Management of Rib Fractures

Pain Management

Oral acetaminophen should be administered regularly every 6 hours as first-line treatment for rib fracture pain 1
NSAIDs can be used as second-line treatment for patients with severe pain, considering potential adverse events and drug interactions 1
Ketorolac may be considered for additional pain control in moderate rib fracture pain without high-risk factors 2
Low-dose ketamine (0.3 mg/kg over 15 minutes) can be used as an alternative to opioids for severe pain 1
Avoid ketorolac in patients with aspirin/NSAID-induced asthma, pregnancy, or cerebrovascular hemorrhage 2

Use of incentive spirometry should be encouraged, aiming for >50% of predicted volume 1
Monitor for respiratory rate >20 breaths per minute, which may indicate respiratory compromise 3
Teach effective coughing techniques to clear secretions while supporting the injured area 1

Inform patients that rib fractures typically heal within 6-8 weeks, but complete recovery may take up to 2 years in some cases 1
Gradual return to normal activities should be encouraged as pain allows 1
Return to work may be possible within 8-12 weeks for simple fractures and up to 6 months for complex injuries 1

Instruct patients to seek immediate medical attention for worsening shortness of breath or difficulty breathing 1
Instruct patients to seek immediate medical attention for increasing chest pain not controlled by prescribed medications 1
Instruct patients to seek immediate medical attention for dizziness, confusion, or extreme fatigue 1

Patients over 60 years of age have increased risk of complications and should be monitored more closely 1
Patients with multiple (≥3) rib fractures, flail chest, or pulmonary contusion are at higher risk for complications 1
Patients with chronic respiratory disease, obesity, or on anticoagulation therapy require more vigilant monitoring 1
Consider earlier follow-up appointments for high-risk patients 1

Pain should show significant improvement by 4 weeks post-injury with appropriate management 1
Consider imaging at follow-up visits to monitor healing in cases of severely displaced fractures 3
Evaluate for chronic pain syndromes, which develop in up to 40% of patients 1
Assess for non-union (failure to heal), which occurs in approximately 1-5% of cases and may require surgical intervention 1

Patients with flail chest (≥2 consecutive ribs each fractured in ≥2 places) may benefit from surgical fixation 4
Surgical fixation should be considered for patients with severe refractory pain or chest wall deformity 1
Multiple (≥3) ipsilateral severely displaced rib fractures may warrant surgical evaluation 4
Surgical stabilization performed within 48-72 hours of injury can shorten recovery time in selected patients 1