Rib Fracture and Pneumothorax Complication

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Rib Fracture and Pneumothorax Complication 2017-07-25T17:40:09+00:00

Rib Fracture and Pneumothorax Complication

By Terry Zeigler, EdD, ATC 

A rib fracture is one of the more common injuries to the chest with rib fractures as the most common thoracic injury from blunt force trauma. Uncomplicated single rib fractures can be managed easily. However, multiple rib fractures may result in a pneumothorax, a life-threatening emergency.

There are 12 pairs of ribs that circle the chest for the primary purpose of protecting the heart and lungs. All of the ribs have a posterior attachment to the spine, but only 10 of the ribs have an anterior attachment to the sternum via costal cartilage. The flexible costal cartilage allows for the rib cage to expand during inspiration.

The last two ribs are known as “floating” ribs because they do not have an anterior attachment. Because these two ribs remain unattached, a fracture to these ribs may result in associated damage to the kidneys, liver, or spleen.

Located between each rib are small external and internal intercostal muscles. These muscles are responsible for elevating and then returning the ribs to their natural position during breathing. These muscles can also be injured during a chest injury.

What types of rib injuries are there?

There are a number of possible injuries involving the ribs including stress fractures, nondisplaced simple fractures, displaced multiple fractures, and costochondral separation (separation between the costochondral cartilage and the rib).

Rib stress fractures can be seen in athletes with a history of a violent muscle contraction as can be seen in the sport of weightlifting. Stress fractures can also be seen in golfers, rowers, and baseball pitchers.

stress fracture is a small partial fracture in the bone. These can be painful, but are not dangerous and have a good prognosis with rest and time for healing.

Simple nondisplaced rib fractures are most commonly seen in ribs five through nine from blunt force to the front or back of the body. A simple nondisplaced fracture means that there is a break though the bone, but the bone ends remain in their original position. These types of fractures also have a good prognosis with rest.

Rib fracture

However, displaced multiple fractures can be life-threatening. Displaced multiple fractures can leave sharp bony fragments which may puncture the pleural sac surrounding the lungs. This can lead to a pneumothorax or a collapsed lung. These types of injuries are the most serious with the athlete needing immediate emergency medical treatment.

The last common injury in and around the ribs is a separation of the anterior rib from its costochondral attachment. The costochondral cartilage attaches the anterior rib to the sternum. This type of injury can occur during a collision or as the result of a severe twisting motion of the thorax.

This type of injury can either result in a tear between the sternum and the costochondral cartilage or a tear between the costochondral cartilage and the rib. The tear may be accompanied by a “popping” sound with localized sharp pain for a few days. Unfortunately this type of injury may result in chronic pain.

What are the complications of rib fractures? 

The most severe and critical complication of displaced rib fractures is a pneumothorax. A displaced rib fracture can puncture the lungs and the pleural sac surrounding the lungs effectively deflating the lung on the side of the pleural puncture. As the lung deflates, the athlete will have increasing pain and difficulty breathing.

A pneumothorax should be suspected if an athlete exhibits any of the following signs and or symptoms:

• Anxiety/restlessness
• Painful breathing
• Increased heart rate
• Cyanosis
• Distended neck veins
• Severe chest pain
• Decreased or absent breath sounds of affected lung
• Decreased blood pressure
• Asymmetric chest expansion

If a pneumothorax is suspected, emergency medical services should be immediately called. The athlete should be kept calm and quiet with a focus on slow and controlled breathing.

What are the signs and symptoms of a rib fracture? 

If the mechanism of injury for the athlete involves a direct blow to the ribs or an indirect force resulting in the compression of the rib cage, the presence of the following signs and symptoms may indicate a rib fracture:

• Localized swelling
• Discoloration
• Increased pain on deep inspiration
• Pain on palpation of injured area
• Visible deformity
• Shallow breathing
• Increased pain on trunk rotation and lateral flexion away from fracture site
• Cyanosis
• Rapid, weak pulse and low blood pressure with multiple fractures
• Individual may lean towards injured side

How is a rib fracture diagnosed? 

Because the symptoms of a bruised rib and fractured rib are very similar, an x-ray should be ordered to rule out a fracture. The diagnosis should also include a thorough medical history, physical examination, and auscultation (exam with a stethoscope to listen for breath sounds).

Who gets rib fractures? 

Single and multiple rib fractures have the highest incidence in collision sports including wrestling and football and contact sports such as basketball and soccer. Stress fractures can be seen in athletes with repetitive upper extremity motions as seen in the sports of throwing athletes, golfers, and rowers.

What causes rib fractures? 

Rib fractures can be caused by both direct and indirect forces. Direct forces would include being hit, kicked, or punched with the resulting fracture at the site of contact.

An indirect force can cause rib fractures through general compression of the rib cage as when a football player is compressed by another player during a tackle. The weight of the opposing player can compress the injured player against a hard surface. If the external force is stronger than the tensile force of the ribs, the bones can be fractured.

What can I do to prevent a rib fracture? 

Rib injuries often occur through accidental injury in sports. However, when it applies, protective gear should be properly fitted and worn.

What is the treatment for a rib fracture? 

The length of recovery depends on the severity of the injury.  Sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation can be utilized as well as the use of anti-inflammatory or pain medication.

Unlike other fractures in which the bone is immobilized to reduce pain and enhance the healing process, the ribs cannot be effectively immobilized because they need to expand in order for the individual to breathe. Because of this, pain medication is used to make the athlete more comfortable.

There appears to be some controversy as to whether to strap or tape fractured ribs. Some sources suggest taping while others state that the taping is not recommended because it may aggravate the injury.


Recovery – Getting back to Sport

Return to sport will depend on a number of factors including the number of ribs fractured and the severity of the fractures. Simple fractures should heal within 4 – 6 weeks. However, each athlete is unique and return to sports should be individually determined.

A sports medicine physician can determine if the fracture has healed through the use of a post-injury x-ray. This is especially important for athletes competing in collision or contact sports.

Physicians may allow the athlete to begin noncontact activity sooner if the athlete is pain-free during deep inspirations and rotatory and lateral movements.

When Can I Return to Play? 

An athlete can return to competition when he/she has been released by his/her personal physician to return to sports and when the athlete is pain-free with all trunk movements.

For athletes returning to football, a flak jacket or rib vest can be worn to protect the area from re-injury.


Find a Doctor who specializes in Rib Fractures and Pneumothorax Complications:

American Orthopedic Society for Sports Medicine
6300 North River Rd.
Suite 200
Rosemont, IL 60018
Toll-Free: (877) 321-3500

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Rd.
Rosemont, IL 60018-4262
Toll-Free: (800) 346-2267

American Physical Therapy Association
1111 North Fairfax St.
Alexandria, VA 22314-1488
Toll-Free: (800) 999-2782

National Athletic Trainers’ Association
2952 Stemmons Freeway
Dallas, TX 75247-6196
Phone: (214) 637-6282



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  • Cindy

    This happened in 2000. I was hit by a car at an intersection on my side by my door. I got 4 broken ribs and collapsed lungs. I thought I was dying at the time. Well, it is now 2017 and I’m having horrible pain in my back around where my bra fastens. I have to take the bra off to breath it hurts so bad. I keep heat on my back all the time the pain is so bad. Could this still be coming from these broken ribs 17 years ago? Or something that happened due to the broken ribs? I’ve been under a Dr. care with pain medication which I’m getting off of because it is a temporary fix and I want something permanent. I suffer every single day. Please someone help if you have experienced anything similar.

    • StilesDC

      I’ve been told by a physician that lateral compression injuries that cause rib damage could also cause spine trauma. Each rib has a joint on different vertebrae. Jamming the rib in can damage that joint. At the least, all joint injuries are a step closer to future arthritis at that location. Depending on your age, it could be arthritis creeping in. You may want to consult a good neurologist or pain management anesthesiologist. But surgery for pain mgmt seems to cause more harm than good.

  • Roz Turner

    Two days ago I stumbled, catching my fall, but twisted my torso; feeling a “double pop” on my left side, down into my waistline. It is painful to move, cough, take a breath. I have on a compression t shirt which has provided a degree of relief, without it I feel as though my ribs are sitting in my waistline. Could this be a fracture dislocation or bruise?

  • curtis

    I broke six ribs on my left side and one on the right side along with a punctured lung and three cracked vertebras’ I spent six days in the hospital in CCU(critical care unit)That was a year ago and I am still chronic pain on my left side and the abdomen pain is almost unbearable. I have seen multiple doctors along with numerous x-rays and CT scans and all test were negative on the organs being damaged I have taken several medications for nerve damage with no results.

  • Carl

    Thank God for the internet, I hurt my rib by breaking open a fort with my shoulder ( I know messed up, I should have used my leg) but gosh it’s been 3 days since I did that an now I’ve got this in tense pinching pain in the left part of my chest through the left back. Planning on going to the doc tomorrow.

  • Barry Miller

    My 11 year old daughter has been complaining of a sharp pain in her lower right rib area. This is not a constant pain but only a sharp intense pain when she throws a hard pitch or a very hard overhand throw. The pain is never there during her normal daily activities. This has been going on for a year now and it has not improved. Xrays did not show anything and her doctor thinks it is just a side stitch?? She has been playing softball since she was 7 and never any issues until this. She plays at a high level travel ball and it is pretty much year round with things a little slower in the winter months. It doesn’t affect any of her playing other than when she throws hard. Any thoughts or suggestions on what it could be or what we can try?
    Thanks in advance for any help or guidance you can provide.