A rib fracture is a crack or break in one of the bones of the rib cage. Sometimes the breakage is in the cartilaginous part of the rib and not the bone itself. Mr Scarci regularly sees patients who have intact bones but are still in considerable pain.
The most common cause of a fractured rib is a trauma to the chest. Occasionally, especially in patients with osteoporosis or cancer, rib fractures can occur on coughing.
Rib fractures are usually very painful and can occasionally pierce the lung. This is a serious condition that requires immediate medical attention. Patients can feel short of breath or dizzy with a rib fracture.
Rib fractures are usually diagnosed on physical examination and chest X-rays. However, as they do not always show up on X-rays, you may be treated as though you have a fractured rib even if an X-ray does not show any broken bones.
Quite often a CT scan is also necessary to assess the extent of any potential injuries to internal organs.
Most fractured ribs are treated at home and will heal on their own over time. This usually requires at least six weeks and to help manage the pain while the fracture heals you will be prescribed strong painkillers.
While you are healing, it is important to cough or take the deepest breath you can at least once an hour. This can help prevent pneumonia or a partial collapse of the lung tissue.
Because ribs cannot be fixed in a cast, sometimes the fractures do not heal properly. This relatively common condition is called malunion and can be very painful, even several years after the initial trauma. Mr Scarci treats many patients with long-term chest wall pain caused by non-healed ribs.
When there is more than one rib fracture you can have a condition called flail chest. This is very painful and can severely impair breathing. A novel technique for repair of these fractures uses titanium plates.
A fractured rib is no different from any other broken bone in your body as such it will take the same time to heal as some of the other fractures you might have suffered. Usually, most rib fractures heal on their own within 3 months. The most important difference to highlight when comparing fractured ribs to other bone injuries is that the latter are usually treated in such a way as to immobilise the two edges for a period of time to allow healing.
Unfortunately, this is not possible with rib fractures as we cannot put the chest in a cast and the fractures will continue moving constantly with breathing and normal everyday activities.
After rib fractures, especially after significant trauma or when patients are taking blood thinners, it is possible that the edges of the fracture bleed into the chest cavity. Blood tends to coagulate pretty quickly in there causing what we call, in technical terms, a haemothorax. That is a collection of old blood in the chest cavity. The result of this is that the accumulated fluid compresses the lung and breathing might become impaired. In this situation, the fluid must be taken out. To achieve that a chest tube can be inserted or, more commonly, a keyhole procedure is performed to drain properly the collection.
Most rib fractures tend to heal within three months, but occasionally this is not the case, and pain either tends to increase or remain constant with no signs of abating. The reason for this is a condition called mal-union or bad healing of the fracture. As mentioned before the ribs keep moving all the time during the healing process and sometimes new bone formation, because of that, doesn’t happen and the rib edges become surrounded by fibrous tissue. This is not as strong as bone and it is like a pliable piece of wood, this movement causes pain. In the old days, we used to remove the affected part and leave a gap between the edges of the rib. Nowadays we use a titanium metallic plate to fix the rib in the proper position and eliminate the pain.
Most rib fractures heal on their own leaving no long-term effect, occasionally in case of severe trauma and multiple fractures if they don’t heal properly you can get a deformity of the chest and restriction in breathing. Chronic pain is also something that some patients experience, especially in case of malunion. Very few patients also might experience recurrent fluid accumulation in the chest cavity.
Broken ribs are very painful as such patients tend to reduce the depth of their breaths to reduce pain and avoid all activities that might trigger further pain. If the lungs fail to expand for a prolonged period of time, and even more so in frail patients, phlegm tends to accumulate inside the lung and airways causing pneumonia. Patients refrain from coughing and that further exacerbates the problem. Patients can develop a high temperature, feel sweaty with rigor and struggle to breathe. Those symptoms should always prompt the patient to seek immediate medical attention.
As already mentioned ribs tend to heal on their own, but every now and then patient are referred for surgery to fix ribs using thin metallic plates that are screwed to the ribs. This technique is particularly useful in elderly and frail patients or patients that sustained a significant trauma causing what we call a flail chest. This is a condition when ribs get fractured in more than one place causing paradoxical breathing. In this scenario, the rib cage moves in the opposite way as it should: sinks in during inspiration and blows out during expiration.
The surgical technique is very safe and reliable. The improvement in pain and breathing is usually pretty quick and patients tend to feel a lot better soon after surgery. Using CT to identify accurately the position of the fracture(s) we can reduce significantly the size of the incision.
There isn’t a standard answer here as mostly depends on individual circumstances. Generally speaking, patients that do manual work have to stay off much longer, and patients with clerical occupations tend to go back to work after 2-3 weeks if the pain has subsided completely or is manageable with counter pain killer.