Management of rib fractures in the elderly

Helping elderly patients with rib fractures avoid serious

Addressing pain early is crucial with rib fracture in the elderly. Though there is no standard formula, pain management needs to be balanced with the patient's condition and injury pattern. Analgesics not only affect pain control, but also facilitate proper breathing The growing elderly population is at high risk for injury to the thorax as a result of falling from standing and sustaining rib fractures and associated pneumothorax and hemothorax. The elderly patients with rib fractures are challenging therapeutic dilemmas for the trauma surgeon Background: Surgical rib fixation in the general population can decrease morbidity, including length of stay and ventilator days. Elderly rib fractures convey high rates of morbidity and mortality, and it is unclear whether this population benefits from operative management Analgesia algorithms may aid early aggressive management and escalation of pain control. The current role for surgical fixation of rib fractures remains unclear for older adults who have been underrepresented in the research literature. Older adults with rib fractures often have multi-morbidity and frailty which complicate their injuries

Management and Complications of Rib Fractures in Older

  1. Implement an effective pain management protocol for elderly patients hospitalized with rib fractures. Incidence / Prevalence Rib fractures are a common injury for patients presenting to emergency departments with blunt thoracic trauma, with approximately 10% of these patients requiring admission to a trauma center
  2. Elderly patients who sustain blunt chest trauma with rib fxs have twice the mortality and thoracic morbidity of younger patients with similar injuries. For each additional rib fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27%. As the number of rib fractures increas
  3. Elderly rib fractures convey high rates of morbidity and mortality, and it is unclear whether this population benefits from operative management. Methods. A single-centre, retrospective study at a Level 1 Australasian trauma centre was conducted. Registry-identified patients aged ≥70 years, admitted to hospital with blunt trauma-induced rib.
  4. Geographically, patients with rib fractures in Europe and United States are mainly treated by traumatologists; while in China, over 95% of patients with surgical stabilization of rib fractures (SSRF) treatments would be mainly treated by thoracic surgeons
  5. Diagnosis of Rib Fractures. Many of the earlier studies of mortality and rib fractures relied on CXR alone to diagnose the fractures. CXRs pick up some of the more severe fractures, but screening CXRs can miss up to 50% of rib fractures [4]. As more and more patients are imaged with CTs, the mortality of rib fractures may appear to fall, since.
  6. Stawicki SP, Grossman MD, Hoey BA, et al. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc 2004; 52:805. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 2003; 54:478

Outcomes of rib fractures in the geriatric population: A 5

Rib fractures can occur at any age, but elderly patients are at higher risk because of osteoporosis (brittle bones). Sometimes the ribs crack, and other times they completely break into 2 or more pieces. The more rib fractures a patient has, the more dangerous they can be Ventilatory management of patients with rib fractures begins with supplementary oxygen. This should be humidified to loosen secretions and help sputum clearance improving patient comfort. Nebulized saline may also help reduce sputum retention

Each additional rib fracture increases the mortality rate by 19% and the risk of pneumonia by 27%. 55 Clearly, with even a few rib fractures, the elderly trauma patient needs more aggressive treatment in an inpatient setting. Pain control is of critical importance when treating these patients and may help improve mechanical ventilation and. That's so 1990s. And even if no rib fractures are seen on imaging, physical exam is the prime determinant for admitting your patient for aggressive pain management and pulmonary toilet. Reference: Chest CT imaging utility for radiographically occult rib fractures in elderly fall-injured patients. J Trauma 86(5):838-843, 2019 CETN Mgt Rib Fractures v1.4 / J.Owen / Apr 2016 1 Management of Rib Fractures Rib fractures are common injuries. Whilst the pain from a single rib fracture is usually quite easy to control, the significant pain associated with multiple rib fractures is much more difficult to manage Management of Traumatic Rib Fractures With a growing elderly population, however, there are increasing numbers of elderly patients sustaining rib fractures following a simple fall from standing. The posterolateral angle of the rib is structurally the weakest point. The pattern of injury, however, will often be determined b While rib fractures may lead to other complications including fracture non-union, intercostal nerve entrapment, and chronic pain and disability, the prevention and treatment of pulmonary complications in the acute phase, including pneumonia and atelectasis, remains an essential component of clinical management

New horizons in rib fracture management in the older adult

The Harborview rib fracture management protocol applies to all patients admitted with acute rib and/or sternal fracture(s) who meet the following criteria: age >14 years, extubated or recently extubated, GCS 13-15, and absence of high spinal cord injury. Patients over age 65 with ≥3 rib fractures are to be admitted to the ICU A rib fracture is a break in the rib bone of the thoracic skeleton. Rib fractures are common injuries that may be due to blunt force trauma, falls, non-accidental injury, aggressive cardiopulmonary resuscitation, severe coughing, athletic activities, or fractures due to primary bone tumours and metastatic lesions

Rib fractures are commonly encountered in the setting of thoracic trauma as a consequence of significant impacting forces on the chest wall. Rib fractures are found in 10% of all trauma patients and over 30% of chest trauma admissions. 1 Concomitant injuries are often identified and complications range from minor discomfort and pain to pneumothorax, pneumonia, and death. 2 The overall. Pain management for Elderly Patients with Multiple Rib Fractures, using Ketamine Infusion Hadi Abdullah RN BSN CEN, Master of Emergency Nursing Student, The University of Sydney Susan Wakil School of Nursing and Midwifery 88 Mallett St, Camperdown NSW 2050 E-mail address : habd9082[at]uni.sydney.edu.a

Background: Due to increased frailty and comorbidities, surgeons may be reluctant to perform surgical stabilization of rib fractures (SSRF) in geriatric (≥65yr) and super-geriatric (≥80yr) patients. We hypothesized that elderly patients would have delayed time to operation and more complications. We aimed to determine whether advanced age was a factor in deciding to proceed with SSRF and. lated rib fractures. Objectives: To describe the management, morbidity and mortality seen with isolated rib fractures in elderly patients and assess the need for hospitalization. Design: A case series. Setting: A tertiary care centre in Tel Aviv. Methods: Hospital records of 77 elderly patients (age 65 yr and older) admitte Elderly rib fractures convey high rates of morbidity and mortality, and it is unclear whether this population benefits from operative management. METHODS: A single-centre, retrospective study at a Level 1 Australasian trauma centre was conducted. Registry-identified patients aged ≥70 years, admitted to hospital with blunt trauma-induced rib. Surgical rib fixation in the general population can decrease morbidity, including length of stay and ventilator days. Elderly rib fractures convey high rates of morbidity and mortality, and it is unclear whether this population benefits from operative management. A total of 920 presentations were. This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients.

Managing Pain in Elderly Rib Fracture Patients (>65 years) #

  1. Using low levels of radiation, X-rays make bones visible. But X-rays often have problems revealing fresh rib fractures, especially if the bone is merely cracked. X-rays are also useful in diagnosing a collapsed lung. CT scan. This often can uncover rib fractures that X-rays might miss
  2. Researchers have found that rib fractures are the most frequently seen injury of chest-related injuries in trauma centers and emergency rooms. One study found that about 40 percent of all chest-injury cases are the result of rib fractures. Rib fractures can occur to young children, elderly adults, and everyone in between
  3. stay after traumatic rib fracture. Am Surg. 2013;79(11):1207-1212. 13. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003;54(3):615-625. 14. Kieninger AN, Bair HA, Bendick PJ, Howells GA. Epidural versus intra-venous pain control in elderly patients with rib fractures. Am J Surg. 2005;189(3.
  4. Medical treatment for fractures in the elderly. Treatment for bone fractures depends on the location of the break. For most fractures occurring in the arms, legs, hands, and feet, the initial treatment is splinting the injured limb and immobilizing the joints above and below an injury to prevent movement at the fracture site
  5. BackgroundElderly patients with rib fractures carry a high morbidity rate, particularly due to pulmonary complications as decreased respiratory efforts ensue secondary to pain. Risk of bleeds in th..
  6. Rib fractures are common but painful. They usually heal normally with the passage of time and management of pain. But rib fractures are considered complicated if the rib is broken in multiple places, causing segments to be displaced, or when the ends are severely displaced. Such fractures are often less stable and will take longer to heal
  7. Rib fractures are the most common injury in elderly blunt chest trauma patients, and each additional rib fracture increases the odds of dying by 19% and of developing pneumonia by 27%. [ 16 , 17 ] Position of the fractured rib in the thorax helps identify potential injury to specific underlying organs

Rib fractures in the elderly - PubMe

Rib fractures resulting from blunt thoracic trauma occur frequently in the elderly. Even though these are usually due to a low impact trauma mechanism (e.g. a fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient Rib fractures can be associated with injury to internal organs. This includes injury to lung parenchyma, hemothorax, pneumothorax etc. In first rib injury underlying vessels and spinal injuries. Fracture of the lower ribs usually is associated with injury to abdominal organs [spleen, liver, kidney]. When there is an associated pelvic fracture. The management of patients with rib fractures is dependent on the age of the patient, number of ribs fractured, and concomitant injuries. A patient with multiple injuries will require evaluation by the appropriate specialists. In traumatic rib injuries, the main goal is to determine the extent of injuries to the thoracic cage and other organ. While rib fractures may lead to other complications including fracture non-union, intercostal nerve entrapment, and chronic pain and disability, the prevention and treatment of pulmonary complications in the acute phase, including pneumonia and atelectasis, remains an essential component of clinical management

Purpose of review Pain management for traumatic rib fractures has been described in literature, but there is paucity of data when it comes to acute pain management in the elderly, let alone pain resulting from traumatic rib fractures. Recent findings This article focuses on challenges of assessment of pain in elderly patients and the various options available for pain management including. Elderly patients with rib fractures carry a high morbidity rate, particularly due to pulmonary complications as decreased respiratory efforts ensue secondary to pain. Risk of bleeds in the elderly on anticoagulant therapy is high. The effort to reduce narcotic use in patients is now a health care priority Rib fractures are a common consequence of blunt chest trauma, typically a result of motor vehicle crashes and falls. It is estimated that two thirds of all blunt chest trauma involves at least 1 rib fracture with a disproportionate share of these patients being elderly (older than 65 years).1 Elderly patients are particularly susceptible to rib fractures because with increased age, the ribs. (65 years or older) with rib fractures than younger patients (younger than 65 years) with rib fractures (20.1% vs 11.4%). Mortality rates went up as the number of rib fractures increased for both age groups. Stawicki et al concluded that the number of rib fractures might be a useful predictor of outcomes, especially for elderly trauma patients Here is why breaking ribs — or any bone — at an older age is such a concern. Rib fractures typically heal on their own, but can have serious complications. Broken or fractured ribs are a common injury typically caused by chest trauma, such as a fall, a car accident, or impact sustained during contact sports, according to the Mayo Clinic

An elderly male patient sustained multiple rib fractures from a car accident. Summary. Rib fracture is a common traumatic injury that does not have a clear route for management. Surgical fixation of rib fractures has been performed in the past, but its utility is currently debated in the medical literature Trauma in the elderly (>65 years) is an increasingly common presentation to the ED. A fall from standing height is the most common mechanism after which such patients present, and rib fracture is the most common non-spinal fracture. Thoracic injury in patients aged over 65 is associated with significant morbidity and mortality. There are currently no universally applied guidelines for. Rib fractures vary from being a minor injury that can be treated in outpatients, to a major injury that can have life-threatening consequences. Accurate diagnosis, adequate analgesia and effective physiotherapy are all essential components in the management of rib fractures if complications are to be avoided. FURTHER READIN New Orleans—Elderly trauma patients, an ever-increasing population, may experience just as much pain control from oral medication as from IV acetaminophen, according to new research. Rib fractures are the most common chest injuries in patients over the age of 65, and pain is the most common symptom after rib fracture Pneumonia is the most common complication of rib fracture, affecting 6-34% of all patients in hospital with rib fracture. Splenic hemorrhage. Hepatic Laceration. Cardiac contusion. Aortic Injury. Holistic medicine. Appropriate management of osteoporosis is crucial in preventing rib fractures in elderly patients

Bulger EM, Arneson MA, Mock CN, et al. Rib fractures in the elderly. J Trauma 2000;48:1040-6. Kent R, Woods W, Bostrom O. Fatality risk and the presence of rib fractures. Ann Adv Automot Med 2008;52:73-82. Holcomb JB, McMullin NR, Kozar RA, et al. Morbidity from rib fractures increases after age 45 Outpatient treatment of a rib fracture typically consists of the application of ice packs and prescription of pain medications as well as breathing exercises. 9 . The pain from rib fractures can be treated with a combination of: Benzodiazepines and opioids have abuse potential Classification. Flail - 2 or more ribs with segmental fractures.; Other - May be radiological or clinical fractures based on the findings of point tenderness pain on inspiration and a likely mechanism.; Epidemiology. Flail - In younger patients as part of a major trauma, or the elderly with osteopenia.; Other - At any age but young and active and then elderly and osteopaenic is the bimodal.

Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, affecting more than 700,000 Americans annually. Fracture risk increases with age, with four in 10 white. References. Answer. Several researchers recommend hospital admission for any patient with 3 or more rib fractures, and ICU care for elderly patients with 6 or more rib fractures. They cite the. Traumatic rib fractures are the consequence of significant forces impacting the chest wall and are most commonly due to blunt injuries (eg, motor vehicle crash, falls, assault), but penetrating injuries (eg, gunshot) can also fracture ribs. Rib fractures are a marker of more severe injuries and are present in 10 percent of all trauma patients. Rib fractures are the most common thoracic injury and are a frequent finding on chest x-ray after trauma (Figures 6-121 through 6-124). 26 Rib films are not typically indicated to assess for rib fracture, as it is the underlying parenchymal injury or the clinical status of the patient that most often drives management. 26 The x-ray should be. Approximately 10% of blunt trauma patients are found to have rib fractures, which can be associated with significant morbidity and mortality. 1 Elderly patients are particularly susceptible to associated complications with pneumonia rates as high as 31%. 1 Providing effective analgesia helps to prevent these complications, ICU stays, and even.

Rib fractures are the most common injury in elderly blunt chest trauma patients, and each additional rib fracture increases the odds of dying by 19% and of developing pneumonia by 27%. [ 22 , 23 This activity reviews the evaluation and treatment of rib fractures and highlights the role of the interprofessional team in treating patients with this condition. Objectives: Describe the pathophysiology of rib fractures. Review common presenting symptoms of rib fractures. Outline the appropriate management of acute rib fractures and flail chest The 4 th -10 th ribs are the most commonly fractured 1. Fractures of the 1 st -3 rd ribs are associated with high-energy trauma 3. When the rib is fractured twice, the term floating rib is used to describe the free fracture fragment, and when three or more contiguous floating ribs are present this is called a flail chest The bones of the ribcage and sternum can break (fracture) and the muscles of the chest that support the ribcage can also be injured, strained, or bruised. 5  The term bruised rib is sometimes used to describe an injury where the ribs are hurt, but they are not broken. In this case, it is not the bones that are involved

A standard protocol for non-operative management of both midshaft and distal clavicle fractures is the use of a conventional sling for 4-8 weeks, with active self-assisted stretching exercises initiated when fracture healing is established. 8,17 The sling must be worn with adequate padding, as elderly patients lose collagen and fat within the. Objectives Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas With Feng Pan, MD, PhD, and Don L. Goldenberg, MD. Multi-site musculoskeletal pain is associated with prevalent and incident fracture risk in the elderly, 1 according to a study led by Feng Pan, MD, PhD, research fellow at the Menzies Institute for Medical Research at the University of Tasmania in Hobart, Australia. The study's hypothesis—individuals with a greater number of painful sites. Rib Fractures in Elderly 2019. Type: New Practice Management Guideline (PMG) Category: Trauma Committee Liaison: George Kasotakis, MD, MPH Team leader(s) Kaushik Mukherjee, MD, MSCI, FACS. This PMG is being developed in collaboration with the Chest Wall Injury Society. Work Group Member A. Rib Fractures are one of the most common injuries, found in more than one half of blunt thoracic injuries and 10% of all trauma admissions [1]. B. In 2017, Denver Health admitted 494 patients with rib fractures, or 1.4 patients per day. C. Morbidity and mortality in patients with rib fractures is substantial, and related to certai

Rib fracture management in the elderly - a panel discussion 2017-09-20T16:30--T: Australia/Sydney Join meeting a Rib Fractures and Pain Management Brian Shapiro, MD Genesys Regional Medical Center Grand Blanc, Michiga • 39% of all thoracic trauma patients will have rib fractures • High morbidity and mortality • Reported mortality in up to 22% in blunt chest injury • Pulmonary complications in isolated rib fractures in patients aged over 65 in 36% • High proportion of elderly require ICU and ~12% require mechanical ventilatio Compression fracture of the vertebral body is common, especially in older adults. Vertebral compression fractures usually are caused by osteoporosis, and range from mild to severe. More severe.

Fracture Management Overview History Who, what, when, where, why o Who - age, job, hobbies, hand dominance (if hand involved), cognition (AMTS score if elderly) o What happened and exactly how it happened Mechanism of injury Force involved Likelihood of other structure damage o When it happened o Where it happened o Wh Each rib injury and recovery period is unique, but in general, broken ribs take about six weeks to heal. That time frame could be shorter if the fracture is mild Pneumonia is a delayed complication of rib fractures and is a significant source of morbidity and mortality in rib fractures, especially in the elderly . Visceral injuries , specifically splenic and liver injuries, occur in 2-4% rate of patients presenting with traumatic rib fractures and are associated with fractures of lower ribs ( 14 ) fractures in the elderly, and it may only be indicated in selected subgroups of relatively healthy patients. The peri-operative use of tranexamic acid has recently been shown to result in a reduction in transfusion requirements. Arguably the most important recent development in the management of hip fractures is the decrease in mortalit

A rib fracture can be very painful because your ribs move when you breathe, cough, and move your upper body. The ribs in the middle of the chest are the ones that break most often. Rib fractures often occur with other chest and organ injuries. So, your health care providers will also check to see if you have any other injuries Rib fractures are common, affecting four to eight people per 10,000 population annually 1.Depending on the extent of the injury, rib fractures are associated with a high risk of pulmonary complications, requirement for critical care admission, and mortality, especially in older patients 2.Prognosis is affected by pattern and location of injuries and outcomes are worse with multiple fractures.

with six rib fractures and 34.4% mortality in those with eight (p<0.02 for mortality increase with each increase in the number of fractured ribs).10 Despite the prevalence and significance of chest wall injury in the elderly, there is currently no universally applied investigation strategy, risk or severity score, or management guideline in use i In one series, elderly patients with rib fractures suffered a mortality rate of 22%, compared to 10% for younger patients. 93,95 Also, the number of rib fractures correlates with increased morbidity and mortality. Geriatric patients had significantly increased mortality rates if they suffered three or more rib fractures Rib Fracture Healing Time. Rib fractures may take 6 weeks to 6 months to heal. Depending on the health status of the patient, the healing time varies from one patient to another. Factors that affect the healing time include: Age: In young patients, rib fractures heal much faster as compared to older patients. Nutrition: Adequate nutrition helps. Rib Fractures. Typically, rib fractures result from blunt injury to the chest wall, usually involving a strong force (eg, due to high-speed deceleration, a baseball bat, a major fall); however, sometimes in older patients, only mild or moderate force (eg, in a minor fall) is required. If ≥ 3 adjacent ribs fracture in 2 separate places, the. Rib fracture The curved design of the ribs makes them resistant to fractures. Their ability to flex helps the bone to absorb the force of a blow. However, any bone will break if the force exerted against it is stronger than it can structurally withstand. A rib is most likely to fracture at its outer curve, which is its weakest point

The ideal methods for the management of rib fracture

These sequelae are most common in the elderly population. Multiple studies has shown that elderly patients with rib fractures have worse outcomes compared to younger patients with the same fracture pattern. Pain control for acute rib fracture is achieved using multimodal analgesia to reduce the usage of opioids Abstract 8: Isolated Rib Cage Fractures in the Elderly: Need for ICU 4:01. Abstract 9: Timing/Volume of Crystalloid and Blood Products in Pediatric Trauma 6:18. Abstract 10: Immediate Angiogram in OOHCA Patients Without ST-Segment Elevation 4:58. Abstract 11: Baloxavir Marboxil for Prophylaxis Against Influenza 7:48 B: Diagonal fracture is not a type of fracture. A: Open fracture is one of the types of fractures. C: Closed fracture is one of the types of fractures. D: Comminuted fracture is one of the types of fractures. 2. Answer: C. X-ray. C: X-ray is the most definitive diagnostic tool in assessing for fracture as it allows visualization of the affected part. A: Blood studies are not used in a patient. Rib fractures and associated injuries often carry a high mortality. In adults a mortality of up to 10% has been shown and this increases up to 20% in patient populations >65 yo (2,3). 1st and 2nd rib fractures may be associated with great vessel injury, whereas fractures to ribs 9-12 can cause splenic, liver or kidney laceration (4) The fractures, 65 percent of which were located at one or both pubic rami, were triggered by a fall in 89 percent of the cases. 1 During their hospital stay, 52 percent of patients had a complication, mostly urinary tract infections or bedsores. At discharge, only 31 percent went directly home. In follow-up after 29 months, 11 patients had died

In this study, an elderly person with six rib fractures had a mortality risk of 24% and a pneumonia rate of 35% vs. 10% and 20% respectively for a younger patient. ((p<.05). Co-morbidity. Barnea and colleagues [84] retrospectively reviewed 77 elderly (age>65) with isolated rib fractures. They identified a strong relationship between non. Rib Fractures. Rib fractures are often seen in the elderly or sportspeople. Rib fractures in the elderly are generally caused by slips, trips or falls whilst rib fractures in sports can be caused by high impact from teammates, the opposition, sports equipment, trips or falls

Rib fractures are the most common chest injury accounting for 10 to 15 percent of all traumatic injuries in the U.S. Nearly 300,000 people are seen annually in acute-care settings for rib fractures and 7 percent of this population will require hospitalization for medical, pain and/or surgical management Rib Fracture Outcomes for High-Risk Patients Vary by Trauma Capacity. March 11, 2021 84 views 0. (R Health) - Two groups of high-risk rib fracture patients, the elderly and those with flail chest, have better outcomes at trauma centers than at non-trauma centers, a U.S. study suggests. Researchers examined data on 504,085 rib fracture.

However, rib fractures themselves have been associated with mortality, most often as sequelae of pulmonary embarrassment including pneumonia, intubation, and death. Mortality in elderly patients with rib fractures is significantly higher than the younger counterparts at 22% and 10% respectively [8,9]. Mortality is between 3-13 Rib fractures are common among the traumatically injured and are increasing in incidence. An estimated 350,000 patients in the U.S. alone were diagnosed with rib fractures in the year 2017 (1). While the pain associated with a single rib fracture is relatively easy to control, the significant pain of multiple rib fractures Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma First Rib Fractures may also occur with fall on outstretched arm or direct Shoulder Trauma. Presents with pain at posterior Scapula, Shoulder or base of neck. Ribs 4 to 10. Most commonly Fracture d ribs (especially 4 and 9) Risk of Pneumothorax. Ribs 10 to 12

9th, 10th, 11th rib fractures associated with intra-abdominal injury. Elderly patients have double the mortality of younger patients. <2 years old with >2 rib fractures → 50% mortality. Ribs more flexible in children, so fractures require extreme force. Consider non-accidental trauma Anticoagulants also had an effect on overall fracture risk in this study, but other investigators have not found associations except with vertebral and rib fractures. 44, 45 Alcoholism has been linked to an increase in all sorts of fractures as we also/observed. 46 The use of thiazide diuretics was linked with a 40% reduction in osteoporotic.

Rib Fractures in Older Adults - What's the Big Deal

Bergeron E, et. al., Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 2003 Mar;54(3):478-85 Wardhan, R. Assessment and management of rib fracture pain in geriatric population: an ode to old age Y1 - 2017. N2 - This is a recommended management algorithm from the Western Trauma Association addressing the management of adult patients with rib fractures. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, these recommendations are based primarily on published observational. Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment Mortality increased from 1.79% without rib fracture to 5.81% with one rib fracture. With each rib fracture, mortality rate increased in nearly linear fashion up to 8.23% for 7th rib fractured. Moral of the Morsel. Highly consider abuse in children with rib fractures! May even want to consider extra thoracic injuries A rib fracture is a break in a rib bone. This typically results in chest pain that is worse with inspiration. Bruising may occur at the site of the break. When several ribs are broken in several places a flail chest results. Potential complications include a pneumothorax, pulmonary contusion, and pneumonia.. Rib fractures usually occur from a direct blow to the chest such as during a motor.


  1. X-rays are often used to diagnose rib fractures, however, sensitivity can be as low as 50%. CT scan and MRI are much more sensitive in detecting rib fractures. Pain control is of utmost importance in management of rib fractures in order to keep the patient breathing as deep as possible and clear pulmonary secretions (i.e., coughing)
  2. BACKGROUND Rib fractures (RFx) remain the most prevalent injury in an elderly population that will increase from 40 to 81 million for the next 30 years. We sought to create an accurate cost-effective algorithm to triage elderly patients with RFx that accounted for both frailty and trauma burden
  3. The term rib injury usually means rib fracture - that is, a break in one or more of the ribs. Sometimes the ribs are not broken but there is bruising of ribs or nearby muscles. Rib injuries occur when there is a force to the chest such as from a fall, road accident or assault

Rib Fractures In The Elderly The Trauma Pr

Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017 Jan 5;2(1):e000064. doi: 10.1136/tsaco-2016-000064. eCollection 2017. Review Each rib fracture is associated with an additional 19% risk of fatality. Also each rib fracture increases the risk of contracting pneumonia by 27% [4]. Rib fracture is the commonest injury in cases of chest trauma caused to elderly patients. This population is associated with the highest mortality and morbidity rates following chest trauma

Rib Fractures in the Elderly : Journal of Trauma and Acute

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Plain abdominal CT (bony density) CT demonstrates rightFlail Chest Workup: Laboratory Studies, Imaging StudiesRib Fracture Imaging: Overview, Radiography, ComputedTrauma in Older Adults: An Overview of Injury Patterns andFlail chest - [PPT Powerpoint]