Diagnosis of Rib Fracture and Intercostal Nerve Block

An 85-year-old woman fell against the edge of a table. She had pain during respiration and motion. The bruising was suggestive of a rib fracture. The diagnosis of rib fracture is based on clinical examination - no radiographs are necessary. However, a chest radiograph may be indicated if hemo- or pneumothorax is suspected. When the rib is compressed by fingers distant and dorsal to the suspected fracture, the patient reports pain at the fracture site. This patient had two fractured ribs. Of the ribs examined in the video, the lowest had no fracture, whereas the upper two were broken as suggested by the avoidance reaction. The intercostal nerve is blocked with 2 ml of long-acting anaesthetic (bupivacain or ropivacain). The tip of the needle is inserted into bone contact, and then moved towards the lower edge of the rib with small "steps" until the resistance disappears when the tip advances under the rib margin. Before injection aspiration is necessary to make sure that the needle is not in a blood vessel. The nerve block may need to be repeated after 1-2 days.

Diagnosis of Rib Fracture and Intercostal Nerve Block