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. 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