A fracture is a break in a bone. This code refers to the ribs, which are a series of twelve pairs of narrow, curved bones that form a part of the skeletal thorax. Ribs are connected to the sternum by cartilage, with the exception of the floating ribs. The connecting point for these ribs is the sternum by costal cartilages.

A direct blow to the chest is the usual cause of rib fracture. The condition could result from trauma, falls, crush injuries, or from forceful coughing. Tumors must be considered when there is no obvious cause for the fracture.

Manifestations of the condition usually include severe, well-localized pain that worsens with deep inspirations. Most patients avoid deep breaths because of the pain. Movement of the trunk of the body produces pain, whether the action is active, passive, or resistive. The rib that is fractured will dictate the exact location of the pain and the degree of pain related to movement. In fractures between the second and sixth rib, there will be pain when adducting and medially rotating the arm. If the ends of the fractured rib have movement, there will be sharp, localized pain. In addition, most fractures present with crepitus, muscle spasm, and bruising.

X-rays are used to confirm the presence of a fracture.

Treatments for a simple fracture are not required. Pain relief may include use of regional anesthesia and the avoidance of systemic analgesics. Constrictive bindings are not recommended. If the patient is elderly, or has an underlying lung disease, then hospitalization may be needed. An arteriogram may be considered if the second or third rib is broken due to the potential for vascular chest injuries, since it takes significant force to break these ribs. Fractures of the tenth to the twelfth ribs are associated with liver and spleen injuries.

When two or more ribs are fractured in two or more places, or the sternum is detached, a flail chest may result. This usually results in difficult breathing and hypoxemia. Rib fractures and subsequent pneumothorax may occur secondary to cardiopulmonary resuscitation (CPR).

• Rib fractures usually heal with no residuals.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• 38 CFR 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. If painful motion is demonstrated then a minimum compensable evaluation is warranted.

• The rating for rib resection or removal is not to be applied with ratings for purrulent pleurisy, lobectomy, pneumonectomy or injuries of pleural cavity.

• However, rib resection will be considered as rib removal in thoracoplasty performed for collapse therapy or to accomplish obliteration of space and will be combined with the rating for lung collapse, or with the rating for lobectomy, pneumonectomy or the graduated ratings for pulmonary tuberculosis. 38 CFR 4.71a [Schedule of ratings-musculoskeletal system]