In general, the management of patients with rib fractures is dependent on the age of the patient, number of ribs fractured, and concomitant injuries. Fracture healing can be demonstrated by callus formation at the fracture site and consolidation of the fracture with the bridging bone. Since older patients and those with more than 2 rib fractures are at higher risk of pulmonary complications, admission for pain control, pulmonary toilet, and observation is warranted. Additionally, the patient with multiple injuries will require evaluation by the appropriate specialists.
Stress fractures, which often occur in athletes, are initially treated with periods of rest, analgesia, and activity modification until symptoms resolve.[50]Reeder MT, Dick BH, Atkins JK, et al. Stress fractures: current concepts of diagnosis and treatment. Sports Med. 1996 Sep;22(3):198-212.
http://www.ncbi.nlm.nih.gov/pubmed/8883216?tool=bestpractice.com
To avoid recurrence, training errors should be eliminated.
Patients should be monitored for delayed complications or non-union.
British Orthopaedic Association trauma standards highlight the importance of early (within 24 hours) multidisciplinary rehabilitation prescription and communication for all trauma patients.[36]National Institute for Health and Care Excellence. Rehabilitation after traumatic injury. January 2022 [internet publication].
https://www.nice.org.uk/guidance/ng211
[48]Battle C, Pelo C, Hsu J, et al. Expert consensus guidance on respiratory physiotherapy and rehabilitation of patients with rib fractures: an international, multidisciplinary e-Delphi study. J Trauma Acute Care Surg. 2023 Apr 1;94(4):578-83.
https://journals.lww.com/jtrauma/fulltext/2023/04000/expert_consensus_guidance_on_respiratory.12.aspx
http://www.ncbi.nlm.nih.gov/pubmed/36728349?tool=bestpractice.com
[69]British Orthopaedic Association. British Orthopaedic Association standards for trauma: rehabilitation and communication with trauma patients. August 2016 [internet publication].
https://www.boa.ac.uk/static/f841773c-f520-45b4-b56d6ca215f34ae1/372a0925-b190-4d84-b3ac355d6eb864b5/rehabilitation%20and%20communication%20with%20trauma%20patients.pdf
The standards recommend at least one face-to-face meeting with the major trauma coordinator for all major trauma patients and carers.[69]British Orthopaedic Association. British Orthopaedic Association standards for trauma: rehabilitation and communication with trauma patients. August 2016 [internet publication].
https://www.boa.ac.uk/static/f841773c-f520-45b4-b56d6ca215f34ae1/372a0925-b190-4d84-b3ac355d6eb864b5/rehabilitation%20and%20communication%20with%20trauma%20patients.pdf
They also recommend an assessment by the fracture liaison service to provide secondary prevention measures for all patients aged 50 years or older with fragility fractures (defined as a fracture following a fall from standing height or less).[70]British Orthopaedic Association. British Orthopaedic Association standards for trauma: fracture liaison services. 2015 [internet publication].
https://www.boa.ac.uk/static/41b78902-50b3-4197-86ee192efa68b4ab/233cee08-aef8-4604-b81132b119cf7351/fracture%20liaison%20services.pdf