From the Guidelines
The treatment plan for a nondisplaced posterior rib fracture primarily focuses on pain management and preventing complications, with surgical stabilization of rib fractures (SSRF) generally not recommended for nondisplaced fractures, as stated in the 2024 WSES and CWIS position paper 1.
Key Components of Treatment
- Pain control: oral analgesics such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) and/or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) are recommended 1.
- Deep breathing exercises: performed hourly while awake to prevent atelectasis and pneumonia.
- Ice application: to the affected area for 20 minutes every 2-3 hours during the first 48-72 hours to reduce inflammation.
- Activity modification: gradual return to normal activities as pain allows, typically over 4-6 weeks.
- Splinting: the area when coughing or sneezing can help manage pain.
Follow-up and Monitoring
Follow-up is recommended if pain worsens, breathing becomes difficult, fever develops, or if symptoms don't improve within 2-3 weeks.
Healing and Prognosis
Most nondisplaced rib fractures heal without surgical intervention in 6-8 weeks, with pain significantly decreasing after the first 2 weeks as the initial inflammatory response subsides 1.
Surgical Considerations
Surgical stabilization of rib fractures (SSRF) is typically reserved for cases with significant displacement, flail chest, or other complications, and not generally recommended for nondisplaced posterior rib fractures, as the risks and benefits of surgery must be carefully weighed on a case-by-case basis 1.
From the Research
Treatment Plan for Nondisplaced Posterior Rib Fracture
The treatment plan for a nondisplaced posterior rib fracture typically involves:
- Symptomatic treatment with analgesics to manage pain [ 2 ]
- Encouragement of deep breathing to avoid secondary or delayed pulmonary complications [ 2 ]
- Multimodal analgesia approach, including risk stratification and prompt implementation of analgesic pathways [ 3 ]
- Adequate analgesia coupled with meticulous respiratory care to prevent complications [ 4 ]
Analgesic Techniques
Various analgesic techniques can be used to manage pain associated with rib fractures, including:
- Systemic opioids and non-opioid analgesics
- Regional anesthesia techniques, such as thoracic epidural analgesia (TEA), paravertebral block (PVB), serratus anterior plane blocks (SAPB), and erector spinae blocks (ESPB) [ 5 ]
- Intercostal nerve block (ICNB), although it may have less analgesic impact and require concurrent intravenous medication [ 5 ]
Use of Rib Belts
The use of rib belts in treating patients with acute rib fractures has been discouraged due to possible complications from restricted ventilation [ 2 ]. However, a randomized clinical trial found that patients with simple rib fractures who used rib belts experienced additional pain relief without apparent additional compromise to respiratory parameters [ 6 ].