It’s Dr. Parker again and in this post I’m going to talk about rib fractures.  Rib fractures are a pretty common problem I see, and it’s not just the young dare-devil types! I often see folks in their 50s, 60s, 70s and 80s with multiple rib fractures.  These are the result of a wide range of accidents – anything from falling off of a bench to getting bucked off of a horse.  Of course, in Jackson in the winter time, skiers/snowboarders and snowmobilers are common recipients of a good ole’ fashioned butt kicking from mother nature.

Rib fractures can be mild to life threatening, depending on the severity of the injury and other associated injuries.  I’m going to talk about common associated injuries in another post, so this one I’ll just stick to rib fractures.

Commonly, patients present with one or two non-displaced fractures (meaning the bones are still in the right place, they are just broken) and no other organ injury.  This is the simplest form of rib fracture.  The good news is, there is no surgery needed for something like this.  The bad news is, there is no good way to splint the rib fractures.  Some people may find some comfort in “taping the ribs or wearing a tight-fitting undergarment. If this works for you, great….if not….no big deal.

Our goal is to get you fairly comfortable using pain medication and avoid other complications commonly associated with rib fractures.  The medication will not be able to take all of your pain away, but the main objective is to get you breathing and moving fairly easily.  One of the main complications that can arise after rib fractures is pneumonia.  When we have ribs fractured, we don’t want to take normal deep breaths.  We often breathe much more shallow than normal.  This lets the lung partially “collapse” in the bases and outer portion.

(Quick anatomy lesson….the lung is made of millions of microscopic sacs which take the oxygen in the air, and put it into the blood.  If not kept inflated normally, these microscopic sacs can collapse.  When they collapse, they are a good place for bacteria to attach to and start multiplying thus, causing pneumonia).

So to prevent pneumonia after rib fractures, I like to give patients a good amount of narcotic pain medication for the first 3 or so days.  This is the time when the pain peaks and starts to subside.  If we can keep you comfortable and breathing normally, we can lower your chance of pneumonia.  In addition to breathing normally, we generally have patients use a “spirometer”.  This is a little plastic machine that helps you determine exactly how much (in millilitres) you are breathing in when you take a deep breath.  This just helps you monitor the deep breaths and actually put a number on them, instead of guessing.

The downside to taking narcotic pain medication is that it can make people very constipated.  This is why I start a stool softener with everyone who has rib fractures and is taking narcotics.  I generally give patients Senokot twice daily to prevent constipation.  Some patients may need a little extra to keep them regular, and in this case, I start Milk of Magnesia twice daily as well.  You should continue to take stool softeners as long as you are still taking narcotics.

The other main complication that is associated with rib fractures is “Deep Venous Thrombosis” or DVT.  A DVT is basically a blood clot that usually start somewhere in the lower extremities.  The dangerous part about a DVT is that it can break loose and then “embolize” or “travel through  the blood stream” to the lungs.  This is called a “Pulmonary Embolism”, or PE.  PE’s can be very small and virtually have no symptoms, or they can be very large and result in death.  So, we definitely want to prevent against a DVT and PE while you are in the hospital.  There are  a couple reasons people get DVTs after rib fractures.  It’s not necessarily the ribs being broken which is the problem, but that the patient has sustained a significant trauma.  Just like when you cut your finger accidentally, the body will try to “stop the bleeding” by producing blood clots.  In a significant trauma, where ribs are broken and maybe even some other organs are bruised (skin, muscle, spleen liver), the body will try to “stop the bleeding” by forming clots.  The body will be in a “hypercoagulable state” (coagulate = blood clotting).  So, we develop a hyper-clotting state after major trauma, or even surgery.  Depending on the trauma, the elevation of the clotting status will be variable, but combine that will laying in a hospital bed for a couple of days (the blood then doesn’t circulate as well….or as fast as if you were up walking or running around) and now we have a pretty good set up for blood clots…..or DVTs and subsequent PEs.

So prevention measures consist of two things.  First, we get you walking as soon as possible, and we thin your blood just a little bit to prevent excessive clotting. The walking prevents DVTs by keeping good blood flow and circulation.  The slower the blood flow, the easier it is for your body to make clots, so the walking prevents against that.  Second, is the blood thinner.  It’s a little stronger than aspirin, and not quite as strong as Coumadin (if you are familiar). Everyone who sustains a significant trauma (including rib fractures) will receive this blood thinner while in the hospital.  When you go home, we typically stop the blood thinner because you are generally more active at home than in the hospital.  Those are the main complications we are trying to avoid with rib fractures, so when I come in and ask how your deep breathing and walking is going, you’ll know why.

Lastly, patients always want to know “when they can get back to normal activity”.  Well, unfortunately the only thing that is going to heal those ribs is time.  In general, bones take about 6-8 weeks to heal well.  You, of course, will be feeling much better in about 1-2 weeks, but you should gradually increase your activity during those 6-8  weeks.  It’s fairly normal to have a few good days followed by a really bad day (as far as pain is concerned).  As long as you are improving week to week, you are on the right track.

I hope this has given you a little insight to the natural course of rib fractures and what to expect while you are in the hospital.
-Dr. Buck

P.S. Please leave comments or questions for me below.  Thanks!

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