Let broken ribs lie

You know that old saying, "let sleeping dogs lie"? Well, this is a good thing to remember with broken ribs, too. Like other broken bones, broken ribs have to be treated with caution so they don't shift from their positions as they heal. It is a slow process, taking several months. For other broken bones, the doctor can set the bone with a splint, cast, or sling to ensure the broken ends are kept together, avoiding misshapen features or a loss of function. The ribs are in an awkward position in the body for this kind of help. Doctors used to use a compression wrap around the chest to help keep the rib bones in place, but these wraps can prevent the ability to take deep breaths and increase the risk of pneumonia.

So what should you do? Follow your doctor's instructions and keep your activity levels low for at least 6 weeks as the pain and discomfort subsides.

Broken ribs are the most common type of chest injury and often go unreported, based on estimates from MD Guidelines. Cracked, or fractured, ribs are a less serious condition than broken ribs, as the bone is not broken off (all the way through), which helps avoid organ damage, and the bone may heal faster.

Bones generally heal on their own, growing new bone without treatment. Seeing a doctor for a broken rib is to ensure no other damage, especially to the heart, lungs and spleen. For other broken bones, the doctor can set the bone with a splint, cast or sling to ensure the broken ends are together, avoiding misshapen features or a loss of function. The ribs are in an awkward position in the body for this kind of help. Traditionally, doctors used a compression wrap around the chest to help keep the rib bones in place. However, these wraps can prevent the ability to take deep breaths, which can lead to pneumonia, so they are generally not used anymore. However, doctors may still prescribe medications to alleviate pain during the healing process.

Though they are generally thought of as a hard, solid structure, bone is made of a matrix of deposited minerals, including calcium and phosphorus. When the body needs more, it takes it from the bone. Bones undergo a constant cycle of creation and destruction in a process called bone remodeling. When a break occurs, the bone starts rebuilding immediately, because the cells that are needed are already active. Chondrocytes (cartilage cells) lay down a cartilage matrix, osteoblasts lay down the solid bone tissue to replace this soft matrix and osteoclasts break down old bone and remodel the new bone for a smooth joint between old and new. Having the broken bone ends together allows fusion, which repairs the break by having new bone bridge the gap.

In more detail, the process of broken rib repair can be characterized by four steps, as outlined by Discovery Health:

Blood vessel damage and repair – Blood vessels run along the bones, providing nutrition to the bone cells. When a break occurs, it also damages the blood vessels. The clotting process, which forms a fracture hematoma, begins the repair process, causing inflammation and tissue repair around the broken bone while the bone cells start their work. New blood vessels grow for this tissue healing process, aiding in bone growth and replacing the damaged vessels.

Callus formation – The fracture hematoma is acted on by fibroblasts to create connective tissue, which is integrated with cartilage, the blueprint for the new bone. This fibrocartilage callus lasts about three weeks and holds the two pieces of bone together. The ribs cannot be splinted or put in a cast, and movement that disrupts the callus or prevents the bone fragments from joining together may prevent healing. Surgery may be needed if it impacts breathing or endangers the organs. Many give the healing process several months before ruling it a nonunion fracture.

Bone callus – The fibrocartilage is replaced by thin bone, a shell that lasts three to four months as the healing process is completed. Caution is still needed to avoid re-breaking the ribs, because they are not splinted or in a cast. For at least six weeks after the injury, sports and impact activities should be avoided; rest and easy movements should be the norm. A doctor may recommend particular movements to continue avoiding, depending on which rib(s) are broken.

Bone shaping – The callus is replaced  with compact bone, and the bone is mineralized and remodeled, completing the assimilation with the old bone ends. At this point, the ribs are repaired.