In the article, we will consider how to determine the fracture of the ribs. This pathology is a violation of the integrity of several ribs or one of them due to traumatic impact. The condition is accompanied by intense pain in the chest, which leads to a significant limitation of the mobility of the chest area. In this regard, the patient's breathing becomes superficial, which can provoke a violation of the processes of pulmonary ventilation. A multiple fracture of the ribs can be combined with various injuries of the organs located in the chest, and pose a significant danger to life. The diagnosis of a rib fracture is made on the basis of data obtained after an x-ray. If necessary, ultrasound diagnostics of the pleural cavity is performed, as well as its puncture. The symptoms and treatment of a rib fracture are interrelated.
Thisthe most common thoracic injury. Such injuries account for approximately 16% of the total number of fractures. In older patients, they are more common, and this is due to the age-related decrease in the elasticity of bone structures.
Uncomplicated fractures of the ribs of the chest heal quickly and do not pose a threat to life. The main danger in such an injury is associated with a violation of the respiratory process, damage to organs and the development of associated complications. Uncomplicated fractures are observed in only 40% of cases. Other injuries of this nature are accompanied by damage to the pleura, lungs and structures of the cardiovascular system. Multiple rib fractures are a serious injury and very dangerous in that they can contribute to pleuropulmonary shock, which is considered an extremely life-threatening complication. Multiple rib fractures with displacement of bone fragments often occur, which also seriously affects the patient's condition and treatment methods.
Causes of occurrence
To figure out how to identify a broken rib, let's look at the causes first. The main causes are most often a direct blow to the sternum, a fall or compression of the chest. The most common situations are when the ribs break in the area of \u200b\u200bthe greatest bend - along the lateral surface of the chest. During a fracture of one rib, displacement of fragments occurs very rarely. As for multiple fractures, they are more often combined with displacement of fragments. In this case, fragments can damage the lungs, pleura and intercostalvessels.
The most common causes of rib fractures are traffic accidents, domestic situations and industrial accidents.
Symptomatics
Sharp pain with a broken rib is noted in the chest, increases with movement, coughing, breathing, talking and decreases at rest, in a sitting position. Breathing is superficial in this case, the chest on the affected side lags behind when breathing. When palpating a broken rib, an area of severe pain is determined, in some cases - bone crepitus (a characteristic crunch of bone fragments).
Lateral and anterior fractures of the ribs (in the ICD-10 they are assigned the code S22) are difficult for patients to tolerate, accompanied by respiratory disorders. With damage to the posterior sections, the violation of pulmonary ventilation, as a rule, is less pronounced. With multiple rib fractures, the patient's condition deteriorates sharply. His breathing is superficial, his pulse is quickened, his skin is markedly pale or even cyanotic. The patient tries to sit still, avoids the slightest movement.
In the fracture zone of the 9th rib, for example, there are bruises, severe swelling of the soft tissues. On palpation, one can notice a diffuse sharp pain, bone crepitus. If the fracture is accompanied by such a problem as subcutaneous emphysema, then in this case, palpation of the subcutaneous tissue determines air crepitus, which resembles a soft creaking.
Possible Complications
How to identify a fractureribs, it is important to know in advance. The development of pneumothorax is indicated by the deterioration of the general condition of the patient, increasing shortness of breath. Breathing on the affected side of the chest is not audible. In addition, if the lung is damaged, hemoptysis may occur. Pneumothorax and hemothorax are conditions that develop in the immediate period after injury. A few days after the fracture, another dangerous condition may occur - post-traumatic pneumonia. Elderly people are more prone to its occurrence, in which pneumonia is usually very severe.
The development of pneumonia may be indicated by a deterioration in the general condition, signs of intoxication, shortness of breath and fever. It should be borne in mind that in debilitated elderly patients and patients with severe concomitant injuries, post-traumatic pneumonia is not always accompanied by hyperthermia. In a number of situations, only a general deterioration is noted.
The development of post-traumatic pneumonia is due to the inhibition of lung ventilation processes. Breathing during a fracture is very painful, so the patient tries to breathe more superficially. This problem is also often exacerbated by self-medication. Many people believe that for the fusion of the ribs, it is necessary to limit their mobility, to bandage the chest. As a result, breathing is even more limited, congestion develops in the lungs, and congestive pneumonia occurs. In fact, with such injuries in mostcases do not require fixation. The exception is some multiple and complex fractures of the ribs, in which assistance should be provided exclusively in stationary conditions. In the absence of timely therapy, complications are life-threatening. In order to prevent the development of complications or stop their consequences, you need to seek medical help as soon as possible.
How to identify a broken rib?
Diagnosis of the disease and existing complications is carried out by a traumatologist mainly on the basis of x-ray studies. If hemo- and pneumothorax is suspected, ultrasound of the pleural cavity, fluoroscopy of the lungs, and pleural puncture are additionally performed.
Thus, the only method for determining rib fractures (according to the ICD-10 code, see above) today is high-quality radiography.
Treatment
Uncomplicated rib injuries are treated on an outpatient basis, that is, at home. An injury to more than three ribs is considered an indication for emergency hospitalization in the Department of Orthopedics and Traumatology. With an uncomplicated rib fracture, at the time the patient is admitted to the hospital, the traumatologist performs local anesthesia or vagosympathetic blockade. After that, the patient is prescribed analgesics, some expectorant drugs, physiotherapy and therapeutic exercises to improve lung ventilation processes.
Sometimes hemothorax and pneumothorax develop not at the stage of admission of the patient to the hospital, buta little later. If there are suspicions of the development of these complications, additional fluoroscopy is performed during therapy. During the treatment of complex fractures of the ribs, along with standard medical procedures (taking analgesics, anesthesia of the fracture, therapeutic exercises and physiotherapy), additional therapeutic measures are carried out. A small amount of blood in the pleural cavities resolves on its own. If the patient has a pronounced hemothorax, doctors perform a puncture of the pleural cavity. Under local anesthesia, the specialist inserts a special needle into the pleural cavity and removes the blood accumulated in this area. Sometimes hemothorax occurs repeatedly, so during therapy, the puncture has to be performed several times.
With pneumothorax, in certain cases, a puncture is sufficient to remove air from the pleural cavities. Tension pneumothorax is considered an indication for emergency drainage. Under local anesthesia, the doctor makes a small incision in the second intercostal space along the midclavicular line. A drainage tube is inserted into this incision. Its other end is lowered into a jar of liquid. It is imperative that the jar is below the level of the patient's chest. The air that accumulates in the pleural cavity is removed through the tube, and the lung begins to expand. Pleural drainage, as a rule, is kept for several days until all the air is out. Then a control fluoroscopy is done and the drain is removed.
In the treatment of post-traumatic pneumoniaalong with general therapeutic measures (physiotherapy, antibiotics), it is very important to conduct therapeutic exercises to restore proper lung ventilation. Fixation of fractures is extremely rare, and this is done, as a rule, with multiple injuries of the sternum, which are accompanied by unstable costal fractures.
Home Therapy
The algorithm for treating rib fractures at home depends entirely on the severity of the injury. However, it should be borne in mind that those patients who are diagnosed with a fracture of one or a maximum of two ribs are treated at home, otherwise the treatment takes place in a hospital. To speed up recovery at home, you need to take medications, primarily anti-inflammatory and painkillers. If the patient, due to severe pain, has to breathe superficially, then an infectious process develops in the sternum. You can eliminate the pain syndrome with the help of drugs "Ibuprofen", "Ketorol", "Naproxen".
Medicines should be taken regularly, not just when pain occurs. Gradually, with a decrease in the severity of pain, the dosages of the drugs are reduced until they are completely canceled. In addition to taking medication, breathing exercises should be performed, which consists of 10 slow breaths every hour. Useful periodic application of cold compresses, which reduce swelling of the chest and help dissolve bruising. For the same purpose, absorbable cooling ointments with anti-inflammatory effects can be used. Induring therapy, you need to try to breathe fully. The patient must also follow a diet, wear a special corset, follow all medical recommendations.
Treatment of fractured ribs at home is quite realistic. During wakefulness, it is recommended to perform the simplest gymnastic exercises that will help maintain the tone of the body. It is not recommended to stay in bed all the time. This can provoke the development of congestion, the development of pneumonia and other serious complications.
How to tell if a rib is broken or bruised?
Bruising of the ribs is a fairly common phenomenon, and it is especially true in winter, when the number of provoking factors (strong wind, ice) increases. At first glance, it seems that there is no serious danger in such an injury and it is not necessary to carry out therapy. In many cases, the soreness of the damaged area may increase, and the diagnosis reveals not only a bruise, but also a crack in the rib.
To determine the nature of the injury, in particular a broken or bruised rib, you need to see a doctor and take a chest x-ray. The symptoms of these injuries are also very different. With a broken rib, the pain is more intense than with a bruise. In no case, if you suspect such an injury, you should not stay at home and ignore the symptoms. The same applies to self-medication. In case of a bruise or fracture of the rib, you should immediately go to the hospital, where the traumatologist will accurately determine the nature of the injury and prescribe the most appropriate treatment.
What type of rib fracture can be seen on x-ray? Consider further.
Types of costal fractures
Depending on the presence of skin damage, rib fractures are:
- open - the integrity of soft tissues and skin is broken by bone fragments;
- closed - fragments are located in soft tissues and do not damage the skin.
Depending on the complexity of the damage, a rib fracture can be:
- subperiosteal, when the costal bone tissue is damaged;
- complete, in which the bone is damaged throughout its thickness;
- fracture, when only bone tissue is damaged, and there is no fracture.
According to location:
- unilateral rib fractures - violation of integrity on one side of the sternum;
- double-sided - damaged ribs on both sides of the chest.
There is also a fenestrated fracture of the 6th rib, for example, which is characterized by bone damage in two places at the same time, as a result of which there is a movable fragment.
By the number of faults:
- single, when one rib is damaged;
- multiple – several ribs damaged.
How to sleep?
There are twelve pairs of ribs in the human chest, and their fractures account for, according to statistics, about 15% of other bone injuries. This injury occurs during road accidents, domestic accidents and fights.
How to sleep with a broken rib and lead a normal life? In patients in a similarcondition, there is a significant limitation of mobility, increased pain when changing body positions, a constant feeling of discomfort. If in a state of wakefulness a person still somehow suffers pain, then during sleep, a rib fracture delivers a lot of unpleasant sensations. Patients develop traumatic insomnia, a person cannot fall asleep for a long time, often wakes up in an attempt to roll over on his side.
Medical recommendations are to choose the most appropriate position for sleeping. Sleeping on your back is best for this injury, but many patients feel better when they sleep on their side. In such positions, it becomes easier for a person to breathe.
A good solution to this problem is to sleep in a reclining chair. If a person sleeps on a bed, then pillows can be used for comfort. They should be placed in such a way as not to wake up at night from pain due to involuntary movements of the body. You can put a pillow under your knees, which effectively helps to relax your back.
In addition, experts recommend taking painkillers or even sleeping pills before bedtime.
Prevention and prognosis
So we looked at the symptoms and treatment of rib fractures. The prognosis for uncomplicated single injuries is the most favorable. With multiple rib injuries, especially complicated ones, the prognosis depends on the adequacy and timeliness of the start of therapeutic measures. The approximate period of disability for simple injuries is 1 month. Duration of therapy for complex and multiple fracturesdetermined by their severity and the general condition of the patient.
The primary prevention of these injuries is to take measures to reduce injuries. A reduction in the risk of complications is observed with immediate medical attention and early medical procedures.
When driving in a car, it is recommended to use seat belts and follow the rules of the road.
