What to do if you have a broken rib

In most cases, a broken rib will heal on its own. Why treatment is still important

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Rib fractures are one of the more common bone fractures. Most of the time they are caused by accidents.

Man has twelve pairs of ribs. At the front they are connected to the sternum, which is also bony, via pieces of cartilage. At the back they are in contact with the spine via small joints. Together, these anatomical structures form the skeleton of the chest, also called the thorax.

Animation: The ribs run here

The chest, which protects the lungs, is flexible and mobile, but at the same time very stable."That's why healthy younger people need a lot of force to cause a rib fracture," says Boris Möbius, senior consultant at the clinic for orthopedics, trauma surgery and sports medicine at the Evangelical Hospital Hubertus in Berlin. With the number of years of life, however, the mobility and strength of the ribs often decrease. This explains why broken ribs mainly affect older patients with osteoporosis.

Main causes of broken ribs: falls and accidents

Typical triggers include falls on edges such as the edge of the bathtub, steps or the back of a chair. Other possible reasons are accidents with cars and bicycles or in contact sports such as soccer, handball, hockey or martial arts and physical violence such as kicks or punches. It is not uncommon for a rib to break during chest compressions, even if it is performed correctly - but it should by no means be a reason to abort this possibly life-saving first aid measure.

Persistent coughing, for example due to a chronic obstructive pulmonary disease, can under certain circumstances cause a rib fracture. "With such a fatigue fracture, however, the bone structure is usually also weakened by osteoporosis," reports Boris Möbius.

There are different types of fractures:

  • Series of ribs fracture: If three or more ribs on top of each other are broken on the same side of the body, doctors speak of a series of ribs fracture.
  • Rib fracture: In a rib fracture, the affected rib has at least two fractures, so that the bone piece or pieces in between move practically freely.
  • Open break: If a break end pierces the skin, it is an open break.

The majority of those affected suffer a simple, closed rib fracture in which the fragments are stabilized by the surrounding structures and are not shifted against each other.

Series of ribs fracture: three adjacent ribs are broken (red)

© Masterfile /

What are the symptoms of a broken rib?

"The main characteristic of a broken rib is relatively severe pain, which gets worse when you breathe in deeply and when you cough," says expert Boris Möbius. Pressure on the affected rib area, for example when lying down, and movements of the upper body also increase the pain. In addition, you can sometimes hear grinding noises when breathing. The fracture is often visible from the outside through swelling and bruising over the fracture site. Due to the pain, those affected usually breathe more shallowly than usual and look for the position in which it hurts the least.

Emergency lung collapse

If the patient suffers from acute shortness of breath, this indicates a pneumothorax or a hemothorax. This complication arises when air or blood gets into the pleural space between the outer and inner lungs. As a result, the lungs collapse, can no longer take part in the breathing movements and lose their function. "A pneumothorax only occurs in a maximum of five to ten percent of all broken ribs," says Möbius. "But then it's a medical emergency that needs to be treated immediately."

One symptom that can appear in fractures of the rib and serpentine ribs is inverse or paradoxical breathing. In contrast to the normal breathing movement, the chest in the fracture area then pulls inward during inhalation and bulges when exhaling.

It happens that the blood vessels that run along the ribs are injured as a result of the rupture, "but overall this happens relatively rarely," says the specialist in surgery, orthopedics and accident surgery. "A rib fracture is uncomfortable, but with the right treatment it is usually harmless and without major complications."

How does the doctor recognize a broken rib?

Even the physical examination provides the doctor with clues that substantiate the suspicion of a rib fracture: severe pain when palpating the chest and breathing, audible crunching, also called crepitations. In the conversation, he specifically inquires about possible causes such as accidents, their course and other symptoms.

The most important aid in diagnosis is a chest x-ray. "X-rays in several planes are usually sufficient to determine a rib fracture," says Boris Möbius. "A pneumothorax or a hemothorax can usually be identified with it."

If in doubt, a computed tomography of the chest is also done, with which these two complications can be safely excluded. This examination may also be necessary for seriously ill or injured patients who cannot stand or sit upright.

Sometimes it is difficult to distinguish a simple rib fracture from a rib bruise. However, this distinction is not very important, as the treatment is largely similar.

How is a broken rib treated?

Reconnecting the fragments in one operation is only necessary in very rare exceptional cases. As a rule, the bone parts remain stabilized by the periosteum and muscles, even with serial rib fractures, to such an extent that they hardly move against each other and therefore grow back together by themselves. "The alpha and omega of treatment is adequate pain therapy," says Boris Möbius. "The patient must be able to breathe in and out deeply without any problems and, above all, properly cough up."

Effective pain relief is therefore so important so that those affected do not fall into shallow breathing. Because then the lungs are insufficiently ventilated, which increases the risk of pneumonia.

Therefore Möbius advises to always consult a doctor in the event of a fall on the ribs and subsequent pain. "A rib fracture should by no means be taken lightly." Bandages or plaster casts also hinder breathing and for this reason are no longer used today.

Dr. Boris Möbius, senior physician in charge of the clinic for orthopedics, trauma surgery and sports medicine at the Evangelical Hospital Hubertus in Berlin

© W & B / private

Take it easy - but don't overdo it

Which pain medication the patient needs varies from person to person and should be discussed with the doctor. Usually a non-steroidal anti-inflammatory drug such as ibuprofen or diclofenac is sufficient. In the case of a serial rib fracture, additional opiates are sometimes necessary.

Boris Möbius patients also get a breathing trainer to take home with them. The most common of these devices work with three small balls that are moved with the breath flow. How deeply you breathe in and out is a very subjective feeling, explains Möbius. "The requirement to be able to blow up three balls makes that objectifiable."

To prevent pneumonia, bedridden patients must be given physiotherapy and respiratory therapy. Heavy physical and sporting activities that endanger the broken rib are usually taboo in the first four to six weeks after the break. They should not be practiced again until the doctor has given the go-ahead.

Apart from this restriction, Boris Möbius recommends all those affected not to take too much care, but to continue participating in life as normal as possible. According to the expert, it takes six to eight weeks for a broken rib to heal completely. "The pain usually subsides after two weeks and then the patient has survived the worst."

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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