Chest X-ray is not indicated for suspected uncomplicated rib fractures
Chest X-ray is indicated for thoracic injury with suspected complications
Standard view
Chest X-ray - A chest X-ray is not indicated for suspected uncomplicated rib fractures. This is because rib fractures are often undisplaced and therefore not visualised, and, even if a fracture is visible, management is unchanged. Rib fractures are often seen as an incidental finding on X-rays of the chest, shoulder or thoracic spine.
If there has been trauma with a suspected complications such as pneumothorax or haemothorax then chest X-ray is indicated.
Severe thoracic injury often requires CT examination.
Rib fractures are often found unexpectedly in patients with chest pain as they may occur without a clear history of trauma. Patients treated with steroids may sustain a rib fracture as the result of minor trauma, for example on coughing.
This patient presented with no clear history of trauma and complained of shoulder pain
Shoulder examination was unremarkable
Complications of rib fractures
If more than a simple rib fracture is suspected then a chest X-ray may be indicated to look for a pneumothorax or haemothorax.
A chest X-ray alone cannot determine if a pleural effusion is a haemothorax or simple fluid, however in the context of significant chest trauma this is often a reasonable assumption.
