If you’ve ever had a rib fracture—a crack or an actual break in a rib—you know that this type of injury can cause severe pain. A hallmark of a rib fracture is that a deep breath makes the pain worse. Pain from a fractured rib can even impede your breathing, leading to a chest infection. 

In addition, since the rib cage protects some of your most vital organs in the chest and abdomen, a rib fracture can be associated with other injuries to internal organs and blood vessels.

While some people will be fine going to see their regular doctor with a single broken rib, those with more complex fractures, severe symptoms or injuries caused by a motor vehicle crash or fall from a height should seek care at a trauma center. 

"Yale New Haven Hospital’s Level 1 Trauma Center provides 24/7 access to a team of different specialists,” says Adrian Maung, MD, a Yale Medicine trauma surgeon. “If you suspect your fracture is serious, or you’re not sure, the best advice is to go to the trauma center immediately.”

We humans have 12 pairs of ribs that wrap around the chest. You can fracture one or more ribs in a trauma, such as a car crash, a fall from a height, or a contact-sports mishap. Rib fractures can even result from repetitive movements in sports, such as golf. Occasionally, severe coughing can cause a rib fracture, especially in people who have a bone-weakening cancer, or who are elderly or have osteoporosis.

Any rib injury should be evaluated by a physician. You will want advice for pain management, as well as to be assessed to see if there has been any other damage.

Your rib fracture may be complicated by other injuries. Upper rib fractures can cause injuries to the large vessels that bring blood to and from the heart. It’s not uncommon for a fractured rib to cause injury to the lung itself, sometimes leading to a collapsed lung or bleeding into the chest cavity. Lower rib fractures can cause injuries to the liver and spleen.

If you have broken or cracked three or more adjacent ribs in two places, you may experience a condition called “flail chest.” With flail chest, your upper rib cage separates from the rest of the chest wall and can’t hold its shape when you breathe. Flail chest can cause a pulmonary contusion, or bruise on the lung that can lead to serious lung conditions and respiratory failure.

It is important to see a doctor immediately, seeking emergency care if your rib fracture is accompanied by:

• Increasing shortness of breath
• Trouble breathing deeply or coughing
• Fever
• Unusual cough, or a cough that produces mucus or blood
• Feeling dizzy or weak
• Abdominal pain

If you have experienced a physical trauma, such as being in a car accident, or you have chest pain (which could be a sign of a heart attack), you should call 9-1-1 immediately.

A doctor can assess the severity of your rib fracture by performing a physical examination and by looking at a chest X-ray. If you have a complex injury, the or she may want to order further testing such as a CT scan to help diagnose any related injuries.

The doctor will determine if the fracture is serious enough for hospitalization and if there are additional injuries, says Dr. Maung.

Most people with rib fractures are sent home with advice on taking care of themselves. In most cases, a fractured rib will heal on its own in about six weeks. Doctors no longer prescribe compression wraps for rib fractures, because they can restrict breathing, leading to pneumonia, or even a partial lung collapse.

Pain management is important, especially in the first few days after an injury. There are many options for pain control, including such over-the-counter medications as acetaminophen, ibuprofen or naproxen; lidocaine patches, a topical treatment; and stronger medications such as narcotics. Your doctor may even recommend placement of catheters to provide continuous anesthesia that targets a nerve or group of nerves to control pain.

Although narcotic pain medications may be prescribed at first, these can be highly addictive, so you may want to minimize their use as your pain improves.

You should also be mindful of the following:

• Stay active while avoiding movements that put pressure on your injury.
• Always be aware of your breathing. Try to breathe deeply and cough gently at least once every hour. You may want to hold a pillow against the site of your injury to make this easier. Your doctor may give you an incentive spirometer, a device you can use to monitor your lung function.
• See your doctor immediately if you develop new symptoms, including shortness of breath, fever, or pain that is so bad you can’t breathe or cough.

Surgery for rib fractures may be recommended only for the most complex cases, including when the injury has made breathing so difficult that a respirator is necessary. Yale Medicine thoracic surgeons are skilled in rib-stabilization surgery, which uses plates and screws to stabilize the ribs so that the patient can breathe properly while healing.

Yale New Haven Hospital’s Level 1 Trauma Center has trauma surgeons available 24-7 to provide immediate care for patients with rib fractures. We provide continuous care to all trauma patients from admission to discharge. 

In addition, we have 24-hour imaging services available, as well as attending radiologists to review and discuss the results with clinicians. “So not only are the tests done quickly, they are interpreted quickly,” says Dr. Maung.

Yale New Haven Hospital serves as a referral center accepting transfers from emergency departments across Connecticut.