Spirometry in Patients with Old Rib Fractures

Contraindications to Spirometry

Hemodynamic instability is a contraindication to spirometry, similar to contraindications for surgical stabilization of rib fractures (SSRF) 1
Recent thoracic or abdominal surgery (within 2-4 weeks) is a contraindication to spirometry 2
Acute myocardial infarction or unstable angina is a contraindication to spirometry 3
Pneumothorax or recent pneumothorax is a contraindication to spirometry 2
Hemoptysis of unknown origin is a contraindication to spirometry 3

The American College of Surgeons and other guideline societies imply that hemodynamic instability is a contraindication to surgical intervention, not pulmonary function testing, through their discussions on SSRF contraindications 1, 3
Rib fractures typically heal within 6-8 weeks, with bone scan activity returning to normal in 79% of patients by 1 year, allowing for normal respiratory mechanics 2
Pain from old fractures is minimal to absent, eliminating the primary concern that exists with acute fractures 2

If the patient reports acute pain at the old fracture site, suggesting possible non-union or new injury, imaging should be obtained first before spirometry 2
If there are signs of acute complications (new chest wall deformity, respiratory distress), these should be addressed before routine spirometry 2