Rib fracture is the most common type of thoracic injury, and can be a single or multiple rib fracture, or the same rib can be fractured in one or more places. In children, the ribs are flexible and have a high capacity to withstand violence, making them less likely to fracture. Older people have osteoporotic and brittle bones and are prone to fractures. 1-3 ribs: short ribs, protected by clavicle, scapula and muscles, less likely to fracture; 4-7 ribs: long and fixed ribs, most likely to fracture; 8-10 ribs: longer, but the front end is connected to the sternum to form a rib arch, more elastic, less likely to fracture; 11-12 ribs: front end is free and unfixed, more elastic, less likely to fracture. Causes of fracture: 1, direct violence (fall, blunt object impact on the chest) applied to the ribs, so that the point of force at the rib bends inward and fractures. 2. Indirect violence applied to the front and back of the chest, causing the ribs to bend excessively outward and break. 3.Geriatric fracture: often caused by violent coughing and sneezing. 4.Pathological fracture: caused by metastatic lesions of malignant tumors, etc. Inward displacement of the fracture end – piercing the pleura, lung tissue, etc. – pneumothorax, hemothorax, subcutaneous emphysema or hematochezia, hemoptysis – piercing the intercostal vessels – -massive bleeding in the chest cavity, rapid deterioration of the condition, multiple multiple rib fractures – continuous shackle chest, paradoxical breathing – respiratory and circulatory failure Continuous shackle chest: after multiple multiple rib fractures, especially the anterolateral local chest wall is softened due to loss of intact This type of thorax is called shackle chest, where there is paradoxical respiratory movement due to softening of the rib support. If the softened area is extensive, the pressure imbalance in the pleural cavity on both sides during respiration makes the mediastinum flutter from side to side, which affects the airway ventilation, causes lack of oxygen and CO2 retention in the body, and affects the venous blood flow back to the heart, and respiratory and circulatory failure occurs in severe cases. Paradoxical respiratory movement: during inspiration, the chest wall of the softened area is invaginated without expanding outward with the rest of the thorax; during exhalation, the softened area bulges outward. Symptoms: local pain, especially aggravated by deep breathing, coughing or turning position; some patients have symptoms of shortness of breath, coughing and coughing up bloody sputum; severe cases have different degrees of dyspnea and circulatory disorders.