What is the treatment for a stable, minimally displaced left lateral sixth rib fracture with a possible nondisplaced lateral seventh rib fracture?

From the Guidelines

For stable minimally displaced left lateral sixth rib fracture and possible nondisplaced lateral seventh rib fracture, the recommended treatment is conservative management focusing on pain control and respiratory support. This approach is supported by the most recent evidence, including the study by 1, which highlights the importance of pain control and respiratory support in managing rib fractures. The study notes that standard treatment of severe chest wall injuries includes nonoperative management via multimodal analgesia, pulmonary hygiene, chest physiotherapy, pleural drainage as needed, and in severe cases, intubation and mechanical ventilation.

The treatment plan should include:

• Oral analgesics such as acetaminophen 650-1000 mg every 6 hours and ibuprofen 400-600 mg every 6-8 hours (if not contraindicated) for 7-10 days
• Short-term opioid analgesics like hydrocodone/acetaminophen 5/325 mg every 6 hours for 3-5 days for moderate to severe pain
• Ice packs to the affected area for 20 minutes every 2-3 hours during the first 48-72 hours to reduce inflammation
• Deep breathing exercises (10 deep breaths every hour while awake) and incentive spirometry to prevent atelectasis and pneumonia
• Avoiding strenuous activities and heavy lifting for 4-6 weeks, but maintaining gentle mobility as tolerated

As noted by 1 and 1, isolated rib fractures have a relatively low morbidity and mortality, and treatment is generally conservative. Follow-up imaging is typically not necessary unless symptoms worsen. It is essential to seek immediate medical attention if experiencing increased pain, shortness of breath, fever, or coughing up blood, as these may indicate complications such as pneumothorax or pneumonia.

From the Research

Treatment Options for Stable Minimally Displaced Left Lateral Sixth Rib Fracture

• Nonoperative treatment alternatives are available for stable minimally displaced rib fractures, including epidural analgesia, thoracic paravertebral blockage, intercostal nerve block, intravenous or enteral analgesics, and intrapleural analgesia 2
• Regional anesthesia techniques, such as serratus anterior plane blocks and erector spinae blocks, have shown promising outcomes in alleviating pain related to rib fractures, with lower incidences of adverse effects compared to other techniques 3
• Multimodal analgesia, incorporating regional techniques, systemic analgesics, and analgesic adjuncts, is recommended to reduce morbidity and mortality associated with rib fractures 4

Considerations for Nondisplaced Lateral Seventh Rib Fracture

• The treatment approach for nondisplaced rib fractures is often nonoperative, focusing on pain management and monitoring for potential complications 2
• Risk stratification tools, such as the Study of the Management of Blunt Chest Wall Trauma score, can help identify patients at higher risk of morbidity and mortality, guiding the treatment approach 4
• A multidisciplinary approach to management, combined with appropriate analgesia and adherence to care bundles/protocols, has been shown to decrease morbidity and mortality in patients with rib fractures 4

Surgical Stabilization of Rib Fractures

• Surgical stabilization of rib fractures is recommended in cases of multiple bicortically displaced rib fractures, especially in those with a flail chest and/or a concomitant ipsilateral displaced midshaft clavicular fracture or sternal fracture 2
• The procedure provides definitive stabilization of fractures, improves pulmonary function, lessens pain medication requirements, prevents deformity formation, and results in reduced morbidity and mortality 2
• However, surgical stabilization may not be necessary for stable minimally displaced rib fractures, and nonoperative treatment alternatives should be considered 2, 5