Background on Rib Fractures
- Ribs protect the lungs as they contract/expand with breathing.
Rib Fracture Mechanism
- Typically from a blow to the chest
- General population: motor vehicle accidents
- Children’s bones bend easily and can often withstand breaks during a blow or fall
- Older adults: fall
- Patients with weak bones (cancer or osteoporosis) may fracture a bone from coughing too hard or sneezing.
Rib Fracture Management
- Risks: hypoventilation, atelectasis, pneumonia
- Incentive spirometer
- Generally, heal in 1 to 2 months with rest or activity modification.
- Overall recovery may take longer if internal organs (lungs) are involved
- Indications for surgical intervention include a flail chest (three or more adjacent ribs broken in multiple places) or multiple rib fractures that are causing breathing problems.
- Aren’t treatable with a cast or splint
- Ice to the affected area
- Pulmonary hygiene and “pulmonary toileting”
- Yoga and other strenuous activities are to be avoided for up to 6 weeks in most cases.
- Avoid intensive hand, arm, and leg exercises, with the use of clinical judgment, unless appropriate for neurological conditions such as stroke, Parkinson’s disease, or brachial plexus injuries.
- Avoid lifting over 10 pounds.
- Avoid contact sports or high-impact activities, including golf (excruciating pain).
- Avoid activities that require pushing or pulling.
Occupational Therapy Intervention
- Early mobilization in acute care
- Pain management education
- Splinting/bracing a pillow or folded blanket for coughing or deep breathing.
- Breathing Techniques
- Modified techniques to reduce pain during ADLs and using…
- Sleep positioning
- Bed mobility
- Sexual activity
- Light housework
- Return to working within precautions
- Adaptive equipment if appropriate
- Maintaining ROM/strength in neighboring joints
- Energy conservation & pacing
- Posture education
- Fall prevention
- Home safety/modifications