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%.[70]

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 ARDS, 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 breaking point for significant complications.[70][71]​ Pneumonia in this setting has a high mortality.[72] It is important to remember that even single rib fractures can be associated with significant morbidity and mortality, particularly in frail, older patients.[43]​​

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.[73]

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.[74]

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