Fractures of the Ribcage

Simple fractures, characterised by bruising and tenderness over the fracture site, are usually confined to one broken rib, with no underlying damage to the lungs or other internal organs. Multiple, or complicated, rib fractures will often result in the casualty having difficulty in breathing, as the chest wall is unable to move effectively. There may also be lung damage. Broken ribs are generally not strapped up because the chest needs to expand normally during breathing to reduce the risk of pneumonia.

Treating a simple broken rib

The best treatment for a simple fractured rib is to put the arm on the injured side into an arm sling and to advise the casualty to seek medical aid.

Multiple broken ribs

In a case of multiple rib fractures there may also be lung damage, where one or a number of ribs have punctured one or both of the lungs. There may also be an open break on the chest wall where ribs have sprung out. Remember that the ribs extend around the back of the casualty and there may be injuries here as well as on the front. Rib injuries may be accompanied by a sucking wound to the chest, creating a direct passage between the external environment and the lungs.

Signs and symptoms of multiple broken ribs

• Chest rises on the injured side as the person breathes out (paradoxical breathing)
• Swelling or indentation along the line of the ribs
• Open breaks
• Difficulty in breathing
• Pain on breathing
• Shock (as there is likely to be some degree of internal bleeding)
• Bright red, frothy blood coming from the mouth and/or nose. (This is an indication of a punctured lung as oxygenated blood is escaping from the respiratory system. There may or may not be an associated sucking wound to the chest)
• Sucking wound to the chest

First Aid Treatment

1. Treat any sucking wounds by covering, initially with a hand and then with plastic. Treat any open breaks.
2. If the casualty is conscious, lay him down. The casualty is most likely to find breathing easier in a half-sitting position.
3. Lean the casualty towards the injured side. This allows any blood to drain into the injured lung, leaving the good lung free to breathe. Place the arm on the injured side into an elevation sling.
4. Treat for shock.

If the casualty becomes unconscious, monitor the airway and breathing and place the person into the recovery position with the injured side upwards.

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