No Ribbing About Ribs

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Ribs are long, thin bones that are prone to breaking from direct trauma to the chest (like from a fall, car accident, or assault) or from repetitive trauma (such as repetitive coughing or sports). Rib fractures may occur at any age but are more common in older patients because many older individuals suffer from osteoporosis, which makes bones thinner and more brittle. Rib fractures may just be a crack in the rib or a complete fracture with misalignment of the ends of the bones at the fracture. The more fractured ribs a person has, the more severe the injury is. In patients older than 65 years, each additional rib fracture increases the risk of developing pneumonia by 27 percent, and the risk of death by 20 percent. Therefore, prompt medical evaluation of any rib injury is crucial.

The most common symptom of a rib fracture is pain with touch, taking a deep breath, coughing, or sneezing. Because there is pain with deep breaths, those with rib fractures splint when they breathe, meaning they take short, shallow breaths, and they minimize movement. This can lead to collapse of some alveoli, or air sacs in the lung, which may lead to pneumonia. The first test to diagnose a rib fracture is an X-ray. A normal X-ray does not mean there is no fracture. X-rays may miss small, non-displaced cracks in the ribs, which is why a CAT scan is often ordered if the X-ray is normal. Rib fractures, especially those where a portion of the rib is displaced, may cause bruising of the lungs, bleeding into the chest and lungs, or a pneumothorax (an air leak which leads to a collapsed lung). Flail chest occurs when two or more consecutive ribs are broken in a least two separate areas of each rib. In flail chest, the broken section of the chest wall moves paradoxically, meaning it moves in during inspiration and out during expiration. Flail chest is often associated with more severe lung injuries.

The key to treatment is pain control, breathing exercises to keep the lungs fully inflated, and physical therapy. Many medications are used to control pain up to and including narcotics. Incentive spirometry is often used to keep the lungs fully inflated. This is accomplished using a device with a float level in it that measures inspirational effort. Using this device and pain control enables the patient to take slow, deep breaths which keeps the alveoli inflated and prevents pneumonia. Because the risk of complications increases with age, older patients with broken ribs are often admitted to the hospital. If the broken rib(s) are bent or displaced, and often in flail chest, surgery is necessary to stabilize the fractures. A surgical technique called rib plating is used to repair the ribs. Rib plating uses thin steel strips that are attached to the ribs across the fracture line. Rib fractures may take three months or longer to heal. The fractures are considered fully healed when the patient can take deep breaths, cough effectively, and walk without significant pain.

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