 Introduction/Background Rib fracture is the most common thoracic injury and is present in 10% of all traumatic injuries and in almost 40% of patients who sustain severe nonpenetrating trauma [1,2]. Rib fractures typically affect the fifth through ninth ribs. This may be due to the fact that the shoulder girdle affords relative protection to the upper ribs, and the lower ribs are relatively mobile and may deflect before fracturing [1]. Although rib fractures can produce significant morbidity, the diagnosis of associated complications (such as pneumothorax, hemothorax, pulmonary contusion, atelectasis, flail chest, cardiovascular injury, and injuries to solid and hollow abdominal organs) is arguably more important as these complications are likely to have the most significant clinical impact [1,2]. When isolated, rib fractures have a relatively low morbidity and mortality [2,3]. Treatment of rib fractures is generally aimed at pain control and avoidance of respiratory distress and intubation, but the presence of multiple rib fractures, underlying organ injury, or in an elderly patient especially, may warrant transfer from a community hospital to tertiary care center [2,4-6]. Radiography Chest In combination with the physical examination, a standard posteroanterior (PA) chest radiograph should be the initial diagnostic test for detection of rib fractures. Despite the low sensitivity of the chest radiograph, which may miss 50% of rib fractures [2], studies suggest that failure to detect fractures does not necessarily alter patient management or outcome in uncomplicated cases. A review of 271 patients who presented to a community hospital emergency department after minor trauma showed no difference in treatment (use of pain medications, etc) between patients who did and did not have rib fractures diagnosed on physical examination or radiographs [3].
Rib Fractures.  Introduction/Background Rib fracture is the most common thoracic injury and is present in 10% of all traumatic injuries and in almost 40% of patients who sustain severe nonpenetrating trauma [1,2]. Rib fractures typically affect the fifth through ninth ribs. This may be due to the fact that the shoulder girdle affords relative protection to the upper ribs, and the lower ribs are relatively mobile and may deflect before fracturing [1]. Although rib fractures can produce significant morbidity, the diagnosis of associated complications (such as pneumothorax, hemothorax, pulmonary contusion, atelectasis, flail chest, cardiovascular injury, and injuries to solid and hollow abdominal organs) is arguably more important as these complications are likely to have the most significant clinical impact [1,2]. When isolated, rib fractures have a relatively low morbidity and mortality [2,3]. Treatment of rib fractures is generally aimed at pain control and avoidance of respiratory distress and intubation, but the presence of multiple rib fractures, underlying organ injury, or in an elderly patient especially, may warrant transfer from a community hospital to tertiary care center [2,4-6]. Radiography Chest In combination with the physical examination, a standard posteroanterior (PA) chest radiograph should be the initial diagnostic test for detection of rib fractures. Despite the low sensitivity of the chest radiograph, which may miss 50% of rib fractures [2], studies suggest that failure to detect fractures does not necessarily alter patient management or outcome in uncomplicated cases. A review of 271 patients who presented to a community hospital emergency department after minor trauma showed no difference in treatment (use of pain medications, etc) between patients who did and did not have rib fractures diagnosed on physical examination or radiographs [3].