Rib Fracture Management: Conservative Treatment and Indications for Surgery

Most rib fractures heal conservatively in 4–6 weeks. Core management:

• Analgesia – scheduled acetaminophen/NSAIDs; opioids for severe pain; consider regional blocks (intercostal, paravertebral, epidural) for multiple fractures.
• Pulmonary hygiene – incentive spirometry, deep breathing q1–2h to prevent atelectasis/pneumonia.
• Ice – 20 min/q2–3h for analgesia/edema.
• Activity modification – avoid twisting, heavy lifting; no bed rest.
• Physical therapy – guided mobilization, posture, core strengthening after acute phase.

Surgical Indications

• Flail chest (≥3 consecutive ribs fractured in ≥2 places) with respiratory failure.
• Severe displacement threatening viscera.
• Nonunion with chronic pain.
• Thoracoscopic plating (rib fixation) increasingly used for select cases.

Multidisciplinary rib fracture pathways reduce pneumonia, ICU stay, and mortality.