| Anatomy |
- Osteology
- 12 ribs per side
- the first seven pairs are connected with the sternum
- the next three are each articulated with the lower border of the cartilage of the preceding rib
- the last two have pointed extremities
- can have an accessory clavicular rib
- anterior ribs articulate with the sternum via the costal cartilage
- Blood Supply
- derived from intercostal vessels
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| Presentation |
- Symptoms
- pain
- respiratory difficulty
- hemopneumothorax
- Exam
- paradoxical respiration
 
- area of injury "sinks in" with inspiration, and expands with expiration (opposite of normal chest wall mechanics)
- chest wall deformity can be seen
- bony or soft-tissue crepitus is often noted
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| Imaging |
- Radiographs
- may ne hard to distinguish non- or minimally-displaced rib fractures
- may see associated hemothorax
- CT
- improved accuracy of diagnosis with CT (vs. radiographs)
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| Treatment |
- Nonoperative
- observation
- indications
- no respiratory compromise
- no flail chest segment (>3 consecutive segmentally fractured ribs)
- techniques
- pain control
- systemic narcotics or local anesthetics
- positive pressure ventilation
- Operative
- open reduction internal fixation
- indications
- displaced rib fractures associated with intractable pain
- flail chest segment (3 or more consecutive ribs with segmental injuries)
- rib fractures associated with failure to wean from a ventilator
- open rib fractures
- technique
- approach
- full thoracotomy approach
- limited exposure approach
- open reduction and internal fixation
- plate and screw constructs
- intramedullary splinting
- postop
- early shoulder and periscapular range of motion
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| Complications |
- Intercostal neuralgia
- periscapular muscle weakness
- pneumonia
- restrictive type pulmonary function
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