Last Updated on August 19, 2026
Presentation
• Patient presented to ED post trauma
History Taking
Chest pain
• Site: at the site of rib fracture post trauma
• Onset: post trauma
• Severity: pain score
Relevant history
• Is patient a smoker?
Physical Examination
• Is patient tachypnoeic? Chest Spring • Chest spring positive (i.e. tenderness) suggests rib fracture Notes: • However, if chest wall is tender during palpation, rib fracture needs to be ruled out, e.g. by doing a chest X-ray. Hence, NO NEED to proceed with chest spring. https://www.youtube.com/watch?v=OnTtmQGjgEQ&t=0m22s
•
Chest spring
Investigations
Blood
• ABG
Imaging
•
Chest X rays
To identify rib fracture as well as other complications of chest trauma e.g. pneumothorax, evidence of lung contusion, and (later) haemothorax Indication e.g. to look for pneumothorax especially if chest X-ray suspicious of pneumothorax and patient desaturated
•
CT thorax
Management
Conservative treatment
•
Oxygenation
Monitor SPO2, keep more than 95% • Analgesia e.g. IV Tramal 50 mg TDS
•
Pain management
• If pain not well controlled, consider refer acute pain service (APS)
• Incentive spirometry
Some Important Points during Clerking / Referring
- Mechanism of injury
- Clinical findings
- SpO2 on arrival?
- ABG?
- Chest X-rays: any oblique
CXR
done?×CXR
Abbreviation: CXR
Notes
• Middle ribs (4 to 10) are most susceptible to injury from blunt trauma
• Superior ribs fracture suggests trauma involving significant force and the potential for injury to major vessels and lung parenchyma
Source: Initial evaluation and management of rib fractures, UpToDate