From the Guidelines
Treatment for fractured ribs and vertebrae should prioritize pain management and stabilization to improve patient outcomes and reduce morbidity and mortality, with surgical stabilization of rib fractures (SSRF) considered in appropriate cases, as recommended by recent studies 1. The primary focus for fractured ribs is pain control using medications like acetaminophen (500-1000mg every 6 hours) and NSAIDs such as ibuprofen (400-600mg every 6-8 hours), as well as alternative methods like thoracic epidural (TE) and paravertebral blocks (PVB) 1. Applying ice packs for 15-20 minutes several times daily can reduce pain and swelling. Deep breathing exercises are essential to prevent pneumonia, performing 10 deep breaths every hour while awake. For vertebral fractures, treatment depends on severity but often includes pain management with similar medications, possibly a back brace for stability, and bed rest initially followed by gradual activity increase. Severe vertebral fractures may require surgical intervention with procedures like vertebroplasty, kyphoplasty, or spinal fusion, as suggested by studies on vertebral compression fractures 1. Some key points to consider in the treatment of fractured ribs and vertebrae include:
- Pain management is crucial to prevent complications like pneumonia and respiratory failure
- Surgical stabilization of rib fractures (SSRF) may be considered in cases with flail chest or multiple and displaced rib fractures
- Alternative methods like TE and PVB can provide effective pain control for rib fractures
- Vertebral fractures may require surgical intervention depending on severity
- Recovery typically takes 6-8 weeks for ribs and 8-12 weeks for vertebrae, with proper pain control and stabilization essential for optimal outcomes, as supported by recent studies 1.
From the Research
Treatment Options for Fractured Ribs
- Analgesic techniques such as intravenous acetaminophen and morphine have been shown to be effective in relieving pain associated with rib fractures 2
- Oral acetaminophen has been found to be equivalent to intravenous acetaminophen in elderly trauma patients with rib fractures, with no difference in morbidity or mortality 3
- Regional anesthesia techniques such as thoracic epidural analgesia, paravertebral block, and serratus anterior plane block have been found to be effective in alleviating pain related to rib fractures 4
Comparison of Treatment Options
- A study comparing oral versus intravenous acetaminophen in elderly trauma patients with rib fractures found no statistically significant difference in pain reduction between the two groups 3
- A narrative review of analgesia for rib fractures found that a multimodal analgesia approach, including risk stratification and prompt implementation of analgesic pathways, is recommended to reduce morbidity and mortality associated with rib fractures 5
- A single-center comparison of treatment options for rib fractures found that surgical fixation and intercostal nerve block or local anesthetic pump were associated with decreased ICU length of stay, ventilator days, and pneumonia rates compared to treatment with opiates 6
Regional Anesthesia Techniques
- Thoracic epidural analgesia has been found to have positive analgesic effects, but is contraindicated for many patients 4
- Paravertebral block is a viable alternative to thoracic epidural analgesia, but has a failure rate of up to 10% and adverse complications 4
- Serratus anterior plane block and erector spinae block have been found to be practical alternatives to thoracic epidural analgesia or paravertebral block, with lower incidences of adverse effects and similar levels of analgesia 4