Cardiac injury from a fractured rib following a blunt trauma to chest from a fall combines the mode and mechanics of penetrating and nonpenetrating injury. 59% of penetrating cardiac injuries are stab wounds, 26% gunshot wounds and 5% others, and 80% of patients die before they reach hospital. Right ventricular injury is most frequent (46%), followed by injuries to left ventricle and right atrium (30% and 11%) .
Blunt chest trauma resulting in cardiac injury is not very common. The cardiac injuries can be contusion, heart chamber rupture, ventricular septal rupture, tricuspid valve rupture, coronary arterio venous fistula, mitral tensor apparatus rupture or rarely an aortic cuspal rupture [2, 3]. Cardiac contusion is by far the commonest of these, is followed by cardiac rupture uncommonly (0.3%), which, in turn, is associated with mortality as high as 80% .
Cardiac injury following a fractured rib due to blunt trauma to chest is an extremely rare event and there are only isolated case reports in world literature [5–10]. All these injuries except one  followed motor vehicle accidents [6–10].
Suszoko reported the first cardiac laceration following non-penetrating trauma in 1968 after a man struck his chest while he fell onto a chair . Perchinsky reported one patient who had a cardiac perforation from a rib fragment, 0.007% of all blunt traumas in his series .
Glock et al reported two left ventricular perforations with rib fractures . One patient exsanguinated and died and the other one presented with late subacute tamponade and underwent a successful cardiac repair . Bourguignon reported a 60 year old man who had a right ventricular perforation by a rib fragment which came to light following induction of anaesthesia for open fracture of left arm when patient had a rapid cardiovascular collapse. This patient had already had a tube thoracostomy for haemopneumothorax and fractured ribs . Galvin et al described a motor vehicle accident in which a detached fractured rib from a flail chest caused lung perforation and haemopericardium, the full diagnosis of which was appreciated on CT. A thoracotomy resulted in successful salvage . Roth et al described a 33 year old patient with blunt chest trauma and left flail chest. 6 hours after admission patient suddenly drained 1.5 L blood from left chest tube with hypotension and tachycardia. An emergency sternotomy with left anterolateral extension revealed secondary left ventricular perforation by a sharp rib fragment. This was repaired and the outcome was favourable .
Although cardiac perforation with rib fracture following blunt chest trauma is rare, it should be kept in mind when 1) there are anterior rib fractures in close proximity to the heart, 2) when there is evidence of raised venous pressure, and 3) when drainage of a haemothorax and replacement of blood losses do not result in expected recovery even though there is no ongoing blood loss. Echocardiogram and CT scan clinch the diagnosis and an early operation can be life saving.