From the Guidelines
For a non-displaced 6th rib fracture, I recommend conservative management focused on pain control and respiratory support. This approach is supported by the most recent evidence from the World Journal of Emergency Surgery 1, which suggests that non-displaced rib fractures can be effectively managed without surgical intervention.
Key Components of Conservative Management
- Take acetaminophen 650-1000mg every 6 hours and/or ibuprofen 400-600mg every 6-8 hours as needed for pain, as recommended by general medical guidelines and supported by the principles outlined in 1.
- For moderate to severe pain, a doctor may prescribe a short course of opioids like hydrocodone/acetaminophen 5/325mg every 4-6 hours for 3-5 days, considering the patient's overall health and potential for addiction.
- Apply ice packs to the affected area for 20 minutes every 2-3 hours during the first 48-72 hours to reduce pain and swelling, a common practice for acute injuries.
- Practice deep breathing exercises (10 deep breaths every hour while awake) and use an incentive spirometer if provided to prevent lung complications, as these measures can help maintain pulmonary function and prevent atelectasis.
- Avoid activities that increase pain for 4-6 weeks, but maintain gentle movement rather than complete immobilization, to promote healing and prevent stiffness.
Rationale for Conservative Management
The evidence from 1 and 1 suggests that the anatomical location of rib fractures affects prognosis, but for non-displaced fractures, especially of the 6th rib, conservative management is often sufficient. The studies 1 provide a comprehensive overview of the management of rib fractures, including the role of surgical stabilization, but they also support the use of conservative management for non-displaced fractures.
Monitoring and Follow-Up
It is crucial to seek immediate medical attention if severe pain, difficulty breathing, fever, or coughing up blood develops, as these could be signs of complications. Regular follow-up with a healthcare provider is necessary to monitor the healing process and adjust the treatment plan as needed.
By following this conservative management approach, most non-displaced rib fractures can heal within 6-8 weeks without surgical intervention, thereby minimizing the risk of complications and promoting a full recovery.
From the Research
Non-Displaced Fracture of the 6th Rib Care
The care for a non-displaced fracture of the 6th rib is primarily nonoperative, focusing on pain management and respiratory care to prevent complications.
- Nonoperative treatment alternatives include:
- Epidural analgesia when not contraindicated due to anticoagulant venous thromboembolism prophylaxis 2
- Thoracic paravertebral blockage, e.g., serratus anterior or erector spinae plane nerve block 2, 3
- Intercostal nerve block 2
- Intravenous or enteral analgesics, e.g., opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4
- Intrapleural analgesia, e.g., bupivacaine infusion 2
- Multimodal analgesia that incorporates regional techniques, systemic analgesics, and analgesic adjuncts 2, 3, 4
- Accurate diagnosis, adequate analgesia, and effective physiotherapy are essential to avoid complications 5
- A multidisciplinary approach to management, combined with appropriate analgesia and adherence to care bundles/protocols, has been shown to decrease morbidity and mortality 3
- Surgical stabilization of rib fractures is typically recommended for cases of multiple bicortically displaced rib fractures, especially in those with a flail chest and/or a concomitant ipsilateral displaced midshaft clavicular fracture or sternal fracture 2, 6
Considerations for Non-Displaced Rib Fractures
- Non-displaced rib fractures may not require surgical intervention, and treatment can be as an outpatient 5
- Patients with more severe fractures or those at high risk of complications may be admitted to hospital for oxygen therapy, ventilation, aggressive analgesic techniques, and physiotherapy 5, 4
- Calculation of a rib fracture score can aid management decisions and identify patients at high risk of complications 4