Ribs are pretty hard to break. They are surrounded by strong muscles and usually can take a lot of abuse before they crack. The elderly can get broken ribs easier than younger adults. Kids have more flexible bones. Most broken ribs -- including children -- come from vehicle accidents, but they're also common from falling off horses, sports injuries and falls. In some cases, lots of forceful coughing -- like from a bout of pneumonia -- can cause rib fractures.
Most of the time, the broken rib is only broken in one place, and is an "incomplete fracture," meaning not all the way through the bone.
Completely broken ribs may or may not move out of place. If they do move, they're called displaced rib fractures and are more likely to puncture lungs or damage other tissues and organs. Ribs that stay in place -- usually ribs that are not completely broken in half -- are called nondisplaced rib fractures.
Broken Rib Symptoms
One of the best ways to identify a broken rib is by the mechanism of injury. Getting hit in the chest, falling on something and hitting the chest or smashing the chest into a steering wheel or dashboard during a car accident could certainly lead to broken ribs. Forceful coughing can also be a mechanism for breaking ribs.
After injury to the chest -- or particularly forceful coughing -- consider the possibility of a broken rib if the victim has any of the following:
- Extreme pain when taking a breath
- Tenderness to the chest or back over an area of ribs
- Crepitus -- a "crunchy" feeling under the skin
Rarely, a section of the ribcage breaks away from the surrounding bone and muscle. This area loses its stable structure (imagine a short rack of baby-backs connected to the rest of the ribcage only by muscle) and moves fairly easily as the victim breathes. This section is known as a flail segment, and is much more dangerous than simple broken ribs.
Broken Rib Complications
The most common complication of broken ribs is not being able to take a deep breath because it hurts. If you don't breathe deep enough, mucous and moisture can build up in the lungs and lead to an infection such as pneumonia.
Displaced rib fractures can damage other tissues or organs and sometimes lead to collapsed lungs (pneumothorax) or internal bleeding.
Broken Rib Treatment
First of all, if you've been hit hard enough in the chest to make you think you may have broken a rib or two, go to the emergency department or call 911. Any force hard enough to break a rib is powerful enough to cause other, more life-threatening injuries. It's especially dangerous if the victim has any of the following signs or symptoms:
- Severe shortness of breath
- Coughing blood
- Confusion or dizziness
- General weakness
- Blood in the urine
It's also possible to break more than one rib at a time. More than 3 broken ribs at one time is potentially life-threatening. Since the only way to know for sure is to get an x-ray, it's important to go to the emergency department anytime you suspect a broken rib.
There is good news and bad news about treating simple broken ribs. The good news: It will heal on its own and probably not develop any additional problems. The bad news is it hurts a lot and there's really very little you can do for it.
In the past, treatment for broken ribs included wrapping the chest with a wide band often called a rib belt. A study in 1990 found no benefit from wrapping victims. Displaced rib fractures caused more problems in this study when they were treated with the belt than when they were not. Most emergency physicians today don't wrap broken ribs.
The best broken rib treatment is simple pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are best. If you go to the ER for your broken rib, the doctor is likely to give you a prescription pain medication as well as an NSAID.
It's important to keep your lungs healthy. As you heal, practice taking deep breaths. It's important not to be afraid of taking the pain medication as prescribed, because keeping the pain under control is important for taking strong, deep breaths.
If you go to the ER, the doctor may send you home with a tool to encourage deep breathing. The tool is called an incentive spirometer. It measures lung capacity so victims can see how well their lungs are recovering as the broken rib heals.
Quick, G. "A randomized clinical trial of rib belts for simple fractures." Am J Emerg Med. Jul 1990
Sirmali, M, et al."A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management." Eur J Cardiothorac Surg. Jul 2003