The article discusses rib fractures, their classification, as well as what needs to be done first if such an injury is suspected.
What is this?
Fracture of the ribs (ICD-10 code - S22) is one of the most common injuries in the chest area. It can arise as a result of direct or indirect force impact.
Direct fracture refers to damage caused by deep or sharp deflection, and occurs at the point of impact on a limited area. If a sufficiently large surface was covered, which, as a rule, entails transverse damage to several ribs and their displacement to varying degrees, then often in this case there is a shortening of the bones due to the overlap of their fragments.
In rare situations, it happensaxis shift. Very serious consequences are given by a comminuted or, as it is also called, a “fenestrated” fracture of the ribs (ICD-10 code - S22). In this case, there is a violation of the anatomical and functional unity of the chest skeleton, which leads to a violation of the normal breathing process. In this area, paradoxical movements of the ribs occur. This entails a decrease in respiratory amplitude and a decrease in normal lung capacity, quantitatively increasing the volume of residual air.
Most common fracture
The most common type of fracture occurs in the region of the fourth to eighth rib. The first, axillary and back parts of the second and third are damaged in rarer cases due to the anatomical structure. In older people with a history of chronic cough, fracture of the lower rib often occurs spontaneously. A broken off part with a sharp end can damage the pleura or lung, which can lead to hemo- or pneumothorax of varying severity. Severe bleeding, provoked by rupture of the intercostal vessels, is also rare. Such injuries are often accompanied by damage to the scapula, collarbones and humerus.
So, how does a fracture of the ribs manifest itself (ICD-10 code - S22)? Let's find out.
Clinical signs
Fractures of the ribs are characterized by severe pain in the chest, which in a calm state are of a dull aching character, and when inhaled they become sharp, cutting. The pain may also be aggravated by coughing. Chest movement inthe affected area is limited. In the area of injury, there is usually swelling, accompanied by sharp pain on palpation. If a rib fracture is accompanied by a lung injury, then hemoptysis and signs of subcutaneous emphysema are observed at the site of injury. But a closed fracture of the ribs (ICD-10 code - S22) is not characterized by this.
X-ray
If a rib fracture is suspected, a chest X-ray is mandatory. X-rays should also be done if possible. The picture will allow you to determine the fracture, confirm or exclude the fact of displacement. But a minor hemothorax or pneumothorax in some situations can be easier to see in the process of transillumination, since the middle and upper ribs are fully visible, and the air-filled lungs act as a background. Injuries to the organ are usually clearly identified on plain chest x-rays. In some cases, the pulmonary pattern projected onto the costal bones can be mistaken for lines of damage or prevent their detection, therefore, computed tomography is often prescribed for a fracture. It is for this reason that multiple rib fractures (ICD-10 code - S22) are considered the most dangerous.
In order for the lung pattern not to interfere with an accurate diagnosis, the picture is taken with less stress, but with a longer exposure. During the x-ray examination, the patient's breathing should be superficial, excluding motor activity of the chest.
If the picture is taken in a direct projection, then the lateral parts of the costal bones may appear shorter, due to their angular structure. In addition, in order to exclude an error in the diagnosis, it is necessary to take into account the possibility of projection crossing during the study. It is necessary to turn the patient so as to improve visibility in the region of the costal angle. Pictures of the lower ribs (they are projected just below the diaphragm) are taken by specialists using a Bucca hood. Such an injury can cause damage to the kidney and spleen.
Comminuted fractures
As already mentioned, if a rib fracture is suspected (ICD-10 code - S22), radiographic images should be taken. In the case of a comminuted type of injury, this is a vital measure, since it is not possible to notice rib fractures otherwise. As a rule, with such injuries, lateral pieces of bones are broken out with a displacement. Sharp fragments protrude freely. It is also possible to overlap several ribs on top of each other, which illusory changes one side of the chest. Damage to the pleura and blood vessels is not ruled out, hemothorax or pneumothorax occurs, and the transparency of the lungs decreases. With such complex injuries, one should always remember that it is possible to reliably assess the clinical picture only in dynamics. This can be achieved by conducting X-ray examinations at the required frequency.
How is a rib fracture treated (ICD-10 code - S22)? This will be discussednext.
Treatment
The patient is assigned to bed rest for a week, taking into account the characteristics of the injury. In case of fracture of the ribs (ICD-10 code - S22), which is not complicated, it is possible to use novocaine or alcohol-procaine blockades in the area of damage. In addition, it often becomes necessary to prescribe expectorants, perform breathing exercises. In the presence of multiple fractures, a paravertebral blockade is prescribed with a 0.5% solution of procaine or a vagosympathetic blockade according to A. V. Vishnevsky. In addition, for complex injuries of the ribs, it is possible to use the method of skeletal traction behind the sternum.
