Hospital Treatment For Multiple Rib Fractures

Multiple rib fractures are often caused by falls, accidents, or trauma to the chest. Treatment for multiple rib fractures aims to alleviate pain and breathing difficulties, and restore thoracic stability. The treatment method depends on the severity of the injury and whether there are any associated internal organ injuries. Most patients with multiple rib fractures are managed with conservative therapy, including rest, ice, and breathing exercises, and over-the-counter NSAIDs. In more severe cases, surgical intervention may be required to stabilize the chest wall and prevent long-term disability and chest wall pain.

Pain management with medication

Pain management is the initial treatment goal for patients with rib fractures. This is best achieved through a customised medication plan based on the patient's symptoms and pain severity.

For minor rib fractures, over-the-counter NSAIDs such as aspirin or ibuprofen can be used to manage pain. Patients with more severe pain may require opioid medication. However, opioids can cause respiratory depression, so they are often administered parenterally under medical supervision.

Regional anaesthesia, such as continuous thoracic epidural narcotic infusion, can be used to reduce suffering, decrease opiate use, lower rates of in-hospital delirium, and improve pulmonary function. Nerve blocks, such as the serratus anterior plane block (SAPB) and erector spinae plane block (ESPB), are also effective methods to anesthetise the chest wall and provide pain relief without affecting respiratory function.

Intercostal nerve blocks have been shown to be dramatically more effective than conventional medications in the initial stage of treatment for patients with thoracic injuries. However, for patients with multiple rib fractures, the procedure may need to be performed at multiple intercostal levels.

In addition to pain medication, anti-inflammatory medication, muscle relaxers, and nerve medications may also be used to address the different sources of pain associated with rib fractures.

Breathing exercises

Coughing

Patients may be instructed to cough on purpose every few hours during their recovery. This helps to clear the lungs and prevent the development of pneumonia.

Pillow Support

Using a pillow during breathing exercises can help to cushion the injured ribs and reduce pain. Holding a pillow against the ribs can make deep breathing exercises more comfortable.

Intercostal Nerve Blocks

Intercostal nerve blocks are a type of injection that provides pain relief without affecting respiratory function. This procedure can be particularly useful for patients with multiple rib fractures, but it does carry risks, including intravascular injection and pneumothorax.

Epidural Narcotic Infusion

Continuous thoracic epidural narcotic infusion has been used to treat patients with multiple rib fractures. This method provides pain control and helps restore ventilatory function, improving breathing.

Oral Probiotics

In elderly patients with multiple rib fractures, oral administration of the probiotic Lactobacillus casei Shirota (LcS) has been found to reduce the incidence of pneumonia and improve pulmonary functions. This approach can help improve breathing and reduce the risk of respiratory complications.

Icing

The treatment of multiple rib fractures depends on the severity of the injury and the patient's overall health. Most rib fractures can be treated with rest, icing, and over-the-counter NSAIDs such as aspirin or ibuprofen.

It is important to remember that icing should be done in moderation. Do not ice for longer than the recommended duration, as excessive icing can cause skin and tissue damage. Additionally, it is crucial to avoid falling asleep with an ice pack on, as prolonged exposure to extreme cold can lead to frostbite.

In addition to icing, your doctor may recommend breathing exercises to prevent pneumonia and improve lung function. These exercises help keep your lungs and chest moving properly. During recovery, you may need to purposefully cough every few hours to prevent pneumonia and maintain healthy lung function.

Surgery

The goals of surgical treatment are to stabilize the chest wall and improve the patient's quality of life by decreasing pain, reducing the risk of pneumonia, and improving breathing.

There are several types of surgery for multiple rib fractures. Surgical fixation, or rib plating, involves placing a metal or absorbable plate to stabilize and hold the ribs in the correct position while they heal. This has become a popular alternative treatment for multiple rib fractures, although it was once considered controversial. Other surgical procedures include open reduction and internal fixation, which is used for flail chest injuries, a life-threatening condition where a section of ribs separates from the chest wall.

Before surgery, patients may need to modify their diet or lifestyle to improve bone healing. During surgery, careful management of the fracture is required to protect surrounding structures like blood vessels and nerves.

One retrospective analysis compared surgical treatment with conservative treatment for patients with multiple rib fractures. The hospital stay for the surgical group was shorter, at 13.12±4.21 days compared to 18.57±5.39 days for the conservative group. The hospitalization cost was also lower for the surgical group.

Hospital admission

Upon hospital admission, a patient with multiple rib fractures will likely undergo a CT scan of the chest and abdomen to check for significant related injuries. The initial treatment goals are to manage pain and prevent respiratory issues. This is often done through a customised medication plan, which may include a combination of pain medication, anti-inflammatory medication, muscle relaxers, nerve medications, and opioid medication for severe pain. Regional anaesthesia, such as the serratus anterior plane block (SAPB) and erector spinae plane block (ESPB), can also be used to reduce suffering, decrease opiate use, and improve pulmonary function.

In some cases, nerve blocks may be used for pain control. Intercostal nerve blocks, for example, can provide effective pain relief without affecting respiratory function. However, this procedure carries risks such as intravascular injection and pneumothorax, and it may need to be performed at multiple intercostal levels for patients with multiple rib fractures. Epidural and intravenous administration of fentanyl has also been used for pain control and restoration of ventilatory function following multiple rib fractures.

In addition to pain management, patients with multiple rib fractures may need to perform breathing exercises to prevent pneumonia and maintain normal lung and chest function. This may include purposeful coughing every few hours during recovery. Surgery is rarely needed for rib fractures unless there are serious internal injuries or non-union fractures that have not healed properly.

Frequently asked questions