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So let's just summarize information around rib fractures. Rib fractures

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are not very common, only 29 in 100,000 in terms of incidents,

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population generally tends to skew, so elderly athletes, cancer patients,

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victims of abuse. Patients will present with pain at the site of fracturing,

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which is generally aggravated by palpation movement, respiration. You may

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actually identify on the examination crepitus, and again on radiographs

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we're seeing a lot of that subcutaneous air. Patients may have shortness

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of breath, secondary splinting and the pain of breathing, and there may

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be bruising over the air secondary to direct trauma.

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The American College of Radiology recommends that the initial imaging varies

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by indication, so if there's really just minor trauma, a radiographic chest

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is sufficient, but a radiographic view with rib series may be appropriate.

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And so we have looked at cases where on radiograph we couldn't see

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the rib fracture, but on the rib series we were able to see

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that. In our practice, we tend to do and start with radiographs. If

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there's nothing big, bad, and large, then we generally will stop there.

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If it's something that's very specific, or if we're doing problem solving,

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the rib series is something that we employ at that point.

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In terms of other examinations, they're listed here. But in general,

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and in speaking, the CT is much more sensitive than the X ray

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for actually being able to evaluate the ribs and to see them really

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clearly. And in our trauma patients, we tend to, as part of the

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trauma protocol, do CT of chest and then we're able to comment very

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easily on the presence of rib fractures. A lot of our patients where

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they're getting the portable chest X ray, that may be poor inspiration,

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there's a lot of lines and tubes overlying, it's gonna be hard to

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look at the ribs, but the CT gives you a much better opportunity.

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In terms of the imaging finding, discontinuity of the ribs, the secondary

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finding which we've discussed will include the hemothorax, the pneumothorax

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lung contusion, if the fracture is not visible at first, again,

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sono manipulation may be something to do if you're using ultrasound.

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If you don't see on the radiograph, consider CT.

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Pros and pitfalls. Be careful, if you're looking at radiographically, pectus

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excavatum may mimic or hide rib fractures on radiography. Be aware that

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conditions like fibrous dysplasia or Paget's may mimic rib fractures. And

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then when you're looking at where rib fractures are, understand that there

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are certain injuries that are associated with certain rib fractures. So

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again, very high up rib number one, remember that the subclavian vessels

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are running in that area, and so injuries to the subclavian are a concern.

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Ribs 1 through 3 also think about, and recognize the brachial plexus is

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in that area, and so an inquiry around other sorts of injury presentation

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is something to consider. Ribs 4 through 9, think pulmonary and cardiovascular.

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And in the lower ribs, 9 through 12, consider that on the right

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side you might have injury to the liver, and on the left side

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you might have injury to the spleen. Generally speaking, ribs 4 through

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10 are the ones that are most commonly fractured. And here are some

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references.