Bony Thorax Case 1 Management

The majority of rib fractures are managed with analgesia and incentive spirometry to prevent atelectasis and subsequent pneumonia. Admit patients for flail chest, unmanageable pain, or respiratory impairment (especially in the setting of underlying heart or lung disease). Factors to consider when determining disposition are age (especially > 65), pain control, other associated injuries, comorbidities, functional status, frailty and home support.

Patients with a negative x-ray but still suspicious for rib fracture can be treated as a probable (nondisplaced) rib fracture, with the management the same as those with a confirmed rib fracture.

Do not discharge rib fractures with any degree of “pleural effusion.”  Pleural effusion in the setting of a rib fracture is a hemothorax that will likely progress until proven otherwise.

Order a CT scan of the abdomen to rule out solid organ injury for significant costal margin tenderness and any upper abdominal tenderness.