Outline:   
Fracture of rib often occurs from the 4th to 7th ribs, and mostly seen in old people. In the case of fracture caused by direct violence, the bone stump may penetrate through the pleurae or into the lung due to internal displacement of the fractured end. Fracture caused by indirect violence often occurs near the midaxillary line because of compression of the violence from the front to the back or vice versa. A serious cough or sneezing may also lead to fracture of rib. The fracture may occur in one or several ribs. If only one fracture occurs in one rib, it is called single fracture; if two fractures occur in one rib, it is called double fracture. If double fracture occurs in several ribs, there may appear abnormal respiration. When the bone stump penetrates through the pleurae or chest wall and the pulmonary blood vessels, pneumothorax and hemathorax may happen.

Major points for diagnosis  
1. There is a definite traumatic history of chest.
 
2. There are pain and swelling with ecchymosis in the affected part. Speaking, sneezing, cough, deep respirationn and motion of the trunk may aggravate
the pain.
 
3. There is tenderness. Sometimes a bony crepitus may be heard. The test of thoracic pressing is positive.
 
4. When there are complications of pneumothorax, hemathorax and abnormal respiration, corresponding symptoms, such as dyspnea, may appear.

5. X-ray film may reveal the location of fracture, and whether there are complications of pneumothorax and hemathorax and their severity.

Reduction:
Generally, in most cases of fracture of rib there is no marked displacement. So, no reduction is needed. In the cases there is displacement, according to different conditions, the patient may be asked to take standing, sitting or lying positions and throw his chest out, thus the fracture ends can be reduced generally. If reduction does not work, the pushing and pressing manipulations should be taken to press the eminent part fiat.

Fixation:  
1) Fixation with adhesive plaster: The patient sits erectly, taking deep respiration to draw the thorax into the minimum. Then he keeps shallow respiration while the operator uses a long adhesive plaster 7 to10 cm in width to wrap from midcapular line of the normal side, passing the fracture region closely to the midclavicular line of the normal side. Then the second adhesive plaster is used in the same way, with the lower part covering the upper part of the first and the two plasters overlapping each other by half. In this way, the operator does the same from the lower to the upper for fixation until the fracture region with its nearby normal ribs superiorly and inferiorly has been fixed. The course for fixation is 3 to 4 weeks.
 
2) Fixation with broad bandage: The Patient sits erectly, taking deep respiration to draw the thorax into the minimum. Then he keeps shallow respiration while the operator uses broad bandage to wrap in cycle until many rounds have been done for fixation or uses a special multiple headed bandage to wrap for fixation. The fixation duration is 3 to 4 weeks. This fixation is used for patients who are allergic to adhesive plaster.

Functional exercise:
The patient with mild fracture of rib should be allowed to walk freely. The severe patient who needs bed rest may take semireclining position and practice abdominal respiration. He can not walk freely until the condition gets better.

Herbal therapy
Internal treatment based on syndrome differentiation  
1. In the early stage  
Main symptoms and signs:
Chest pain and cough aggravated by deep respiration.

Therapeutic methods:
Promoting blood flow to remove the stasis, and regulating qi to stop pain.
 
Recipe and herbs:
Modified Fuyuan Huoxue Decoction. Specifically, Chaihu (Radix Bupleuri)12 g, Tianhuafen (Radix Trichosanthis)12 g, Jiudahuang ( Radix et Rhizoma Rhei Praeparata )6 g, Taoren (Semen Persicae )6 g, Dangguwei ( Extremitas Radix Angelicae Sinensis)15 g, Honghua ( Flos Carthmi )9 g, Chuanshanjia ( Squama Manitis Pentadactytae )9 g, Chenpi (Pericarpium Citri Reticutatae)9 g, Yanhusuo (Rhizoma Corydalis Yanhusuo )15 g and Gancao (Radix Glycyrrhizae)3 g.
 
2. In the middle stage  
Main symptoms and signs:
Alleviated pain in the chest and hypochondrium, limited turning-about.
   
Therapeutic method:
Reuniting the bones, muscles and ligaments.

Recipe and herbs:
Modified Xinshang Xuduan Decoction. Specifically, Dangguiwei (Extremitas Radix Angelicae Sinensis) 12 g, Zhechong ( Eupolyphaga seu Steleophaga )10g, Ruxiang ( Gummi Olibanum )5 g, Moyao (Myrrha )5 g, Danshen (Radix Salviae Miltiorrhizae)10 g, Xuduan (Radix Dipsaci)12 g, Duanzirantong (Pyritum Carcinatum ) (to be decocted first)20 g, Gusuibu ( Rhizoma Drynarii)12 g, Zhixiangfu (Rhizoma Cyperi Rotundi Praeparata )10 g, Yanhusuo (Rhizoma Corydalis )15 g, Sumu ( Lignum Sappan )10 g and Gancao (Radix Glycyrrhizae )5 g.


3. In the late stage
Main symptoms and signs:
Vague pain in the chest and hypochondrium, shortness of breath and lassitude.

Therapeutic method:
Replenishing qi and blood.

Recipe and herbs:
Modified Bazhen Decoction. Specifically, Dangshen (Radix Codonopsitis Pilosulae )10 g, Baizhi ( Rhizoma Atractylodis Macrocephalae )10g, Fuling (Poriae)10g, Danggui (RadixAngelicae Sinensis)10 g, Baishaoyao ( Radix Paeoniae Alba )10 g, Shudihuang ( Radix Rehmanniae Praeparata )10 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong)6 g, Chenpi (Pericarpium Citri Reticulatae )10 g, Gancao (Radix Glycyrrhizae )3 g, Shengjiang ( Rhizoma Zingiberis Recens) 3 pieces and Dazao (Fructus Ziziphi Jujubae) 2 pieces.