Undisplaced or anterior rib fractures can be difficult to appreciate on normal PA projections.
Dedicated oblique views to detect rib fractures are not normally warranted because the treatment between traumatic chest pain with and without fractures does not differ markedly as treatment is symptomatic relief. However, PA projections should be obtained to assess for complications (e.g. pneumonia, pneumothorax, hemothorax) 1. Chest x-rays (even with optimized projections) may miss up to 50% of rib fractures 2.