Purpose Intrathoracic and intra-abdominal injuries in patients with rib fractures are often overlooked, leading to delayed and ineffective treatment. However, the relationship between rib fractures and organ damage has been rarely studied. The purpose of this study was to analyze the risk factors associated with intrathoracic and intra-abdominal injuries in patients with rib fractures.

Methods This retrospective observational study included 1269 patients diagnosed with rib fractures from September 2020 to April 2023. Patient data were collected, including gender, age, body mass index, systolic blood pressure, heart rate, type of rib fracture, number of fractured ribs, location of the rib fracture, and the presence of thoracic and abdominal organ injuries. Patients without imaging examinations, the patient with rib fractures from iatrogenic causes or mental illnesses or rheumatic immune diseases was excluded. The primary outcomes were intra-thoracic and intra-abdominal injuries. Multivariate logistic regression analysis was conducted to identify the risk factors for these injuries in patients with rib fractures.

Results The rib fracture characteristics in the occurrence group included bilateral fractures, higher number of fractures (≥3), and fractures located anteriorly, posteriorly, and laterally, as well as greater fracture displacement, compared to the non-occurrence group. The results of the multivariate logistic regression analysis indicated that age (p=0.016, odds ratio (OR)=0.95, 95% CI =0.92−0.98), the number of rib fractures (≥3, p=0.001, OR=1.46, 95% CI=1.13−1.89), rib type (bilateral rib fractures, p=0.043, OR=2.63, 95% CI=2.16−3.12), and rib fracture location (lateral rib fractures, p=0.041, OR=2.85, 95% CI=1.31−4.97; posterior rib fractures, p=0.022, OR=3.25, 95% CI=1.46−6.92) were independent risk factors for thoracic and abdominal organ injuries in patients with traumatic rib fractures.

Conclusions Patients with rib fractures resulting from blunt trauma, particularly those with lateral or posterior rib fractures, fractures involving more than 3 ribs, and bilateral rib fractures, are at an increased risk for significant intrathoracic and intra-abdominal injuries. These findings warrant attention and the implementation of appropriate preventive measures during treatment.