Last Updated on Thursday, 28 February 2013 09:21
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I am a high school defenseman and felt a crack in my chest when I was checked into the boards during our last game. I went to the emergency room and had x-rays and was told I had a rib fracture. How long am I out from playing hockey, and are there any precautions I need to take?
Answer: Rib fractures occur commonly in ice hockey, usually in older adolescents or in college hockey players. Luckily, most rib fractures are either minimally or non-displaced fractures, meaning that there is a crack in the rib bone, but the broken pieces still line up so that the whole rib is still close to its normal shape.
With minimal displacement of the fractured rib, the body organs in the chest and upper abdomen that the ribs are supposed to protect (liver, spleen, kidneys, and lungs) usually do not get injured. Rib fractures usually occur when a player is checked against the boards or into the goalpost. I have not seen them occur with on-ice collisions.
While rib fractures by themselves do not contribute to serious long term problems, it is important to check and make sure that there are no other serious injuries present. If there is a localized area over the ribcage which hurts when it is pressed on, or if the player feels like some of the bones are crunching when they take a deep breath in and out, then they should have x-rays taken to determine the amount of fracture displacement. It is especially important to follow-up with a physician if they have any difficulty with breathing or any abdominal pain.
A very small percentage of hockey players can have damage to the internal organs with a rib fracture. Therefore it is important to see a physician for a physical examination and x-rays to make sure that your injury is not more serious than what it seems initially. A rib fracture could cause a tear in the lining of the lung, which could cause it to collapse. A displaced rib fracture, or even just the impact of an injury causing a rib fracture, can cause injury to the liver, spleen or kidneys, which needs to be evaluated by a physician.
In your case, if you have been evaluated by a physician and do not have a displaced rib fracture or any other injuries, the first thing you should do is make sure that you have enough pain relief so you can skate. These injuries can be quite painful because of the motion of the chest wall when you breathe. Since you will be breathing heavily with the exertion of skating, this can cause the broken ends of the ribs to move and worsen the pain.
We most commonly provide a rib strap for our athletes to help “splint” the broken rib. The purpose of the rib strap is to prevent your chest wall from moving as much when you are taking a deep breath, which in turn will cause the rib fracture to be splinted and less painful.
You may return to skating as soon as you can tolerate the pain. We most commonly let our players go back with the use of a flack jacket to protect the fractured rib so they can skate with minimal pain, while minimizing the chance of taking another blow to the fractured area. Our players usually need to wear the flack jacket from anywhere from a few days to up to three weeks, depending upon the location of the fracture and the severity of the initial contact that they had.
Your physician may order prescription pain medications if your rib fracture is very painful, but you should not be on any medications stronger than acetaminophen when you return back to play. We recommend against the use of anti-inflammatory medications, such as Ibuprofen or Naproxen, in the initial few days after this type of injury because they tend to increase bleeding and they may slow down bone fracture healing.
Rib fractures usually heal quickly. In most cases, they are pain-free by three to four weeks after the fracture. It is important that you be assessed by a physician to make sure that there are no underlying injuries and be monitored closely by your athletic trainer to determine when you may safely return back to competition.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
