Learning Radiology xray montage

Healing Rib Fractures


General Considerations

  • Rib fractures are most common traumatic chest injury
  • They are mostly important for their associated morbidity including pneumothorax, hemothorax, lacerations of the liver or spleen, pneumonia or atelectasis from splinting
  • Rib fractures classically take at least 6 weeks to heal, some lasting for up to 6 months before completely pain free
    • Displaced fractures will take longer to heal
  • Ribs 4-9 are most frequently fractured and rib fractures usually occur at the point of impact

Clinical Findings

  • Pain on inspiration
  • Dyspnea
  • Point tenderness or crepitus

Imaging Findings

  • Non-displaced acute rib fractures may not be visible on conventional radiographs in as many as 50% of cases
  • As the rib ends become displaced over time and bony callus begins to form, the fracture may become more evident on follow-up examination
  • Periosteal reaction may be seen 7 days after injury
  • Callus formation may produce nodular densities in the rib at the site of healing which should not be confused for a pulmonary nodule
    • A rib series using conventional radiography will usually distinguish the source of the “nodule”
  • Complete healing should occur by 12 weeks
  • CT is more sensitive than conventional radiography in detecting rib fractures, which may still not be evident because of the plane of the cut
  • US may also show cortical discontinuity 

 healing rib fractures

Healing Rib Fractures. Chest radiograph on left demonstrates multiple rib fractures with bony callus about the fracture sites (white arrows). The close-up image from a rib series again demonstrates multiple displaced healing rib fractures (red arrows).

Keep Your Eyes on the Ribs: The Spectrum of Normal Variants and Diseases That Involve the Ribs. Adam R. Guttentag, MD, and Julia K. Salwen. RadioGraphics, Sept. 1999, Vol. 19, Issue 5