What are possible complications of a rib fracture?

Updated: Jun 13, 2017
  • Author: Sarah L Melendez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Complications of rib fracture may include the following:

  • Respiratory failure: The alteration in chest wall mechanics due to multiple rib fractures increases the work of breathing and the patients with multiple rib fractures are at risk for pulmonary fatigue. Respiratory failure can be due to the chest wall injury (eg, flail chest) but is more commonly due to an underlying pulmonary contusion or development of nosocomial pneumonia, especially if superimposed on a preexisting pulmonary condition. [51]

  • Hypoventilation

  • Hypercapnia

  • Hypoxia

  • Atelectasis

  • Pneumonia: Pneumonia is one of the most common complications associated with rib fractures. Pneumonia rates vary depending on the number of fractures and age of the patient. The incidence of pneumonia for all patients hospitalized with one or more rib fractures is about 6%. [51]

  • Damage to underlying visceral organs

  • Pneumothorax (immediate or delayed) [43]

  • Hemothorax (immediate or delayed) [43]

  • Retained hemothorax: Retained hemothorax refers to the presence of blood/clot in the thoracic cavity that persists in spite of thoracostomy drainage. The risk of empyema is increased in patients with retained hemothorax. [53]

  • Aortic injury (immediate or delayed) [54]

  • Pulmonary contusion

  • Intra-abdominal organ injury [30]

Patients with fractured ribs and vital capacity of less than 30% have been found to have a higher rate of pulmonary complications. One study found that every 10% increase in vital capacity was associated with a 36% decrease in likelihood of pulmonary complications. Patients with a vital capacity greater than 50% had a significantly lower rate of pulmonary complications. [55]

First rib fractures have often been associated with serious head injury, cervical spine injury, delayed subclavian vessel thrombosis, aortic aneurysm, tracheobronchial fistula, thoracic outlet syndrome, and Horner syndrome. [9]

A small percentage of rib fractures do not heal even though a fibrous capsule may envelope the fracture. A nonunion may present months to years after injury and can cause discomfort with respiration due to movement of the fracture site. Some patients find the respiratory restriction due to pain quite disabling.


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