Prognosis
Morbidity and mortality
Chest wall injuries in older people should not be dismissed. Older patients have twice the morbidity and mortality compared with younger patients; for every increase in the number of ribs fractured, mortality increases by 19% while the risk of pneumonia increases by 27%.[41]
As the number of ribs fractured increases, morbidity and mortality increases in all age groups. There is a significant increase in mortality and in the incidence of pneumothorax, pneumonia, and acute respiratory distress syndrome, per increase in the number of ribs fractured. Older patients and those with >2 rib fractures are at a higher risk of pulmonary complications such as atelectasis, poor oxygenation, and respiratory compromise.[27] With 6 ribs fractured, there is a threshold for significant complications.[41] Pneumonia in the setting of rib fractures has a high mortality.[63] It is important to remember than even single rib fractures can be associated with significant morbidity and mortality, particularly in frail, elderly patients.[49]
Pain and disability
In patients with isolated rib fractures, pain is present but gradually declines over 4 months. The average time off work is about 70 days following chest trauma with or without concomitant injuries.[64]
Retrospective data suggest that approximately 30% of patients who were working prior to major trauma with rib fractures will not return to work within the 24 month post-injury period.[65]
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