Rib fracture is relatively common and can be single or multiple. A single rib can have double fractures or multiple fractures.
Clinical presentation and pathology
Clinical symptoms are related to the number, site, and displacement of rib fractures. The main symptom is thoracodynia, exacerbating during respiration and exertion. Multiple fractures of multiple ribs can cause paradoxical chest wall movement. Fracture can occur in all ribs, mostly in the 3rd to 10th ribs, and can be complete fracture or incomplete fracture.
Imaging manifestations
X-ray
Complete fracture shows discontinuity of the rib cortex, and the broken end can be well aligned or displaced. Incomplete fracture shows distortion of the long axis of the bone and separation of the cortex on one side. Secondary signs of rib fracture, such as pneumothorax, hydropneumothorax, and mediastinal emphysema, can also be found.
Figure 1 Rib fracture
a. Frontal chest x-ray film shows fractures of the 4th and 6th posterior ribs on the right side (↗); b. CT bone window shows discontinuity of the left rib cortex with mild displacement (↗).
CT
CT can sensitively detect rib fracture, can show costal cartilage fracture, and can also detect traumatic changes in the lungs, pleural cavity, and soft tissues. CT three-dimensional reconstruction technology can clearly show complete or even incomplete rib fracture, and can accurately locate the site.
Diagnosis and differential diagnosis
The imaging manifestations of rib fracture are typical. With a clear history of trauma and local signs, a definite diagnosis can usually be established. Chest x-ray or conventional CT is prone to missed diagnosis of incomplete fracture and nondisplaced fracture, careful observation is required, and three-dimensional reconstruction of ribs on thin-section CT can be performed if necessary.