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It is important in treating a patient with fractured ribs to place the least emphasis on the broken bones. If attention is focussed on the ribs, certain other more important associated injuries may be overlooked. It is wise to think of all cases of fractured ribs as possible cases of subcutaneous or concealed penetration of the chest. That is, a piece of rib at the fracture site may be as pointed and sharp as a knife and may produce any of the complications of penetrating wounds of the chest. The most important of these are pneumothorax, hemothorax and subcutaneous emphysema. These conditions may produce symptoms and death sometimes erroneously attributed to contusion of the chest with shock and collapse and should be looked for in every case of fractured ribs and corrected when necessary. Aspiration of intrapleural air, and of blood when symptoms of pressure occur, is essential. The pneumothorax
Stenbuck JB. FRACTURED RIBS WITH PARADOXICAL MOTION. JAMA. 1937;108(6):470. doi:10.1001/jama.1937.92780060003009a