From the Guidelines
Treatment for a rib fracture primarily focuses on pain management and preventing complications while the bone heals naturally, with surgical stabilization of rib fractures (SSRF) considered in cases of flail chest, severe pain, and chest wall deformity 1.
Key Considerations
- Pain management is crucial, and over-the-counter pain medications like acetaminophen (Tylenol) at 650-1000mg every 6 hours or ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours as needed can be used, not exceeding maximum daily doses 1.
- Applying ice to the injured area for 20 minutes several times daily during the first 48 hours can help reduce pain and swelling.
- Rest is important, but complete immobilization is not recommended, and controlled breathing exercises (taking 10 slow, deep breaths every hour while awake) can help prevent lung complications like pneumonia 1.
- For elderly patients or those with multiple fractures, medical supervision is particularly important as complications are more common in these groups, and SSRF may be considered to improve outcomes 1.
Surgical Stabilization of Rib Fractures (SSRF)
- SSRF is considered in cases of flail chest, severe pain, and chest wall deformity, and can help reduce morbidity and mortality, as well as improve quality of life 1.
- The optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods, and material selection are crucial considerations for SSRF 1.
Multimodal Analgesia Approach (MMA)
- A multimodal analgesia approach (MMA) including acetaminophen, gabapentinoids, NSAIDs, lidocaine patches, and tramadol and opioids only for breakthrough pain can be effective in managing acute trauma pain in elderly patients 1.
- Thoracic epidural and paravertebral blocks can offer adequate pain control with limited contraindications and improvement in respiratory function, reducing opioid consumption, infections, and delirium, if skills are available 1.
From the Research
Treatment of Rib Fractures
- Rib fractures are a common reason for hospital admission and are associated with significant morbidity and mortality 2.
- Careful assessment to identify patients at high risk of complications is essential, and calculation of a rib fracture score can aid management decisions 2.
- Pain from rib fractures can be severe and requires multimodal analgesia started promptly and proactively on hospital admission 2, 3, 4, 5.
Analgesia Options
- Multimodal analgesia may include the use of regional anaesthetic techniques such as thoracic epidurals and erector spinae blocks for patients with significant chest trauma or those at high risk of pulmonary complications 2, 3, 5.
- Pharmacologic options include acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, lidocaine, and dexmedetomidine 3.
- Regional analgesia techniques such as thoracic epidural analgesia, thoracic paravertebral block, erector spinae plane block, and serratus anterior plane block may also be used 3, 5.
Respiratory Physiotherapy and Rehabilitation
- Respiratory physiotherapy and physical rehabilitation are important components of care for patients with rib fractures 6.
- A multidisciplinary approach to management, combined with appropriate analgesia and adherence to care bundles/protocols, has been shown to decrease morbidity and mortality 3, 6.
- Expert consensus guidance recommends key recommendations for respiratory physiotherapy and physical rehabilitation of patients with rib fractures, mapped over seven clinical scenarios 6.