Prognosis

Morbidity and mortality

Chest wall injuries in older people should not be dismissed.

The estimated mortality among patients with traumatic rib fractures varies within the current literature, ranging from 10% to 25%.[22]​ Lower mortality figures of around 5% in recent studies mortality figures may be attributable to the optimisation of the acute trauma and intensive care management, including early resuscitation and optimisation of pain management.[22][88][89]

One retrospective cohort study in the US examining patients with one or more traumatic rib fractures admitted to hospital between January 2010 and December 2016 reported half of all patients were admitted to an intensive care unit, with a quarter requiring invasive mechanical ventilatory support.[22]​ The highest mortality rates were observed among patients with flail chest (13.0%), followed by patients with polytrauma (10.6%) and elderly patients (7.6%).[22]

Older patients have twice the morbidity and mortality compared with younger patients; for every increase in the number of ribs fractured, mortality increases by 19% while the risk of pneumonia increases by 27%.[58]

As the number of ribs fractured increases, morbidity and mortality increases in all age groups. There is a significant increase in mortality and in the incidence of pneumothorax, pneumonia, and acute respiratory distress syndrome, per increase in the number of ribs fractured. Older patients and those with >2 rib fractures are at a higher risk of pulmonary complications such as atelectasis, poor oxygenation, and respiratory compromise.[42][87]​ With 6 ribs fractured, there is a threshold for significant complications.[58] Pneumonia in the setting of rib fractures has a high mortality.[90] It is important to remember than even single rib fractures can be associated with significant morbidity and mortality, particularly in frail, elderly patients.[22]​[67]​​

Pain and disability

In patients with isolated rib fractures, pain is present but gradually declines over 4 months. The average time off work is about 70 days following chest trauma with or without concomitant injuries.[91]

Retrospective data suggest that approximately 30% of patients who were working prior to major trauma with rib fractures will not return to work within the 24 month post-injury period.[92]

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