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# Rib fractures

A rib fracture is a break in one or more [ribs](https://durgical.com/en/anatomy/ribs/), usually from a blow to the chest; the pain limits breathing and coughing and can lead to pneumonia.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Ribs (back part)](https://durgical.com/en/anatomy/ribs/)
- [Costal cartilages](https://durgical.com/en/anatomy/costal-cartilage/)
- [Intercostal nerves](https://durgical.com/en/anatomy/intercostal-nerves/)
- [Posterior intercostal arteries](https://durgical.com/en/anatomy/posterior-intercostal-arteries/)
- [Pleura](https://durgical.com/en/anatomy/pleura/)
- [External intercostals](https://durgical.com/en/anatomy/external-intercostal-muscles/)

## In the clinical exam

- [Chest palpation: expansion and tactile fremitus](https://durgical.com/en/clinical-exam/chest-palpation-expansion-and-tactile-fremitus/)
- [Pneumothorax syndrome](https://durgical.com/en/clinical-exam/pneumothorax-syndrome/)

## What it is

A break in one or more ribs, usually from blunt chest trauma. The pain limits breathing and coughing, and in older people even a few fractures can lead to pneumonia and respiratory failure.

## Who gets it

The most common injury after blunt chest trauma, from road traffic collisions, falls and assaults. In older adults a simple fall is enough, and they have the highest rates of complications and death.

## Causes

- Blunt chest trauma: road traffic collisions, falls, assaults
- Low-energy falls in older or osteoporotic people
- Repetitive stress (rowing, persistent coughing)
- Pathological fracture through a bone metastasis
- Cardiopulmonary resuscitation

## Risk factors

- Older age
- Osteoporosis
- Chronic lung disease
- High-energy mechanism
- Anticoagulant use
- Several ribs fractured

## Pathophysiology

Ribs 4 to 10 break most often. Pain makes the patient breathe shallowly and avoid coughing, so secretions build up, the bases collapse and pneumonia can follow. Sharp fragments can tear the [pleura](https://durgical.com/en/anatomy/pleura/), lung and intercostal vessels; upper rib fractures signal high energy and lower ones can come with [liver](https://durgical.com/en/anatomy/liver/), [spleen](https://durgical.com/en/anatomy/spleen/) or kidney injury.

## Classification

- Simple (one or a few ribs, single break each)
- Multiple rib fractures
- Flail segment (separate page)
- By site: upper (1–3), middle (4–9), lower (10–12)
- Displaced or non-displaced

## Symptoms and signs

- Localised chest wall pain worse on breathing, coughing or moving
- Point tenderness over the rib, sometimes crepitus
- Shallow, rapid breathing (splinting)
- Bruising of the chest wall

## Red flags

- Hypoxaemia or rising work of breathing
- Signs of pneumothorax or haemothorax
- Fractures of the first or second rib (great-vessel or [brachial plexus](https://durgical.com/en/anatomy/roots-of-brachial-plexus/) injury)
- Lower rib fractures with abdominal pain (liver, spleen, kidney)
- Three or more fractures in an older patient

## Diagnosis

**Clinical**
History of trauma with point tenderness and pain on breathing; the [chest](https://durgical.com/en/anatomy/region/chest/) is examined for paradoxical movement, emphysema and reduced breath sounds.

**Tests**
Pulse oximetry and blood gases in multiple fractures; blood count when bleeding is suspected; ECG if cardiac contusion is possible.

**Imaging**
Chest X-ray looks for pneumothorax and haemothorax but misses many rib fractures; CT is more sensitive and shows associated injuries. Ultrasound can also detect fractures.

## Differential diagnosis

- Chest wall contusion
- Costochondritis
- Pneumothorax
- Pulmonary embolism
- Pathological fracture

## Goal of treatment

Control pain well enough for deep breathing and coughing, prevent pneumonia and respiratory failure, and find associated injuries.

## Treatment

**Medical**
Multimodal analgesia with paracetamol, anti-inflammatories when safe and opioids when needed, adjusted to age and [kidney](https://durgical.com/en/anatomy/kidney/) function.

**Procedure**
Regional anaesthesia (epidural, paravertebral or chest wall plane blocks) in multiple fractures or older patients with poor pain control.

**Rehabilitation**
Breathing exercises, incentive spirometry, early mobilisation and help with clearing secretions.

**Surgical**
Surgical rib fixation in selected cases: flail chest, severe displacement, failure to wean or persistent pain; indications vary between centres.

**Follow-up**
Admission and close observation for older patients, several fractures or underlying lung disease.

## Complications

- Pneumonia
- Respiratory failure
- Pneumothorax
- Haemothorax
- Injury to liver, spleen or kidney (lower ribs)
- Chronic chest wall pain
- Non-union (rare)

## Prognosis

Most heal in about six weeks. Risk of pneumonia and death rises with age and with each extra fractured rib, which is why older patients are watched closely.

## Prevention

- Fall prevention and osteoporosis treatment in older people
- Seat belts and road safety

## Test yourself

Think of the answer, then tap the question to see it.

## Why are rib fractures more dangerous in older patients?

Pain causes shallow breathing and poor coughing, leading to atelectasis and pneumonia; risk of complications and death rises with age and number of fractures.

## What does a first or second rib fracture suggest?

A high-energy mechanism, with a search for associated injuries of the great vessels, brachial plexus and lung.

## Which organs may be injured with fractures of the lower ribs?

The liver on the right, the spleen on the left and the kidneys posteriorly.

## What is the main goal of treating simple rib fractures?

Effective pain control so the patient can breathe deeply and cough, to prevent pneumonia.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/rib-fractures/)

## Related conditions

- [Flail chest](https://durgical.com/en/conditions/flail-chest/)
- [Haemothorax](https://durgical.com/en/conditions/haemothorax/)
- [Pneumothorax](https://durgical.com/en/conditions/pneumothorax/)
- [Community-acquired pneumonia](https://durgical.com/en/conditions/community-acquired-pneumonia/)
- [Osteoporosis](https://durgical.com/en/conditions/osteoporosis/)
- [Costochondritis](https://durgical.com/en/conditions/costochondritis/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Splenic injury](https://durgical.com/en/conditions/splenic-injury/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Flail Chest](https://www.ncbi.nlm.nih.gov/books/NBK534090/) (StatPearls (NCBI Bookshelf), 2025).

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Source: https://durgical.com/en/conditions/rib-fractures/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/rib-fractures/