Rib Fractures

This 80-year-old man fell on his right side and presented to the ED with severe pain and difficulty catching his breath. The chest x-ray shows two displaced lower right rib fractures (arrows). These are better demonstrated on the magnified view on the right. Rib fractures are frequently occult on radiographs as they are often undisplaced or minimally displaced. If it really matters to a clinician that a suspected rib fracture be confirmed, rather than doing a CT with its associated radiation dose, an excellent next test is to perform an ultrasound – this has a very high sensitivity for rib fractures even when undisplaced.