Rib Fracture in POCUS: Seeing Beyond What Appears on X-ray

This image demonstrates a rib fracture identified using Point-of-Care Ultrasound (POCUS). On ultrasound, a normal rib appears as a continuous hyperechoic cortical line with posterior acoustic shadowing. A fracture may present as cortical disruption, irregularity, or a visible step-off deformity.

How do we assess a rib fracture using POCUS?

A high-frequency linear transducer is typically preferred for evaluating superficial structures. Scanning is performed directly over the area of maximal tenderness while following the rib along its course.

Key scanning points:

• Scan an adjacent non-tender area first to recognize normal anatomy.

• Follow the rib rather than focusing only on the painful point.

• Evaluate in at least two imaging planes.

• Use sonopalpation to correlate tenderness with ultrasound findings.

Beyond detecting the fracture itself, POCUS allows rapid assessment for associated findings such as:

• Pneumothorax

• Pleural effusion

• Local hematoma

• Adjacent soft tissue injury

POCUS provides immediate bedside information, but findings should always be interpreted together with clinical history, physical examination, and overall clinical judgment.