What is the treatment for rib fracture?

From the Guidelines

The treatment for rib fractures should prioritize surgical stabilization of rib fractures (SSRF) in patients with flail chest or multiple and displaced rib fractures, as it has been shown to reduce morbidity and mortality, and improve quality of life 1. The primary goal of treatment for rib fractures is to manage pain and prevent complications. Pain control is essential and typically includes nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg every 6 hours) or naproxen (500mg twice daily), along with acetaminophen (1000mg every 6 hours) 1. Some key points to consider in the treatment of rib fractures include:

• Applying ice packs to the injured area for 20 minutes several times daily to reduce swelling and pain
• Deep breathing exercises (10 deep breaths every hour while awake) to prevent pneumonia, as pain may cause shallow breathing
• Avoiding activities that worsen pain, sleeping in a semi-upright position if lying flat is uncomfortable, and holding a pillow against the chest when coughing or sneezing to stabilize the area
• Seeking immediate medical attention if experiencing increasing shortness of breath, fever, or worsening pain, as these may indicate complications like pneumonia or a collapsed lung In terms of surgical intervention, the indications for SSRF include:
• Flail chest patients 1
• Non-flail chest patients with multiple (≥ 3) ipsilateral severely displaced rib fractures 1
• Non-flail chest patients with multiple (≥ 3) ipsilateral displaced rib fractures in combination with respiratory failure despite mechanical ventilation or weaning failure or at least two pulmonary derangements in non-ventilated patients despite loco-regional anesthesia and multimodal analgesia 1 It is also important to note that the use of ketamine for pain control in elderly patients with rib fractures has been shown to be effective, with reduced use of morphine and lower rates of cardiovascular events 1. However, the decision to undergo surgical rib fixation should be made on a case-by-case basis, taking into account the individual patient's condition and medical history 1.

From the Research

Treatment Options for Rib Fractures

• The primary goal of treatment is to manage pain and prevent complications, such as respiratory issues 2, 3, 4.
• A multimodal analgesia approach is recommended, which may include pharmacologic and regional analgesic blocks 2, 3.
• Regional anesthesia techniques, such as thoracic epidural analgesia, thoracic paravertebral block, erector spinae plane block, and serratus anterior plane block, have been shown to be effective in managing pain associated with rib fractures 3, 4.
• Other treatment options include:
  • Surgical fixation 5
  • Intercostal nerve blocks 5
  • Paraspinous local anesthetic pumps 5
  • Oxygen therapy 6
  • Ventilation 6
  • Physiotherapy 6

Pharmacologic Management

• Acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, lidocaine, and dexmedetomidine may be used to manage pain associated with rib fractures 2.
• Opioid analgesics may be used, but their use is often limited due to adverse effects 3, 4.

Non-Pharmacologic Management

• Respiratory care, including deep breathing exercises and incentive spirometry, is essential to prevent complications such as pneumonia 4, 6.
• Early mobilization and physical therapy can help improve outcomes and reduce the risk of complications 4, 6.