Expansion
Upper ribs suggest severe force, lower ribs threaten abdominal organs, multiple ribs risk flail chest
Expansion
- Ribs 1 to 3 - protected by the clavicle, scapula and shoulder girdle. A fracture implies high energy; look for great vessel, brachial plexus and tracheobronchial injury
- Ribs 4 to 9 - the commonest fractures. Risk of pneumothorax, haemothorax and pulmonary contusion
- Ribs 9 to 12 - overlie the upper abdomen. Right side threatens the liver, left side threatens the spleen, and either may involve a kidney
Flail chest is defined as three or more consecutive ribs fractured in two or more places, producing a free segment that moves paradoxically, inwards on inspiration. The physiological problem is less the paradox itself than the underlying pulmonary contusion.
In children, elastic ribs transmit force without breaking, so significant intrathoracic injury can occur with an entirely normal rib cage.