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Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol
  1. Cordelie E Witt,
  2. Eileen M Bulger
  1. Department of Surgery, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Cordelie E Witt; cwitt{at}


Rib fractures are common among patients sustaining blunt trauma, and are markers of severe bodily and solid organ injury. They are associated with high morbidity and mortality, including multiple pulmonary complications, and can lead to chronic pain and disability. Clinical and radiographic scoring systems have been developed at several institutions to predict risk of complications. Clinical strategies to reduce morbidity have been studied, including multimodal pain management, catheter-based analgesia, pulmonary hygiene, and operative stabilization. In this article, we review risk factors for morbidity and complications, intervention strategies, and discuss experience with bundled clinical pathways for rib fractures. In addition, we introduce the multidisciplinary rib fracture management protocol used at our level I trauma center.

  • rib fractures
  • morbidity and mortality
  • pain management
  • protocols

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors CEW contributed to literature search, literature interpretation, writing and critical revision. EMB contributed to literature interpretation, writing and critical revision.

  • Funding CEW receives funding from the National Institute of Health, Institute of Child Health and Human Development (2T32HD057822-06); principal investigators: Dr Frederick Rivara and Dr Monica Vavilala.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.