FRACTURED RIB

CYRUS DE-VIRUS
 FRACTURED RIB
DEFINITIONS
Chest Injury:- Is an injury that can occur as a result of an
accidental or deliberate penetration of a foreign object into the
chest. This type of injury can also result from a blunt trauma,
leading to chest wall injury (causing rib bruises, fracture, lung
or heart contusions).

A Rib:- Is any one of the 12 pairs of long flat curved bones of

the thorax, each united by cartilage to the spinal vertebrae of the
back.
A Fractured Rib :- Is a
common injury that
occurs when one of the
bones in the rib cage
breaks or cracks
Many broken ribs are merely cracked. While still
painful, cracked ribs are not as potentially dangerous
as ribs that have been broken. In these situations, a
jagged piece of bone could damage major blood
vessels or internal organs, such as the lungs. In most
cases, broken ribs heal on their own in one or two
months. Adequate pain control is important, so you
can continue to breathe deeply and avoid lung
complications, such as pneumonia.
 FUNCTIONS OF THE RIB

The ribs have two main functions:

1. They protect the organs in the chest.
2. They help in breathing by keeping space open inside the
chest. While the muscles use to breathe squeeze in, or
contract it leaves plenty of space for the lungs to fill up
with air.
 PATHOPHYSIOLOGY
The chest wall protects underlying sensitive structures
by surrounding internal organs with hard osseous (bony)
structures including the ribs, clavicles, sternum, and
scapulae. An intact chest wall is necessary for normal
respiration. There are 12 ribs on each side of the normal
human thorax (24 ribs in total) that function to protect
the intrathoracic organs and to aid in respiration. The
first 2 ribs are shorter than ribs 3 through to10 and are
intimately associated with the subclavian artery and the
brachial plexus.
PATHOPHYSIOLOGY CONTI…….
Injuries to these 2 ribs should alert the physician to the
possibility of vascular or neurological injury. Fractures
of ribs 4 through to 10 can be single, segmental, or
multiple. These injuries are the direct result of a
significant force, resulting in fracture and often
displacement of the rib fragments. As a result, these rib
fragments have the potential to injure the pleural or
intra-abdominal viscera. Upper rib injuries tend to
injure the lung parenchyma by direct penetration.
CAUSES OF RIB FRACTURE
CONTACT
FALLS SPORTS(BOXING)
FIGHTS / COMBATS
SEVERE COUGH
PROLONGED COUGHING SPELLS
MOTOR VEHICLE ACCIDENTS
Fractured rib may cause:
Mild to severe pain in the injured area.
Pain when taking a deep breath.
Pain around the fracture that gets worse when the breastbone is
pressed, bending or twisting the body.
If patient can't breathe normally because of pain or flail chest, he
may:
Feel shortness of breath.
Feel anxious, restless, or scared.
Have a headache.
 RISK FACTORS
The following factors can increase risk of breaking a rib:
1. Osteoporosis:- A disease in which the bones lose their density, makes
one more susceptible to a bone fracture.
2. Sports Participation:- Participating in contact sports, such as hockey
or football, increases the risk of trauma to the chest and the trauma increases
the risk of rib fractures.
3. Cancerous Lesion in a Rib:- A cancerous lesion can weaken the
bone, making it more susceptible to breaks.
DIAGNOSIS OF FRACTURED RIB
 CHEST X-RAY

Using Low Levels Of

Radiations ,X Rays
Makes Bones Visible .
They Are Also Useful In
Diagnosing A Collapse
Lung.
 COMPUTERIZED
TOMOGRAPHY(CT-
SCAN)

This Can Uncover Rib

Fractures That X Ray Might
Miss. Injuries To Soft Tissues
And Blood Vessels Are Also
Easier To See With CT-Scan
MAGNETIC RESONANCE
IMAGING (MRI)

An MRI uses a powerful magnetic

and radio waves to produce
cross-sectional images.
this can be used to look at soft
tissues and organs around the rib
to determine if there is a
damage. it can help in the
detection of more subtle rib
fractures.
• Bone scan: (to view stress fractures, where bone is cracked
after repetitive trauma).
During a bone scan, a small amount of radioactive material is
injected to your bloodstream. This helps to detect injured ribs
and bones by a scanner.
 TREATMENT

The main aim of treatment for rib fractures is to provide

the patient with adequate analgesia coupled with
meticulous respiratory care in order to prevent
complications such as atelectasis and pneumonia.
 Single Rib Fractures
Patients with isolated rib fracture without other
associated injury may be treated as out-patients.
Patients should be made aware that pain could last
for up to eight weeks, therefore during this time
adequate oral analgesia should be prescribed. A non-
steroidal anti-inflammatory drug (NSAID) .
A physiotherapist should emphasize to patients the
importance of deep breathing and coughing to clear
phlegm from the chest. To ease the pain of
coughing, patients may support the rib area with
their hands, a towel or a pillow. Any strenuous
activities should be avoided for the first three to
four weeks following the fracture, but after this,
physical exercise can be undertaken. No attempt
should be made by a patient to participate in contact
sports for six weeks so as to avoid the possibility of
further damage.
 TREATMENT OF Multiple Rib Fractures
Patients with multiple fractures will require admission to a
trauma ward or a high dependency unit depending on the
severity of the injury. Initial care will focus on multi-system
evaluation and stabilization, adequate pain relief and
PHYSIOTHERAPY. In rare cases, surgical stabilization is
necessary using Titanium wires and in serious complications
THORACOTOMY is necessary.
NURSING MANAGEMENT
A fractured rib usually takes at least 6 weeks to heal. To help
manage the pain while the fracture;
Put ice on the injured area.
Allow patient to get enough rest.
Serve pain medicine as prescribed such as aspirin or ibuprofen.
Encourage patient to do coughing and deep breathing exercises
at least once an hour to prevent pneumonia or partial collapse of
the lung tissue.
Support injured side with towel or pillow to enhance deeper
breathes.
 EDUCATION
• Educate patient to stop any strenuous activities for the first three to
four weeks following the fracture, but after this, physical exercise
can be undertaken as pain allows.
• No attempt should be made by a patient to participate in contact
sports for six weeks so as to avoid the possibility of further
damage.
• Patients should be advised that if they develop fever, uncontrollable
cough, abdominal pain have increased, difficulty breathing or
cough up thick or discoloured sputum they should contact their
doctor or a hospital urgently.
COMPLICATIONS
1) Pneumothorax
2) Haemothorax
3) Emphysema
4) Atelectasis
5) Hypoventilation
6) Hypoxia
CHEST INJURY {FRACTURED RIBS; PRE- OPERATIVE
MANAGEMENT

1. Psychological CARE
2. Physical care
3. Physiological care
 PSYCHOLOGICAL CARE

 Reassure patient that he is in the hands of competent surgical staff.

 Explain procedures to patient(on condition)to allay anxiety.
 Encourage patient to ask questions and answer all questions in a
clear and simple language.
 Introduce
patient to a successfully recovered patient who has
undergone the same surgery.
 Ensure diversional therapy using newspapers, television.
 Ensure
patient signs consent form and its also countersigned by the
surgeon
 PHYSICAL CARE; Head to Toe
Ensure patient bathes with soap and water

Inspect the surgical site for any rashes, wounds, boils,

lesions, scars
Wash surgical site with soap and water for 3-5 minutes.
Disinfect the surgical site with salvon 1%
Dry the surgical site with sterile gauze or towel
Cover the surgical site with sterile towel(drape)
Remove all contra-surgical items such as dentures,
jewelries.
Assist patient to change into the theatre gown and wear
cap.
Identification tag bearing patients; NAME,
DIAGNOSIS, DATE and PROCEDURE TO BE DONE
Check vital signs such as temperature, pulse,
respiration, blood pressure and write the frequency of
measurement 4hourly,record and report any
abnormality to the nurse in-charge.
Send patient to the operating theatre at the appointed
time.
Make post-operative bed to receive patient after
surgery.
 PHYSIOLOGICAL CARE
Obtain results of laboratory and radiographic investigations such as ,
TESTING ,CROSS- MATCHING,MRI(magnetic resonance
imaging),CBC(complete blood count),PT and PTT values( prothombin time
and thromboplastin time).
Ensure Nil per os 6-8 hours prior to surgery

Ensure patient empty bowel and bladder

Check vital signs such as temperature ,pulse ,respiration ,blood pressure,

every 2hrs record and report ,any deviation to the in charge nurse.
Anticoagulants and antiplatelet medications example aspirin , warfarin should
be stopped at least 2 weeks prior to surgery.
 POST OPERATIVE MANAGEMENT

 Ensure patient is alive by feeling for breath or observing the rise and fall of the
chest/checking for carotid pulse.
 Nurse patient in recovery position or in left lateral position with the head turned
to the side to allow secretions to flow out of the oral cavity if unconscious and in
sitting upright/semi fowlers position if patient is conscious.
 Administer prescribed 100%oxygen 1.2 litres via nasal catheter or mask .
 Administer prescribed postoperative medications such as; analgesic such as
diclofenac ,antibiotic-injection ciprofloxacin and ceftriazone.
 Encourage patient to continue deep breathing exercise using the incentive
spirometer to help improve lung functioning.
 POST-OPERATIVE MANAGEMENT
Provide warmth by using extra clothing or blankets.
Assess patient level of pain using a pain rating scale of 0-
15.
Check vital signs such as temperature, respiration , carotid
pulse and blood pressure 15min for 1st 30mins, 30mins for 1hr
,4hrly record and report any deviation to the nurse in
charge.
Observe mental state of patient for confusion, record and
report any deviation to the nurse in charge.
Monitor fluid intake and output record on the intake and
output chart, and balance after 24 hours record and report
any deviation to the nurse in charge.
 POST-OPERATIVE CARE CONT.
Reinforce dressing with sterile gauze if bleeding occurs by applying firm pressure at the
bleeding point.
Inform surgeon an medical team if bleeding is profuse, prepare patient for theater again.

Observe surgical site for any signs and symptoms of inflammation , odour and discharge.
Assess the amount of blood loss by saving soaked gauze

Set a sterile tray to take blood sample for grouping and cross matching.

Dress wound aseptically by wearing face mask, surgical gloves, apron, using sterile artery
forceps, sterile cotton ,sterile guaze , dress wound with methylated spirit 3rd day post
operatively.
 POST OPERATIVE MANAGEMENT

When bowel sounds return give sips of water followed by

plain tea(without milk)and porridge.
Give easily digestible diet such as tuozafi and light soup.
Give well balanced diet to repair worn out tissues.
Remove all nauseating items such as bedpan, sputum mug.
Serve food in bits and at regular intervals.
Administer prescribed vitamin supplements such as
multivitamins, vitamin D, and B-complex.
 CONCLUSION
Rib fractures vary from being a minor injury that can be
treated in outpatient’s bases, to a major injury that can
have life-threatening consequences. Accurate
diagnosis, adequate analgesia and effective
physiotherapy are all essential components in the
management of rib fractures if complications are to be
avoided.
 REFERENCES:
1. Brunett PH, et al. Pulmonary trauma. In: Tintinalli JE, et al.
Tintinalli's Emergency Medicine: A Comprehensive Study Guide.
7th ed. New York, N.Y.: The McGraw-Hill Companies; 2011.
2. Karlson KA. Rib fractures.
[Link]
3. Fractures. The Merck Manuals: The Merck Manual for Healthcare
Professionals.
[Link]
ml#sec21-ch309-ch309b-141.
4. Preventing falls and related fractures. National Institute of Arthritis
and Musculoskeletal and Skin Diseases.
[Link]
prevent_falls.asp.