Rib fractures · flail chest · rib fixationA broken rib cannot be put in a cast — every single breath moves it. For most simple fractures, good pain control and time genuinely are enough. But for multiple fractures, displaced fractures, flail chest, or pain that is not settling, specialist treatment — from nerve blocks to titanium rib plating — changes the outcome.
Page last updated 5 August 2026
Undertreated rib fractures do not just hurt — they cause pneumonia, chronic pain and long-term disability, most of which is preventable. Any of the following is a good reason to be seen:
“Pain that stops a patient breathing deeply is not just miserable — it is dangerous. Every day spent unable to take a full breath is a day the lungs are at risk. Much of what I see after rib trauma is preventable suffering.”
Mr Marco Scarci, Consultant Thoracic Surgeon
Discharged from A&E with painkillers, then weeks on the sofa — sleeping upright, dreading every cough and sneeze, breathing in shallow sips. That cycle of pain and shallow breathing is precisely what leads to mucus build-up, chest infection and pneumonia. Breaking it is the whole point of specialist rib fracture care.
Rib fractures in older people carry a disproportionate risk of pneumonia and respiratory failure, even after a minor fall. Early expert pain management and close monitoring genuinely save lives in this group.
Without adequate pain relief you cannot breathe deeply or clear your chest, and complications follow. Treatment is escalated step by step until it works.
Paracetamol and anti-inflammatories taken regularly around the clock — not just when the pain peaks. Often sufficient for a single undisplaced fracture in an otherwise healthy adult.
Stronger oral analgesia, topical lidocaine patches and short, monitored courses of opioids where appropriate — balanced carefully against the risk of suppressing your breathing.
Targeted local anaesthetic alongside the affected intercostal nerves can transform pain for hours to days — often the single most useful intervention for multiple fractures.
Continuous chest wall pain relief for severe multi-rib injuries, particularly in older or high-risk patients — delivered in hospital with close monitoring.
Surgical stabilisation of rib fractures uses precision-contoured titanium plates and locking screws to realign broken ribs and hold them rigidly while they heal. It is not first-line for most fractures — but for the right patient, it transforms recovery.
Published evidence in eligible patients shows lower pneumonia rates, shorter hospital stays and better outcomes with fixation — and the benefit is greatest when surgery is done early, ideally within about three days of injury.
A thoracoscopic camera checks the chest cavity, drains any blood or air, and helps position plates precisely in complex or multi-injury cases.
Freezing the affected intercostal nerves under direct vision during surgery gives prolonged post-operative pain relief and cuts opioid requirements.
A small drain removes any collection of blood or air so the lung fully re-expands while the chest wall heals.
Healing follows a broadly predictable path — what varies is the pace, depending on how many ribs are involved, your age, and whether treatment is adequate.
The worst pain. Strictly regular analgesia, hourly deep-breathing exercises despite the discomfort, gentle walking, ice. This fortnight determines whether pneumonia gets a foothold.
Bone callus is forming and movement hurts noticeably less. Light household tasks and short walks; no driving until pain no longer distracts you.
Ribs are usually well consolidated: normal sleeping positions, deeper breaths, desk work. If pain is still severe at this stage, something needs reviewing.
Light resistance work and stretching resume. Contact sport, heavy lifting and impact stay off-limits until you are cleared.
Most people are back to everything by 8–10 weeks. Significant pain beyond 12 weeks means nonunion, malunion or nerve damage until proven otherwise — all of which are treatable.
Each of these is common, serious, and — with the right care — largely avoidable.
Shallow, guarded breathing lets mucus pool in the lower lungs. In frail patients with multiple fractures it can be life-threatening — and it is largely preventable with proper pain control, breathing exercises and early mobilisation. Read about rib fractures in older adults →
Sharp fragments can puncture the lung (pneumothorax) or tear intercostal vessels (haemothorax). Early imaging catches these; a chest drain — or keyhole surgery for larger collections — treats them.
A fracture that never properly knits, leaving a painful mobile segment. Smoking, osteoporosis and inadequate early treatment all raise the risk. Fixable with titanium plating.
Pain persisting beyond three months usually has a specific cause — malunion, nerve damage, scar tissue — and a specific treatment. Read about chronic post-fracture pain →
“ ★★★★★“I broke five ribs in a cycling accident and was sent home from A&E with tramadol and told to come back if it got worse. Two weeks later I was worse — I couldn’t sleep and I was terrified to cough. Mr Scarci saw me within four days, did a nerve block that week, and the change was immediate. I could finally breathe properly again.”
“ ★★★★★“I was in a car accident and fractured four ribs. I was told to manage at home. Three weeks later I ended up with pneumonia. After that nightmare I found Mr Scarci, who explained exactly what should have happened and why. His pain management changed everything within 24 hours.”
“ ★★★★★“I fractured three ribs playing rugby and had been told they would just heal on their own. Six weeks later I was still in significant pain. Mr Scarci identified nonunion, explained the options clearly, and we proceeded to titanium plating. Recovery was straightforward and I was back on the pitch within four months.”
MD(Hons) · FRCS(Eng) · FCCP · FACS · FEBTS · Consultant Thoracic Surgeon, Imperial College Healthcare NHS Trust
Rib fractures kill through the complications they cause, not through the breaks themselves — and those complications are almost entirely the result of pain management that isn’t adequate enough to let the patient breathe. Mr Scarci has spent over two decades treating the full spectrum of rib and chest wall trauma: from expert pain management and nerve blocks in the clinic, through titanium rib plating and VATS-assisted fixation in theatre, to the long-term nonunions and chronic pain syndromes that follow when initial treatment was insufficient.
He performs rib fixation surgery himself — not delegated — and sees every patient personally at consultation, in theatre, and at follow-up.
Rib and sternal fractures from road traffic accidents and workplace injuries are a core part of this practice. Treatment can often be funded through your personal injury claim, and the practice provides the clinical documentation your solicitor needs. Mr Scarci also acts as an expert witness in chest trauma, so reports are prepared to the standard courts expect.
Five London clinic locations. No GP referral required. Insurance verified before you attend.
St John’s Wood, NW8 9LE
11:00am–1:00pm Monday PMMarylebone, W1G 6BW
5:30–7:30pm Tuesday PMBorehamwood, WD6 3BS
5:30–7:30pm Wednesday AMHammersmith, W12 0HS
9:00–11:00am Thursday AMSouth Kensington, SW5 0TU
9:30am–12:30pmA simple, undisplaced fracture usually heals in 6–8 weeks, with pain improving steadily throughout. Multiple or displaced fractures can take 10–12 weeks, and longer in older patients or those with bone disease. The pattern matters more than the number: pain that is not improving — or getting worse — after 4–6 weeks is outside normal healing and should be reviewed. Significant pain beyond 12 weeks is never something to simply accept.
Lying flat loads the fractured ribs, which is why the first two weeks are often worst at night. Sleeping propped up on pillows or in a recliner, timing pain relief for bedtime, and using ice beforehand all help. If sleep has collapsed entirely, that is a reason to be seen: an intercostal nerve block can provide enough relief to restore sleep while the ribs heal.
Surgery (titanium rib plating — ORIF/SSRF) is considered for flail chest, multiple displaced fractures compromising breathing, fractures causing bleeding or a collapsed lung, severe pain despite maximal conservative care, and fractures that have failed to heal by 8–12 weeks. When fixation is indicated, the evidence favours operating early — ideally within about three days of injury — so if surgery has been mentioned to you, see a thoracic surgeon promptly rather than waiting.
Precision-contoured titanium plates are fixed to the broken rib with locking screws, holding the bone in correct alignment while it heals. Titanium is inert and biocompatible: it does not set off airport metal detectors, is MRI-safe, and in almost all cases stays in place permanently without causing any symptoms. Removal is only ever considered if a specific plate causes a specific problem, which is uncommon.
Occasional twinges with strenuous activity can persist for a while, but significant daily pain beyond three months is not normal healing. The usual culprits — nonunion, malunion, or intercostal nerve damage — are all identifiable and all treatable. See our page on chronic post-fracture pain.
Pain control good enough to let you breathe deeply is the single most important factor — shallow breathing lets mucus pool in the lower lungs, which is exactly where pneumonia starts. Beyond that: deep breathing exercises every waking hour, coughing when you need to while bracing with a pillow, staying mobile, staying hydrated, and not smoking. Fever, a productive cough or worsening breathlessness need prompt medical attention.
Yes: rib fracture consultations, nerve blocks and surgical fixation are recognised acute treatment with all major UK insurers, and the practice handles verification and pre-authorisation for you. If your ribs were broken in a road traffic accident or at work, treatment costs can often be recovered through your solicitor as part of a personal injury claim — the practice provides all documentation required.
A specialist consultation reviews your imaging, fixes your pain management, and identifies whether a nerve block or surgery would change your recovery. You leave knowing exactly what should happen next.
