Is an old rib fracture a contraindication for spirometry?

Old Rib Fractures Are NOT a Contraindication for Spirometry

Old (healed) rib fractures are not a contraindication for spirometry and should not prevent pulmonary function testing. The available evidence addresses contraindications for surgical stabilization of rib fractures (SSRF) and the use of spirometry in acute rib fracture management, but nowhere is an old, healed rib fracture listed as a contraindication for spirometry testing.

Key Evidence Supporting Spirometry Use

Spirometry in Acute Rib Fractures

• Spirometry is actively used as both a diagnostic and therapeutic tool in patients with acute rib fractures, demonstrating its safety even in the acute injury phase 1, 2
• Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are measured on hospital days 1,2, and 3 in acute rib fracture patients to predict outcomes and guide management 1
• Admission incentive spirometry volume (ISV) is routinely measured in acute rib fracture patients, with ISV ≥1000 ml associated with lower risk of acute respiratory failure 2

Clinical Application in Acute Settings

• If spirometry is safe enough to perform in patients with fresh, painful rib fractures, it is certainly safe in patients with old, healed fractures 1, 2
• Spirometry measurements are obtained repeatedly (best of three readings) even in acute trauma patients with multiple rib fractures without reported complications 2
• Remote spirometry systems are used for continuous monitoring over 12 weeks following multiple rib fractures, demonstrating safety throughout the healing period 3

Actual Contraindications to Consider

General Spirometry Contraindications (Not Rib-Fracture Specific)

While old rib fractures are not contraindications, standard spirometry contraindications include:

• Hemodynamic instability (similar to SSRF contraindications) 4
• Recent thoracic or abdominal surgery (within 2-4 weeks)
• Acute myocardial infarction or unstable angina
• Pneumothorax or recent pneumothorax
• Hemoptysis of unknown origin

Important Distinction

• The evidence discusses contraindications for surgical stabilization of rib fractures (SSRF), not for spirometry 4
• SSRF contraindications include hemodynamic instability, but these relate to surgical intervention, not pulmonary function testing 4

Clinical Reasoning

Why Old Fractures Don't Affect Spirometry

• Rib fractures typically heal within 6-8 weeks, with bone scan activity returning to normal in 79% of patients by 1 year 5
• Once healed, the structural integrity of the chest wall is restored, allowing normal respiratory mechanics
• Pain from old fractures is minimal to absent, eliminating the primary concern that exists with acute fractures 5

Evidence from Acute Fracture Studies

• Even in acute settings with significant pain (mean pre-block pain scores of 7.93/10), spirometry is performed safely 6
• Spirometry volumes improve from mean 1160 cc to 1495 cc after pain control, but the testing itself is not contraindicated 6

Practical Approach

Proceed with spirometry in patients with old rib fractures without hesitation, as there is no evidence-based reason to defer testing. The only scenario requiring caution would be:

• If the patient reports acute pain at the old fracture site, suggesting possible non-union or new injury, in which case imaging should be obtained first 5
• If there are signs of acute complications (new chest wall deformity, respiratory distress), address these before routine spirometry 5

The extensive literature on rib fracture management consistently demonstrates that spirometry is a safe, valuable tool even in acute injury phases, making it entirely appropriate for patients with healed fractures 1, 3, 2.