Fractured ribs are almost always a result of direct force although in osteoporotic patients something as small as a cough or sneeze can fracture a rib.
The patient complains of a sharp pain in the chest which is made worse by deep breathing and coughing. On examination if the chest wall is compressed ('sprung') in the anteroposterior direction the pain is aggravated. X-ray shows the fracture(s), usually near the rib angle.
Treatment in the majority of cases involves nothing more than the injection of a local anaesthetic and the encouragement of a normal pattern of breathing. In rare cases a bone fragment may puncture the lung resulting in a pneumothorax. Once the pneumothorax has been treated it should be remembered that the fracture is now a compound one and antibiotics should be given.
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