Complications
Occurs in 14% to 37% of patients with rib fractures.[8][9][10] Presents mainly as a sudden shortness of breath, dry cough, cyanosis, and pain felt in the chest, back, and/or arms.
In penetrating chest wounds, the sound of air flowing through the puncture hole may indicate pneumothorax, hence the term "sucking" chest wound. The flopping sound of a punctured lung is also occasionally heard. Subcutaneous emphysema can occur. If untreated, hypoxia and impaired systemic venous return (tension pneumothorax) may lead to loss of consciousness and coma.
Treatment involves draining the pneumothorax, with chest tube placement or a pleural catheter. Thoracotomy may be needed in some patients to repair tears in the lungs or air passages.
Often occurs with rib fractures. Tachypnea, cyanosis, decreased or absent breath sounds on affected side, tracheal deviation to unaffected side, dull resonance on percussion, unequal chest rise, tachycardia, hypotension, and pale, cool, clammy skin are typical exam findings. Treatment involves draining the hemothorax, usually with chest tubes but occasionally requiring video-assisted thoracoscopic surgery or a thoracotomy. Surgery may also be necessary for hemostasis.
Occurs in around 17% of patients with rib fractures.[8] Results from high-impact blunt chest trauma, leading to edema, blood collecting in alveolar spaces, and loss of normal lung structure and function. It develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance, and decreased lung compliance. Pulmonary contusion is associated with an increased risk of pneumonia, acute respiratory distress syndrome, and hypoxemia necessitating ventilatory support.[75] Chest x-ray (CXR) or a computed tomography (CT) scan is used to determine the complication.
Often occurs as a result of significant blunt thoracic trauma. Management of hemodynamically unstable patients with potential aortic injury is to rapidly identify and control ongoing hemorrhage from other sites, and to minimize blood pressure lability and large shear stresses on the aortic wall. Clinical signs of traumatic aortic injury are rarely present, and diagnosis is based on mechanism of injury, and the results of imaging studies. Chest x-ray (CXR), computed tomography (CT) scan, CT angiography, and angiogram are used.
CXR can show mediastinal widening, blunting of the aortic knob, depression of the left mainstem bronchus, and rightward tracheal/esophageal deviation.[76]
In patients with isolated rib fractures, pain is present but gradually declines over 4 months. The average time off of 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]
Thrombus formation in the venous system can occur following trauma, leading to pulmonary embolism; right heart failure and cardiac arrest may ensue if not aggressively treated.
Non-union of a rib fracture is rare but can occur. These may be treated with plate fixation.[77]
Severe trauma can cause ARDS. There is a significant increase in pneumothorax, pneumonia, and ARDS, as well as mortality, per increase in the number of ribs fractured. With 6 ribs fractured there is a breaking point for significant complications.[70][71] Symptoms that suggest ARDS include the acute onset of shortness of breath and hypoxemia leading to acute respiratory failure.
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