Cause - mostly from direct force, e.g. RTC, falls, sport, assaults
Symptoms - pain, tenderness, dyspnoea. Pain is usually localised to the fracture site, made worse on movement (incl. inspiration).
Treatment - adequate analgesia to enable comfortable breathing, self help including splintage.
Potential problems - Rib #s on their own, occurring in fit healthy people are usually benign, albeit painful injuries. However, the elderly and those with pre-existing chest disease are at serious risk of complications associated with reduced chest wall movement and underlying pulmonary contusion. Patients suffering rib fractures may sustain intra-thoracic complications including pneumothorax, haemothorax, atelectasis, and chest infection due to alveolar hypoventilation. There is generally a tendency to underestimate the magnitude of chest trauma.
During inspiration and the generation of negative intrathoracic pressure, the flail segment is sucked in and the lung remains under ventilated = paradoxical movement.
Symptoms - pain, respiratory distress, definitive diagnosis is paradoxical movements, with ↓air entry. ↑resonance in pneumothorax, ↓in haemothorax
Treatment -15L/min O2 via a non-rebreathe mask with reservoir bag. Manual stabilisation & splintage by applying flat palm to the flail segment and maintaining the indrawn position. Adequate analgesia is essential.
Potential problems - associated with intrathoracic injuries e.g. pulmonary contusion. Major flail chest may be associated with mechanical failure of respiration and the necessity for artificial ventilation in hospital.
Cause - most commonly a direct blow to the sternum, where the injury pattern may range from unicortical cracks (e.g. seatbelt injuries) to complete fractures. Can also occur in conjunction with thoracic wedge compression fractures due to a forced flexion of the thoracic-spine (e.g. motorbike falls)
Symptoms - pain & tenderness, holding chest
Treatment - analgesia, oxygen therapy, and manual support for the chest. If long transit time, consider LA injection into site.