The ribs are a series of 24 curved bones arranged in 12 pairs that form the bony cage of the thorax. They articulate with the thoracic vertebrae of the spine at the back and, in most cases, connect to the sternum (breastbone) at the front via cartilaginous extensions. The rib cage protects the heart and lungs and plays an important mechanical role in breathing, rising and falling with each breath.
In the context of cardiac care, ribs are most commonly discussed in relation to CPR (cardiopulmonary resuscitation). Effective chest compressions require sufficient force to depress the sternum by 5 to 6 cm in adults. At this depth, rib fractures, particularly of the anterior ribs near the sternum, occur in a significant proportion of resuscitation attempts, most commonly in older people whose ribs are more brittle. Rib fractures should not deter rescuers from performing CPR or cause them to give inadequate compressions; a cracked rib from effective CPR is a treatable injury, while the alternative is fatal.
After resuscitation, rib fractures cause pain on breathing and movement. In the intensive care setting, this is managed with adequate analgesia (including regional nerve blocks in some cases) to allow the patient to breathe deeply and participate in physiotherapy. Unmanaged rib pain can impair breathing effort and contribute to chest infection. Most rib fractures heal within 6 to 8 weeks with appropriate pain management; operative fixation is rarely required.
Rib fractures identified after resuscitation should be documented and followed up, as they influence the pace and type of rehabilitation activities. Patients and families should be informed that rib pain or soreness after CPR is normal and expected, and that it indicates the compressions were performed with sufficient force to be effective.
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