A Broken Rib
That Has Not Settled

Most rib fractures, including many multiple fractures, are treated without surgery. The aim of pain relief is to let you breathe deeply and cough, because shallow breathing and suppressed coughing after a chest injury are what lead to chest infections. Regular simple analgesia taken on a schedule works better than waiting until the pain is bad, and holding a folded towel or cushion against the chest when coughing helps.

Dr Okiror regularly sees patients with rib fractures referred from urgent care centres, including The Lister Hospital’s Urgent Care Centre, who are managed without surgery with a clear recovery plan: what to expect week by week, when a CT is needed, and when to come back. New breathlessness, fever or a productive cough need medical attention rather than being put down to the fracture.

An intercostal nerve block places local anaesthetic around the nerve that runs beneath the broken rib. For a single painful fracture, Dr Okiror performs intercostal blocks as a day case at London Bridge Hospital. The block relieves pain so that you can breathe deeply, cough, sleep and keep up rehabilitation, and it can be repeated if needed. How long the relief lasts varies between people.

A block does not heal the fracture. This is the most important point for athletes, dancers and other performers, for whom a comfortable rib can be tempting to load before it has knitted. Return to training or performance is planned on healing, confirmed where needed on CT, and agreed with the physiotherapist or medical team working with you. Where a fracture is slow to heal and is keeping someone off the field or the stage, fixation is discussed alongside continued conservative care.

Fixation of one or two ribs is considered when a fracture is still painful well beyond the expected healing window despite adequate conservative treatment, when it has not united on CT, when it is displaced, or when it moves and clicks with breathing. In these patients the fracture, rather than the injury as a whole, is the problem, and fixing it can end months of pain.

The operation is performed under general anaesthetic with local anaesthetic to the chest wall. Through a small incision placed directly over the fracture, the rib is realigned and held with a plate and screws. The plate sits on continuous bone, which carries most of the load, the reason titanium performs well here and less well when it has to bridge a gap after chest wall resection.

• Flail chestA segment of chest wall moving the wrong way on breathing because adjacent ribs are each broken in two places, compromising ventilation.
• Several displaced fracturesRibs overriding or angulated so that healing out of line would impair chest wall mechanics or cause long-term pain.
• Blood in the chest (haemothorax)Drained at the same operation where the fracture pattern also needs stabilising.
• Combined chest and shoulder injuriesClavicle or scapula fractures can be fixed with orthopaedic colleagues under the same anaesthetic where appropriate.

Patients returning to the UK after a chest injury abroad, for example a skiing or sporting accident, can be assessed within days of return. Major trauma with significant head, spine, pelvic or abdominal injury, haemodynamic instability, or a need for ongoing ventilation for other reasons is managed first at a major trauma centre. If you are unsure whether a case is suitable, Jo Mitchelson can arrange a discussion before referral.

Consultations take place at London Bridge Hospital and The Lister Hospital Chelsea, usually within two to three working days, and earlier after a recent injury where needed. Self-referrals are welcome. Nerve blocks and rib fixation are performed at London Bridge Hospital, where high-dependency care and regional anaesthesia are available for more complex cases.

Dr Okiror is recognised by AXA Health, Bupa, Aviva, Vitality, WPA and Cigna, and by most other UK and international insurers. Jo Mitchelson confirms cover before any procedure, and self-paying patients receive an individual written quote before booking; guide prices for other operations are on the fees page. Bring X-rays, CT scans and emergency department letters from the time of the injury.