Trauma X-ray - Axial skeleton
Ribs

Key points

  • 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 - Chest X-ray (detail)

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Rib fractures - Chest X-ray (detail)

  • Multiple displaced lower left rib fractures are visible

Subtle rib fracture - Shoulder X-ray

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Subtle rib fracture - Shoulder X-ray

  • The clavicle fracture is obvious
  • A subtle rib fracture is also seen
  • Note: Always check for a second injury

Rib fractures and chest pain

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.

Unexpected rib fracture - Shoulder X-ray

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Unexpected rib fracture - Shoulder X-ray

  • 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.

Rib fractures with haemothorax - Chest X-ray

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Rib fractures with haemothorax - Chest X-ray

  • Multiple rib fractures are accompanied by a small pleural effusion - likely a haemothorax

Rib fracture with pneumothorax - Chest X-ray

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Rib fracture with pneumothorax - Chest X-ray

  • A minimally displaced rib fracture is visible
  • This fracture is complicated by a haemothorax and a pneumothorax with surgical emphysema