Management of the patient with rib fractures

Abstract

Rib fractures commonly result from blunt chest wall trauma and are often associated with significant morbidity and mortality. Patients often develop a vicious cycle of pain, requirement for opioid analgesia, respiratory dysfunction, hypostatic pneumonia and ultimately respiratory failure. This is more common in those with high-risk features such as increasing age, respiratory co-morbidities and significant burden of injury. Poorly managed chest wall pain can lead to prolonged hospital stay, including critical care admission, invasive ventilation and increased likelihood of morbidity and death. Protocolized assessment and management is recommended to ensure high-risk patients are identified early and ensure that a holistic package of care including physiotherapy, incentive spirometry, multi-modal stepwise analgesia and laxatives are provided for all patients. Regional anaesthesia and surgical fixation should also be considered early for high-risk patients. A multidisciplinary approach is essential to maximize patient experience and outcome.