RIB FRACTURE |
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General Information
DEFINITION--A complete or incomplete fracture of any of the 12 ribs on either side. Most rib fractures are accompanied by sprain or rupture of muscles, tendons or ligaments between the ribs (intercostal structures). Rib fractures are relatively common injuries in athletes, particularly those who compete in contact sports.
BODY PARTS INVOLVED
Any one or several of the 12 ribs.
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments, cartilage and blood vessels.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Tenderness to the touch.
A feeling that the "wind has been knocked out" (sometimes).
Abdominal pain if the fractured ribs are below the diaphragm (the 11th and 12th ribs).
Severe chest pain when coughing, sneezing or breathing deeply.
A feeling of small air pockets under the skin of the chest or neck if the lung has been injured and leaked air.
Swelling and bruising over the fracture site.
CAUSES
Direct blow to the chest from a blunt object, such as an arm or elbow.
Compression of the chest, as when a player falls on his side with a ball or helmet between him and the ground, or when a player is crushed in a pileup.
RISK INCREASES WITH
Contact sports, especially football, hockey, boxing, wrestling or rugby.
History of bone or joint disease.
Poor nutrition, especially calcium deficiency.
If surgery is needed to remove air or blood from the chest, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENTNo specific preventive measures. The chance of reinjury can be minimized by using a chest support or binder that has a rigid pad in it to prevent a direct blow to the injured area.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Application of a wide elastic wrap or chest binder to decrease movement of the chest muscles and reduce pain with breathing. The binder should be applied around the lower chest beneath the breasts, even if the rib fracture is in the upper chest.
Hospitalization if symptoms of injury to the lung, spleen or liver appear. Blood or air in the chest may need to be removed if the lung is punctured from the raw edge of a fractured rib. A lacerated liver may need to be surgically repaired. A ruptured spleen frequently requires surgical removal.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the ribs and vertebral column. Early X-rays may not show fractures if they are not dislocated, but repeat X-rays taken 4 or more days later usually reveal them. The early treatment for an uncomplicated rib fracture is the same as for bruised ribs, so a delay in diagnosis does not hinder treatment.
POSSIBLE COMPLICATIONS
Rupture of the lung with bleeding or escape of air into the chest wall or under the skin in the neck.
Injury to the liver if the right 11th or 12th ribs are fractured and have jagged edges.
Injury or rupture of the spleen if the 11th and 12th ribs on the left are fractured and have jagged edges.
Prolonged pain and slow healing.
PROBABLE OUTCOMEIf this is a first-time chest injury and there are no complications of internal injury, proper care and sufficient healing time before resuming contact sports should prevent later complications. Healing is usually complete in 4 to 6 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDWith uncomplicated rib fractures, no first aid is necessary. If injury to the lung, liver or spleen is suspected, transport the player to the nearest emergency facility.
CONTINUING CARE
Use the binder or wrap as long as needed for pain and support--usually 4 to 6 weeks.
Use an ice pack 3 or 4 times a day. Place chips in a plastic bag. Wrap the bag in a moist towel and place over the injured area. Use for 20 minutes at a time.
After 2 or 3 days, if heat is more soothing than ice, use heat lamps, hot soaks, hot showers or heating pads.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of long-acting local anesthesia into the fracture site to reduce pain and allow normal breathing (sometimes).
ACTIVITYResume your normal activities gradually after clearance from your doctor.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONNone. Continue exercising uninjured parts during recovery.
CALL YOUR DOCTOR IF
You have symptoms of a fractured rib.
Any of the following occur after diagnosis:
Shortness of breath.
Uncontrollable chest pain.
Sudden or severe abdominal pain.
Nausea or vomiting.
Swelling of the abdomen.
New unexplained symptoms. Drugs used in treatment may produce side effects.
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