History and exam
Key diagnostic factors
common
history of trauma
Blunt force trauma can occur from motor vehicle collisions, falls, and industrial incidents.[8] Of patients who experience blunt chest trauma, 55% sustain rib fractures; patients ages >65 years are at greatest risk.[1] In children with no history of trauma, the presence of rib fractures has the highest probability of all skeletal fractures of being attributable to physical abuse.[14] Among infants presenting with rib fractures, as many as 82% have sustained these injuries as a result of physical abuse.[2]
presence of risk factors
Risk factors include blunt chest wall trauma, physical abuse (particularly in children), osteoporosis, and participation in sports such as rowing and golf.
pain
Rib fractures produce chest wall pain that can often reduce ventilation due to impaired effort.
dyspnea
Chest wall pain can reduce ventilation by impaired effort.
Other diagnostic factors
uncommon
signs of impaired oxygenation
Impaired oxygenation can be due to impaired effort of ventilation following chest wall pain or be indicative of underlying pneumothorax, hemothorax, or pulmonary contusion.
Rib fractures impair adequate ventilation resulting in atelectasis, poor oxygenation, and respiratory compromise.[27][Figure caption and citation for the preceding image starts]: CT scan showing large left-sided pneumothoraxFrom the collection of Dr Paul Novakovich; used with permission [Citation ends].
[Figure caption and citation for the preceding image starts]: CXR depicting the same pneumothorax as shown on CTFrom the collection of Dr Paul Novakovich; used with permission [Citation ends].
paradoxical chest wall motion
Paradoxical chest wall motion with inspiration or expiration is a sign of a flail chest. A flail chest results when multiple ipsilateral ribs are fractured in two or more places, resulting in an unstable segment of the chest wall. Flail chest is often accompanied by other injuries, and carries an increased risk of life-threatening respiratory failure, pneumothorax, pulmonary contusion, and hemothorax, with an overall mortality of at least 5%.[32]
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