What is the treatment for a fractured rib?

From the Guidelines

Surgical stabilization of rib fractures (SSRF) should be considered in patients with flail chest or multiple and displaced rib fractures, as it can reduce morbidity and mortality, and improve quality of life, as recommended by the World Journal of Emergency Surgery in 2024 1. When it comes to treating broken ribs, the primary goal is to manage pain and prevent complications.

• Take over-the-counter pain medications like acetaminophen (Tylenol) at 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours as needed for pain, as recommended by the 2023 WSES guidelines on the management of trauma in elderly and frail patients 1.
• Apply ice packs to the injured area for 15-20 minutes several times daily during the first 48 hours to reduce swelling.
• Breathe deeply and cough regularly despite discomfort to prevent lung complications like pneumonia.
• Rest and limit physical activities that cause pain, but avoid complete bed rest as movement helps prevent complications. In cases of severe chest wall injuries, including flail chest or multiple and displaced rib fractures, SSRF may be necessary to improve outcomes, as indicated by the 2024 WSES and CWIS position paper on SSRF 1.
• SSRF should be considered in all flail chest patients, as well as in non-flail chest patients with multiple and displaced rib fractures, particularly those with respiratory failure or pulmonary derangements despite mechanical ventilation or multimodal analgesia.
• The use of thoracic epidural and paravertebral blocks can provide adequate pain control and improve respiratory function in elderly patients with rib fractures, as recommended by the 2023 WSES guidelines on the management of trauma in elderly and frail patients 1. It is essential to seek immediate medical attention if you experience severe pain, difficulty breathing, coughing up blood, or increasing shortness of breath, as these may indicate complications like a punctured lung.
• The decision to perform SSRF should be made on a case-by-case basis, taking into account the individual patient's condition, the severity of the injury, and the potential benefits and risks of the procedure, as discussed in the 2024 WSES and CWIS position paper on SSRF 1.

From the Research

Treatment Options for Broken Ribs

• The treatment of broken ribs typically involves pain management, as the injury itself is not life-threatening but can be quite painful, leading to complications such as respiratory issues 2.
• Various analgesic techniques are used, including systemic opioids and non-opioid analgesics, as well as regional anesthesia techniques like thoracic epidural analgesia (TEA) and paravertebral block (PVB) 3.
• TEA has been shown to have positive analgesic effects, but it is contraindicated for many patients, while PVB is a viable alternative with promising outcomes, although it has a failure rate of up to 10% and potential adverse complications 3.
• Other regional anesthesia techniques, such as serratus anterior plane blocks (SAPB) and erector spinae blocks (ESPB), have been found to be effective with lower incidences of adverse effects, and ESPB can be performed by trained emergency physicians, making it a feasible and low-risk procedure 3.

Comparison of Treatment Outcomes

• A study comparing the use of treatment options for rib fractures found that patients who received rib fixation and intercostal nerve block or local anesthetic pump had improved outcomes, including lower rates of pneumonia and decreased intensive care unit (ICU) length of stay and ventilator days, compared to those treated with opiates 4.
• Another study found that epidural analgesia (EA) and paravertebral block (PVB) were not significantly different in managing rib fractures, but there was an association between the use of a block and improved outcomes, which could be explained by the selection of healthier patients to receive a block 5.

Predictors of Opioid Use

• A study examining the patterns and predictors of opioid prescribing and use after rib fractures found that prior opioid exposure was the strongest predictor of sustained opioid use, while the severity of injury did not predict the duration of use 6.
• Increased number of ribs fractured and prior opioid exposure were significant predictors of initial opioid prescription, with patients with prior opioid exposure having a lower likelihood of opioid discontinuation 6.