Chest injuries are extremely common following blunt and penetrating trauma. They can vary in severity from minor bruising or an isolated rib fracture to severe crush injuries causing multiple fractures and bleeding which result in pain and breathing problems.
Common causes of rib injury include motor vehicle accidents, falls and assaults. Treatment aims to relieve pain allowing you to perform normal tasks while the injury heals.
The majority of chest injuries are treated without requiring an operation, but a chest drain may need to be inserted. Occasionally with severe injuries the ribs may have to be fixed. This requires an operation that is performed under general anaesthetic.
If you follow the advice given to you on this page and by the healthcare professionals on the ward you should find your chest injury much easier to understand and manage.
Your clinician will let you know which injury type you have.
A rib fracture is a break in a rib bone. Bruising of the surrounding muscles and ligaments often occurs with these rib fractures. The lungs and other organs underneath the ribs may also be injured.
A flail chest occurs when a segment of the rib cage is separated from the surrounding structures. This is usually defined as at least two fractures per rib, in at least two ribs.
A sternal fracture is a fracture of the sternum (the breastbone), located in the centre of the chest.
A pneumothorax is a collection of air between the lung and chest wall that causes part or all of a lung to collapse.
A haemothorax is a collection of blood between the lung and chest wall which may be caused by blunt or penetrating injury.
A lung contusion is bruising or bleeding of the lung tissue that may cause pain and trouble breathing. It is a common lung injury after blunt trauma to the chest wall.
The ribcage supports the upper body, protects internal organs, including the heart and lungs, and assists with breathing.
Rib injuries include bruises, torn cartilage and bone fractures.
Very occasionally surgery is required to stabilise the fractures. In severe cases intensive care treatment is also required. If this is needed your doctor will discuss it with you/your family.
Possible complications of chest trauma include:
Lidocaine is a local anaesthetic which works by diffusing into the skin, causing numbness and relieving pain at the site of the rib fractures.
You have been given lidocaine plasters to treat pain from rib fractures and to enable you to deep breathe and cough more easily.
Between one and three plasters will be used depending on your rib injuries. The plaster/s must be applied to dry skin with no cuts or sores. Any hairs over the affected area may be trimmed with scissors (not shaved). Do not apply cream or lotion to the area as the plaster may not stick. If you have had a recent bath or shower, wait until the skin cools prior to sticking the plaster on. Try not to then get the plaster wet.
Lidocaine plasters must only be left in place for 12 hours, then they must be removed for a 12 hour break. For example, your plasters may be applied at 9am and removed at 9pm so that you have a break from them overnight.
Lidocaine plasters are used for between three and five days alongside other forms of pain relief. After this rib fracture pain is usually manageable with other oral painkillers.
If you develop skin irritation at the plaster site it will need to be removed and not reapplied unless the irritation settles.
Please speak to your doctor or nurse if you have any questions about this form of pain relief.
These provide effective pain relief through an injection of local anaesthetic to help numb the injured area. A very small, sterile plastic tube may be inserted to infuse local anaesthetic and help reduce your pain for several days. Anaesthetists perform these blocks and will explain everything to you including any risks.
If you have a pneumothorax or haemothorax you may need to have a chest drain inserted. If this is required your doctor will discuss it with you and explain the procedure.
A chest drain is a sterile soft plastic tube that is inserted into the space between the lung and the chest wall. It is used to drain air (pneumothorax) or blood (haemothorax).
If you have a chest drain some important things to know are:
Start in a comfortable position, ideally sitting upright in the bed or chair with your shoulders relaxed.
The breathing exercise should be followed by a cough. It is very important to cough effectively after a chest injury so that you can clear any sputum promptly and help prevent a chest infection.
Discomfort may be reduced by using a folded towel or pillow to support your chest while coughing.
If you feel that you are unable to clear your chest effectively or are concerned about an excessive amount of sputum, please inform your nurse who will refer you to the respiratory physiotherapist.
Repeat the breathing exercises and coughing at regular intervals for the first few days following your injury.
They may be discontinued when you are walking independently and your chest is clear.
You will be assisted by the nursing staff or physiotherapist to mobilise as soon as possible after your injury. It is essential your pain relief is adequate to enable you to do this.
It’s very important to continue to take regular pain relief as prescribed.
Once you have been discharged from hospital make an appointment to see your GP within three days.
Your GP may order a follow up chest x-ray and monitor your broken rib(s).
Take your hospital discharge summary with you. This summary tells the GP what has happened, tests done and what should happen with your care.
Major Trauma Team
Gate 19, Level 2
Brunel Building
Southmead Hospital
Bristol
BS10 5NB
Telephone: 0117 414 1546
Email: MajorTrauma@nbt.nhs.uk
© North Bristol NHS Trust. This edition published July 2022. Review due July 2025. NBT002945