Management of rib and sternal fractures

Abstract

The majority of thoracic injuries encountered in the UK are secondary to blunt trauma following motor vehicle accidents. Rib fractures account for more than half of these injuries. Sternal fractures, although less common, have an increased incidence following the implementation of seat belt legislation. Both rib and sternal fractures may compromise ventilation by a variety of mechanisms. Pain leads to a reduction in lung expansion and sputum retention. Fractured ribs may cause penetrating injury resulting in a haemopneumothorax. There may also be asso ciated pulmonary contusion and flail chest, which further compromises ventilation. Sternal and rib fractures are managed by a number of specialties including accident and emergency staff, cardiothoracic and trauma surgeons, as well as anaesthetists and intensivists. The management of rib and sternal fractures principally consists of the identification and treatment of associated injuries, appropriate respiratory care and symptomatic relief. This article reviews the literature on the investigations and management of the patient with rib and sternal fractures.