Parker again and in this post I’m going to talk about rib fractures. Rib fractures are a pretty common problem I see, and it’s not just the young dare-devil types! I often see folks in their 50s, 60s, 70s and 80s with multiple rib fractures. These are the result of a wide range of accidents – anything from falling off of a bench to getting bucked off of a horse. Of course, in Jackson in the winter time, skiers/snowboarders and snowmobilers are common recipients of a good ole’ fashioned butt kicking from mother nature.Rib fractures can be mild to life threatening, depending on the severity of the injury and other associated injuries. I’m going to talk about common associated injuries in another post, so this one I’ll just stick to rib fractures.Commonly, patients present with one or two non-displaced fractures (meaning the bones are still in the right place, they are just broken) and no other organ injury.

This is the simplest form of rib fracture. The good news is, there is no surgery needed for something like this. The bad news is, there is no good way to splint the rib fractures. Some people may find some comfort in “taping the ribs or wearing a tight-fitting undergarment. If this works for you, great.if not.no big deal.Our goal is to get you fairly comfortable using pain medication and avoid other complications commonly associated with rib fractures. The medication will not be able to take all of your pain away, but the main objective is to get you breathing and moving fairly easily. One of the main complications that can arise after rib fractures is pneumonia.

When we have ribs fractured, we don’t want to take normal deep breaths. We often breathe much more shallow than normal.

Broken sternum ad cracked ribs healing process Popping in chest Strange Pain that started as pressure on bottom right of ribs. Lower Ribs Protrude Right side chest pain after car accident I have a sharp pain in my left side when I take a deep breath. Throat popping when breathing Chest pain right below breast and on side of torso on right side of body pain in ribs Popping in neck when I swallow symptoms of cracked rib Popping sounds in stomach when doing situps. Sneezes still mess me up the worst. Painful to the touch, tender bruised feeling, no discoloring on my rib, just below right nipple. Really difficult to spike ball tonight, had to swing at 20-35% with right arm. Oh yeah, I'm between jobs and refuse to see a doc, due to insurance. Oddly enough I'm against universal healthcare.

This lets the lung partially “collapse” in the bases and outer portion.(Quick anatomy lesson.the lung is made of millions of microscopic sacs which take the oxygen in the air, and put it into the blood. If not kept inflated normally, these microscopic sacs can collapse. When they collapse, they are a good place for bacteria to attach to and start multiplying thus, causing pneumonia).So to prevent pneumonia after rib fractures, I like to give patients a good amount of narcotic pain medication for the first 3 or so days. This is the time when the pain peaks and starts to subside. If we can keep you comfortable and breathing normally, we can lower your chance of pneumonia.

In addition to breathing normally, we generally have patients use a “spirometer”. This is a little plastic machine that helps you determine exactly how much (in millilitres) you are breathing in when you take a deep breath. This just helps you monitor the deep breaths and actually put a number on them, instead of guessing.The downside to taking narcotic pain medication is that it can make people very constipated. This is why I start a stool softener with everyone who has rib fractures and is taking narcotics. I generally give patients Senokot twice daily to prevent constipation. Some patients may need a little extra to keep them regular, and in this case, I start Milk of Magnesia twice daily as well.

You should continue to take stool softeners as long as you are still taking narcotics.The other main complication that is associated with rib fractures is “Deep Venous Thrombosis” or DVT. A DVT is basically a blood clot that usually start somewhere in the lower extremities. The dangerous part about a DVT is that it can break loose and then “embolize” or “travel through the blood stream” to the lungs. This is called a “Pulmonary Embolism”, or PE. PE’s can be very small and virtually have no symptoms, or they can be very large and result in death. So, we definitely want to prevent against a DVT and PE while you are in the hospital.

There are a couple reasons people get DVTs after rib fractures. It’s not necessarily the ribs being broken which is the problem, but that the patient has sustained a significant trauma. Just like when you cut your finger accidentally, the body will try to “stop the bleeding” by producing blood clots.

In a significant trauma, where ribs are broken and maybe even some other organs are bruised (skin, muscle, spleen liver), the body will try to “stop the bleeding” by forming clots. The body will be in a “hypercoagulable state” (coagulate = blood clotting). So, we develop a hyper-clotting state after major trauma, or even surgery. Depending on the trauma, the elevation of the clotting status will be variable, but combine that will laying in a hospital bed for a couple of days (the blood then doesn’t circulate as well.or as fast as if you were up walking or running around) and now we have a pretty good set up for blood clots.or DVTs and subsequent PEs.So prevention measures consist of two things.

First, we get you walking as soon as possible, and we thin your blood just a little bit to prevent excessive clotting. The walking prevents DVTs by keeping good blood flow and circulation.

The slower the blood flow, the easier it is for your body to make clots, so the walking prevents against that. Second, is the blood thinner. It’s a little stronger than aspirin, and not quite as strong as Coumadin (if you are familiar). Everyone who sustains a significant trauma (including rib fractures) will receive this blood thinner while in the hospital. When you go home, we typically stop the blood thinner because you are generally more active at home than in the hospital.

Those are the main complications we are trying to avoid with rib fractures, so when I come in and ask how your deep breathing and walking is going, you’ll know why.Lastly, patients always want to know “when they can get back to normal activity”. Well, unfortunately the only thing that is going to heal those ribs is time. In general, bones take about 6-8 weeks to heal well. You, of course, will be feeling much better in about 1-2 weeks, but you should gradually increase your activity during those 6-8 weeks. It’s fairly normal to have a few good days followed by a really bad day (as far as pain is concerned).

As long as you are improving week to week, you are on the right track.I hope this has given you a little insight to the natural course of rib fractures and what to expect while you are in the hospital.-Dr. Please leave comments or questions for me below. So here I am a year later going to physio and still have rib issues. Including pain with breathing in the rib area I still cannot lift or carry my laundry up the stairs.

It feels like something gets stuck sometimes that is very painful. I have shoulder rib neck pain and a year later still cannot wear a bra. I was told last wk I have a damaged fascia and am waiting on more insurance money to come thru to pay for more physio therapy. Sound normal to you?It feels like this issue in never going to go away. The idea a broken rib is a painful issue that heals in a a few months is feeling completely untrue to me.

What is a rib fracture?A rib fracture is a crack or break in a rib. A rib fracture can be caused by trauma such as a car accident or fall. Trauma can increase your risk for organ damage when your rib is fractured. Stress fractures in your ribs happen in your upper or middle ribs. Stress fractures can happen when you have a forceful long-term cough.

Other things that increase your risk for rib fractures include being an older adult, osteoporosis, and tumors.What else do I need to know about rib fractures?Flail chest occurs if 3 or more of your ribs are broken in 2 or more places. This condition may make it hard for you to breathe. Normally, when you take a breath, your rib cage expands. Flail chest prevents your ribs from expanding. This can cause your broken ribs to push inward on your organs. What are the signs and symptoms of a rib fracture?. Chest wall pain that worsens when you breathe, move, or cough.

Bruising or swelling near your injury. Shortness of breath or difficulty taking a deep breathHow is a rib fracture diagnosed?Your healthcare provider will ask about your injury and examine you.

The provider will look for any signs of bleeding or bruising. He or she will also ask about your breathing and pain.

An x-ray or CT scan may show the fracture or other injuries. You may be given contrast liquid to help the fracture show up better in the pictures.

Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. You may also need an ultrasound of your abdomen to check for injuries to your abdominal organs. How is a rib fracture treated?. Medicines:. NSAIDs help decrease swelling and pain. NSAIDs are available without a doctor's order.

Ask your healthcare provider which medicine is right for you. Ask how much to take and when to take it. Take as directed. NSAIDs can cause stomach bleeding and kidney problems if not taken correctly. Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen.

Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation. Intercostal nerve block may be given to numb the injured area for about 6 hours. It is given as a shot between 2 of your ribs in the fractured area. You may need this if your pain continues or is getting worse even after you take oral pain medicines.

Deep breathing and coughing will decrease your risk for a lung infection. Hug a pillow on the injured side while doing this exercise, to decrease pain.

Take a deep breath and hold it for as long as possible. You should let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help take deep breaths. Put the plastic piece in your mouth. Take a slow, deep breath. You should then let the air out and cough.

Repeat these steps 10 times every hour. Rest and limit activity as directed to decrease swelling and pain, and allow your injury to heal. Avoid activities that may cause more pain or damage to your ribs such as, pulling, pushing, and lifting. As your pain decreases, begin movements slowly.

Take short walks between rest periods. Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack or put crushed ice in a plastic bag. Cover it with a towel and place it on your injured area for 15 to 20 minutes every hour as directed.

Surgery may be needed if many of your ribs are badly fractured. Surgery is often needed for a flail chest. Broken ribs may be held together with plates and screws. An injury to an organ, nerve, or blood vessel may also be treated with surgery.Call 911 for any of the following:. You have trouble breathing. You have new or increased pain.When should I seek immediate care?. Canon captureperfect 3.0 software.

Your pain does not get better, even after treatment. You have a fever or a cough.When should I contact my healthcare provider?. You have questions or concerns about your condition or care.Care AgreementYou have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive.

You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.© Copyright IBM Corporation 2020 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc.

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