fractured ribs are often well visualised on CXR, but may be poorly shown or not detectable on plain CXR or even rib views - ~50% of fractures are missed on CXR
patients with high impact injuries to the thorax (eg. fall from a roof), or high risk patients with poor respiratory reserve (eg. elderly), should have a low threshold for having a CT thorax performed as this may detect otherwise undiagnosed flail segments and haemothoraces which may have a propensity to cause the patient's condition to deteriorate over the next few hours.
Mx of patients with fracture 1st rib
these patients are at risk of neurovascular injury and should be considered for contrast CT chest
Mx of patients with isolated rib fractures
Mx is generally aimed at:
analgesia (may need intercostal block)
preventing secondary pneumonia from poor respiration
consider prophylactic antibiotics in smokers, those with chronic lung disease and the elderly
diagnosis and monitoring of haemothorax which may be slowly accumulating over days
role of chest CT vs serial CXRs
patients with three or more rib fractures, especially elderly patients, are at significant risk for complications, such as pulmonary contusion and pneumonia, even in the absence of other injuries, and should be admitted for observation
many hospitals have a policy requiring any such patients who require admission be referred to a multi-disciplinary team which includes the pain team to reduce the potentially high morbidity and mortality in at risk patients