rib fractures is yet to be truly standardized. At the core of recommended clinical care pathways is the identification of high-risk patients, appropriate patient disposition, multimodal pain control, aggressive pulmonary care, nutritional support, and early mobilization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bergeron E, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–85.

    Article  PubMed  Google Scholar 

  2. Bulger EM, et al. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–6. discussion 1046-7

    Article  CAS  PubMed  Google Scholar 

  3. Todd SR, et al. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg. 2006;192(6):806–11.

    Article  PubMed  Google Scholar 

  4. Holcomb JB, et al. Morbidity from rib fractures increases after age 45. J Am Coll Surg. 2003;196(4):549–55.

    Article  PubMed  Google Scholar 

  5. Sano A, Tashiro K, Fukuda T. Cough-induced rib fractures. Asian Cardiovasc Thorac Ann. 2015;23(8):958–60.

    Article  PubMed  Google Scholar 

  6. Newgard CD, et al. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a north American prospective cohort. Ann Emerg Med. 2010;55(3):235–246.e4.

    Article  PubMed  Google Scholar 

  7. Teixeira PG, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63(6):1338–46. discussion 1346-7

    Article  PubMed  Google Scholar 

  8. Pulley BR, et al. Utility of three-dimensional computed tomography for the surgical management of rib fractures. J Trauma Acute Care Surg. 2015;78(3):530–4.

    Article  PubMed  Google Scholar 

  9. Murphy CEt, et al. Rib fracture diagnosis in the Panscan era. Ann Emerg Med. 2017 Dec;70(6):904–9.

    Article  PubMed  Google Scholar 

  10. Ismailov RM, et al. Trauma associated with cardiac dysrhythmias: results from a large matched case-control study. J Trauma. 2007;62(5):1186–91.

    Article  PubMed  Google Scholar 

  11. Al-Hassani A, et al. Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury. Am Surg. 2010;76(8):888–91.

    PubMed  Google Scholar 

  12. Ho SW, et al. Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study. BMJ Open. 2017;7(1):e013029.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Carver TW, et al. Vital capacity helps predict pulmonary complications after rib fractures. J Trauma Acute Care Surg. 2015;79(3):413–6.

    Article  PubMed  Google Scholar 

  14. Larsson L, Friedrich O. Critical illness myopathy (CIM) and ventilator-induced diaphragm muscle dysfunction (VIDD): acquired myopathies affecting contractile proteins. Compr Physiol. 2016;7(1):105–12.

    Article  PubMed  Google Scholar 

  15. Mankowski RT, et al. Intraoperative hemidiaphragm electrical stimulation reduces oxidative stress and upregulates autophagy in surgery patients undergoing mechanical ventilation: exploratory study. J Transl Med. 2016;14(1):305.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Vassilakopoulos T, Petrof BJ. A stimulating approach to ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2017;195(3):281–2.

    PubMed  Google Scholar 

  17. Yang Y, et al. Endotoxemia accelerates diaphragm dysfunction in ventilated rabbits. J Surg Res. 2016;206(2):507–16.

    Article  CAS  PubMed  Google Scholar 

  18. Zhu X, et al. The role of calpains in ventilator-induced diaphragm atrophy. Intensive Care Med Exp. 2017;5(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hall JC, et al. Prevention of respiratory complications after abdominal surgery: a randomised clinical trial. BMJ. 1996;312(7024):148–52. discussion 152-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Wahba RW. Perioperative functional residual capacity. Can J Anaesth. 1991;38(3):384–400.

    Article  CAS  PubMed  Google Scholar 

  21. Gage A, et al. The effect of epidural placement in patients after blunt thoracic trauma. J Trauma Acute Care Surg. 2014;76(1):39–45. discussion 45-6

    Article  PubMed  Google Scholar 

  22. Girard TD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126–34.

    Article  PubMed  Google Scholar 

  23. Jaber S, et al. Clinical review: ventilator-induced diaphragmatic dysfunction--human studies confirm animal model findings! Crit Care. 2011;15(2):206.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Petrof BJ, Jaber S, Matecki S. Ventilator-induced diaphragmatic dysfunction. Curr Opin Crit Care. 2010;16(1):19–25.

    Article  PubMed  Google Scholar 

  25. Pinsky MR. Cardiovascular issues in respiratory care. Chest. 2005;128(5):592S–7S.

    Article  PubMed  Google Scholar 

  26. Huang CC, et al. Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure. Crit Care Med. 2008;36(10):2810–6.

    Article  PubMed  Google Scholar 

  27. Marik PE, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.

    Article  PubMed  Google Scholar 

  28. Finfer S, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247–56.

    Article  CAS  PubMed  Google Scholar 

  29. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003;54(3):615–25.

    Article  PubMed  Google Scholar 

  30. Yang Y, et al. Use of ketorolac is associated with decreased pneumonia following rib fractures. Am J Surg. 2014;207(4):566–72.

    Article  PubMed  Google Scholar 

  31. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain--a systematic review of randomized controlled trials. Pain. 2006;126(1–3):91–101.

    Article  CAS  PubMed  Google Scholar 

  32. Mathiesen O, Moiniche S, Dahl JB. Gabapentin and postoperative pain: a qualitative and quantitative systematic review, with focus on procedure. BMC Anesthesiol. 2007;7:6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Wang L, et al. Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials. Can J Anaesth. 2016;63(3):311–25.

    Article  PubMed  Google Scholar 

  34. Weibel S, et al. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis. Br J Anaesth. 2016;116(6):770–83.

    Article  CAS  PubMed  Google Scholar 

  35. Mohta M, et al. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study. J Trauma. 2009;66(4):1096–101.

    Article  PubMed  Google Scholar 

  36. Bulger EM, et al. Epidural analgesia improves outcome after multiple rib fractures. Surgery. 2004;136(2):426–30.

    Article  PubMed  Google Scholar 

  37. Shapiro BS, et al. Comparative analysis of the paravertebral analgesic pump catheter with the epidural catheter in elderly trauma patients with multiple rib fractures. Am Surg. 2017;83(4):399–402.

    PubMed  Google Scholar 

  38. Dennis M, et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373(9679):1958–65.

    Article  CAS  PubMed  Google Scholar 

  39. Lilly CM, et al. Thrombosis prophylaxis and mortality risk among critically ill adults. Chest. 2014;146(1):51–7.

    Article  PubMed  Google Scholar 

  40. Alberda C, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med. 2009;35(10):1728–37.

    Article  PubMed  Google Scholar 

  41. Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest. 2006;129(4):960–7.

    Article  PubMed  Google Scholar 

  42. Taylor SJ, et al. A randomised controlled feasibility and proof-of-concept trial in delayed gastric emptying when metoclopramide fails: we should revisit nasointestinal feeding versus dual prokinetic treatment: achieving goal nutrition in critical illness and delayed gastric emptying: trial of nasointestinal feeding versus nasogastric feeding plus prokinetics. Clin Nutr ESPEN. 2016;14:1–8.

    Article  PubMed  Google Scholar 

  43. Taylor SJ, Manara AR, Brown J. Treating delayed gastric emptying in critical illness: metoclopramide, erythromycin, and bedside (cortrak) nasointestinal tube placement. JPEN J Parenter Enteral Nutr. 2010;34(3):289–94.

    Article  PubMed  Google Scholar 

  44. Montejo JC, et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med. 2010;36(8):1386–93.

    Article  CAS  PubMed  Google Scholar 

  45. Casaer MP, Van den Berghe G. Nutrition in the acute phase of critical illness. N Engl J Med. 2014;370(13):1227–36.

    Article  CAS  PubMed  Google Scholar 

  46. McClave SA, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med. 2005;33(2):324–30.

    Article  PubMed  Google Scholar 

  47. SA MC. Guidelines for the provision and assessment of nutrition support therapy in the adult Criticall ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (a.S.P.E.N). JPEN J Parenter Enteral Nutr. 2009;33(3):277–316.

    Article  Google Scholar 

  48. Sirmali M, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24(1):133–8.

    Article  PubMed  Google Scholar 

  49. Allen GS, Cox CS Jr. Pulmonary contusion in children: diagnosis and management. South Med J. 1998;91(12):1099–106.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Rob Todd .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Musonza, T., Todd, S.R. (2018). Medical Management of Rib Fractures. In: de Moya, M., Mayberry, J. (eds) Rib Fracture Management . Springer, Cham. https://doi.org/10.1007/978-3-319-91644-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-91644-6_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91643-9

  • Online ISBN: 978-3-319-91644-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics