From the Guidelines
The patient with nondisplaced fractures of the right third through sixth ribs and the right eleventh rib without pneumothorax should be treated with nonoperative management (NOM) focusing on pain control and prevention of respiratory complications, as surgical stabilization of rib fractures (SSRF) is not indicated in this case. The treatment should prioritize pain management with acetaminophen (1000 mg every 6 hours) and/or NSAIDs like ibuprofen (400-600 mg every 6 hours) as first-line options 1. For moderate to severe pain, consider short-term opioids such as hydrocodone/acetaminophen 5/325 mg every 4-6 hours for 3-5 days.
Pain control is essential as it allows for deep breathing and coughing, which prevents complications like pneumonia 1. Apply ice packs to the affected area for 20 minutes every 2-3 hours during the first 48 hours to reduce pain and swelling. The patient should practice deep breathing exercises (10 deep breaths every hour while awake) and gentle movement as tolerated. Most rib fractures heal within 6 weeks without specific intervention.
Follow-up is recommended in 1-2 weeks to assess pain control and healing. Seek immediate medical attention if experiencing increased shortness of breath, worsening pain, fever, or coughing up blood, as these may indicate complications 1. According to the recent study by Sermonesi et al. 1, the patient's nondisplaced fractures do not meet the criteria for SSRF, which is typically considered for patients with flail chest, multiple severely displaced rib fractures, or respiratory failure despite mechanical ventilation.
Some key points to consider in the treatment plan include:
- Pain management with multimodal analgesia
- Prevention of respiratory complications with deep breathing exercises and gentle movement
- Monitoring for signs of complications such as pneumothorax, hemothorax, or pulmonary contusion
- Follow-up to assess pain control and healing. The patient's treatment plan should be individualized based on their specific needs and medical history, and should prioritize their morbidity, mortality, and quality of life outcomes 1.
From the Research
Nondisplaced Rib Fractures
- Nondisplaced fractures of the right third through sixth ribs and right 11th rib are considered simple rib fractures 2.
- Patients with nondisplaced rib fractures have a lower rate of hemo- or pneumothorax compared to those with displaced fractures 2.
- The use of a rib belt can provide additional comfort to patients with nondisplaced rib fractures without compromising respiratory parameters 2.
Treatment Options
- Multimodal analgesia and pulmonary toilet are recommended for the treatment of chest wall injuries, including rib fractures 3.
- Regional anesthesia techniques, such as paravertebral blocks, can be used in combination with a multimodal analgesic strategy to improve patient outcomes and reduce complications 4.
- Ibuprofen has been shown to be consistently superior to paracetamol at conventional doses in a range of painful conditions, including acute post-operative pain and osteoarthritis 5.
Complications
- Atelectasis can develop in patients with simple rib fractures, regardless of treatment group 2.
- Pleural space complications, such as hemothorax or empyema, can occur in patients with displaced rib fractures, but are less common in those with nondisplaced fractures 6.
- Pneumothorax is a potential complication of chest trauma, but is not present in this case 3, 4.