From the Research
The incidence of delayed pneumothorax following rib fractures is approximately 0.9% of patients with chest trauma, as reported in the most recent and highest quality study 1. This condition typically develops within 48-72 hours after the initial injury, though it can occur up to 7-14 days post-trauma. The risk factors for delayed pneumothorax include the location of fractures on the x-ray of the hemithorax, with the presence of at least one rib fracture between the third and ninth rib being a significant risk factor 1. Other risk factors may include advanced age, underlying lung disease, and mechanical ventilation, although these are not as strongly supported by the most recent evidence. Clinicians should monitor patients with rib fractures for symptoms such as:
- Sudden chest pain
- Increasing shortness of breath
- Decreased oxygen saturation
- Respiratory distress which may indicate a developing pneumothorax. For high-risk patients, observation in a hospital setting for 24-48 hours is recommended, with serial chest imaging (X-rays or CT scans) to detect early development of pneumothorax 1. After discharge, patients should be educated about warning signs and instructed to seek immediate medical attention if symptoms develop. Delayed pneumothorax occurs when air gradually accumulates in the pleural space, often due to a small tear in the lung tissue caused by the fractured rib that initially seals but later reopens with respiratory movements or coughing. The management of blunt chest trauma, including rib fractures and pneumothorax, involves supportive care, multimodal analgesia, and pulmonary toilet, with surgical treatment considered in select cases 2.