What happens when an 85-year-old woman breaks three ribs?

No planks for a while.
No planks for a while.
Image: AP Photo/Stephan Savoia
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Ruth Bader Ginsburg, the popular US Supreme Court justice, is in the hospital with three broken ribs after falling yesterday.

Elliott Haut, a trauma surgeon and professor of surgery, anesthesiology, and critical care at Johns Hopkins University, says injuries following falls are one of the fastest growing type of injuries in the US, as the aging population grows and other traumatic injuries become less common. Older people tend to fall more due to poorer vision, to reduced balance, coordination, or strength. Ginsburg, now 85, also broke two ribs in 2012.

The seriousness of such injuries can vary dramatically. “People die of falls all the time,” says Haut, “It really depends on what else is injured.” The concussions, blood clots and infections that can follow a fall are what lead to more dangerous complications.

In the case of broken ribs, he says, the lungs can be damaged. Even if they aren’t, the most important thing is to make sure the patient can continue to breath normally. To do so, pain management is key: Since ribs can’t be put in a cast, the broken bones can’t be immobilized, and they hurt whenever the patient moves—or breathes deeply.

Poor breathing can be dangerous, Haut explains, and can lead to infections such as pneumonia, which is particularly risky for for elder patients. The preferred course of care for maintaining healthy breathing is to offer mild painkillers such as acetaminophen, only resorting to opioids if strictly necessary and for limited periods. An alternative, says Haut, is an epidural catheter like those used in pregnancy.

In cases where the only damage is a rib fracture and patients don’t have physically strenuous jobs, “the patients can get up and work as soon as they can; if the pain is controlled, some people go home [from the hospital]in one or two days.” However, he says the injury “might hurt for weeks to months.” Ginsburg, a notoriously avid exerciser, will have to slow down on her routine of pushups and planks.