Rib fractures - violation of the integrity of the bone or cartilaginous part of one or several ribs. Fractures of one rib or fractures of a small number of ribs, which are not accompanied by complications and other injuries, usually coalesce on their own and do not require significant intervention or immobilization.
Chest radiograph. Marked area of multiple old rib fractures.
|ICD-10||S 22.3 22.3 -S 22.4 22.4|
|ICD-9||807.0 807.0 , 807.1 807.1|
|eMedicine||emerg / 204 radio / 609 radio / 609|
Rib fractures account for 5-15% of all fractures.
Rib fractures occur as a result of impacts, falls on protruding objects, as well as without direct injury (chest compression). They can occur with various tumor, infectious diseases, osteoporosis (pathological fracture).
Complaints to severe chest pain, aggravated by deep breathing and coughing, are characteristic. Therefore, the patient's breathing becomes shallow, which increases the risk of developing pneumonia as a complication.
On examination, it is possible to reveal a lagging of the chest in the act of breathing on the affected side, sometimes edema is detected at the fracture site. Palpation in the area of the fracture noted pain, often - crepitus and deformity in the form of steps. The symptom of "interrupted breath", which is not detected when chest injury is characteristic, is interruption of an attempt to take a deep breath due to pain. A symptom of Payr is revealed (pain when bending in a healthy direction) and a symptom of axial loads - with alternate squeezing of the chest in the sagittal and frontal planes, pain occurs in the area of the bone defect, and not in the place of pressure.
To eliminate complications, abdominal palpation, auscultation, measurement of heart rate and blood pressure are performed. If the lung is damaged by a broken rib, hemoptysis, subcutaneous emphysema, pneumo-or hemothorax may occur.
- Damage to internal organs or vessels with an acute fragment of a rib (for example, a lung with the development of pneumo- or hemothorax, heart, liver, spleen, organs of the gastrointestinal tract, intercostal vessels, kidneys), in particular, leading to bleeding.
- Flotation of the chest wall.
- Pleuropulmonary shock.
- Subcutaneous emphysema.
- Infectious complications (pneumonia, purulent pleurisy).
Chest X-ray is performed. However, with this method it is not always possible to identify a fracture. Therefore, the diagnosis of a rib fracture is usually established on the basis of clinical data (history, complaints, objective data). To exclude complications, a clinical analysis of blood and urine is performed.
Edge fracture accretion occurs through the formation of corn in three stages: connective tissue callus, osteoid callus, callus.
Enriched with apatites (hydroxyapatites), osteoid tissue turns into bone. First, the callus loose, in size - more than the diameter of the broken bone. Then the initial callus decreases in size, acquires normal architectonics (phase of the reverse development of callus).
With the first medical care anesthetic is injected - 1 ml of 2% promedol. At the time of transportation the chest is tightly bandaged.
In the hospital used alcohol-procaine blockade. To do this, in the place of the fracture injected 10-15 ml of 1-2% solution of procaine and, without removing the needle, add 1 ml of 70% alcohol. When pain is eliminated, deep breathing and coughing becomes possible. If pain persists, blockade is repeated after 2-3 days. Assign analgin inside, expectorant.
The prognosis for uncomplicated fractures is favorable and the fusion occurs in 3-4 weeks. At the turn of several ribs, working capacity is restored after 6-8 weeks.
Uncomplicated rib fractures
There is no damage to the pleura and internal organs.
TOLinika: the main symptom is pain at the fracture site. The pain is aggravated by breathing, coughing, physical exertion. The position of the victim is forced, often sitting. On examination, it is determined by the restriction of respiration, with multiple and bilateral fractures - shortness of breath, skin cyanosis. Palpation is determined by a sharp pain in the place of the fracture and the crepitus of the rib fragments. In the place of a rib fracture there are often hematomas. With compression of the chest in the sagittal and frontal plane, the pain increases dramatically. Auscultation for single fractures vesicular breathing, is heard in all departments. In case of multiple fractures, there is a weakening of respiration on the side of damage, small wheezing.
The main diagnostic method is an overview fluoroscopy (graphy) of the chest, but we should not forget that the fractures of the cartilaginous part of the rib are not visible on the radiograph. In this case, the diagnosis is based only on the clinic.
Treatment: 1. Pain relief. At admission to the victim intercostal or paravertebral novocainic blockade is performed. For pain relief, analgesics of narcotic (promedol, omnopon) and non-narcotic (analgin, tramal, ketarol, toradol, etc.) are used. You should not prescribe large doses of narcotic analgesics. The patient becomes lethargic, drowsy, inactive. This leads to accumulation of secretions in the bronchial tree and the development of complications.
Analgesics can be applied topically, in the form of ointments, alcohol solutions: menovazin, finalgon, and others. Physiotherapy procedures are used to relieve pain: electrophoresis with analgin, novocaine, ketarol.
2. Maintaining a normal airway and bronchial drainage function. This requires the revitalization of the patient, exercise therapy, breathing exercises. To improve the drainage of bronchial secretions used: chest massage, inhalation, expectorant means, diluting sputum, stimulation of cough.
The main task of the doctor in the treatment of rib fracture: to prevent the development of the main complication - hypostatic pneumonia. This requires the prevention of hypoventilation and lung atelectasis.
Antibacterial therapy for rib fracture (uncomplicated) is not applicable. The exceptions are victims with comorbid lung pathology: chronic bronchitis, bronchiectasis, etc. Given the greater likelihood of pneumonia in this category of victims, they are shown to prescribe antibiotics.
Finned (floating) rib fractures
This is a fracture of the ribs along several anatomical lines, with the formation of a sash of the chest wall. The leaf floats when breathing: during inhalation it sinks, during exhalation it prolapses. Violation of the skeleton of the chest leads to a violation of the biomechanics of respiratory movements and the development of acute respiratory failure.
The clinic and the condition of the victim is determined by the size of the flap of the chest. The larger the sash, the more severe the condition.
The clinic of a finite rib fracture consists of symptoms of shock, respiratory failure and local symptoms of a fracture.
The main complaint is severe pain in the place of rib fracture, shortness of breath.
On examination: shortness of breath, cyanosis of the skin, forced position of the patient, restriction of respiratory excursions. There is a decrease in blood pressure to 100 mm Hg and below, tachycardia to 110-120 per minute. Auscultation in the lungs on the side of damage breathing is weakened, variegated wheezes are determined. Locally determined by the floating window flap of the chest wall, sharp pain and crepitus in places of rib fracture.
Diagnosis is based on the clinic, chest x-ray. Diagnostic measures are carried out in conjunction with medical (anti-shock therapy, analgesics, resuscitation measures). These activities are conducted in the conditions of anti-shock with the participation of resuscitator, therapist.
Treatment: the victim from the emergency room is placed in the intensive care unit and intensive care under the supervision of an intensive care physician. The following events are held:
1. Restoration of the airway and treatment of acute respiratory failure: pulmonary ventilation, oxygen insufflation, mechanical ventilation, tracheostomy with adequate drainage and reorganization of the tracheobronchial tree, therapeutic bronchoscopy.
2. Infusion, anti-shock therapy.
3. Relief of pain syndrome: novocaine blockade, analgesics, anesthesia, long-term epidural anesthesia.
4. Antibacterial therapy.
5. Stabilization of the bone skeleton of the chest. Methods and methods of stabilization are varied. This question remains controversial until recently. Timely and adequate conservative therapy leads to an improvement in the condition of the victim and there is no need to stabilize the chest wall.
After removing the patient from shock, relieving acute respiratory failure and stabilizing the condition, he is transferred to the surgical department. Further therapy is carried out, as described in the section on rib fractures.
1. respiratory distress syndrome (shock lung).
Causes of multiple rib fractures
The cause of such a dangerous injury can be squeezing, falling or direct bang to the ribs. Most of the fractures occur on the sides due to the fact that the edges in this area have a maximum bend. In case of multiple fractures, rib fragments often shift. This is dangerous because fragments can injure the internal organs that are in the chest.
One of the dangerous complications of a fracture is pneumothorax and hemothorax. With hemothorax, blood accumulates in the pleural cavity, which squeezes the lung and reduces breathing. When pneumothorax is a squeezing of the lung due to air entering the chest.
Symptoms of multiple rib fracture
The main symptom of a multiple rib fracture is severe pain in the injured area of the chest, back, or side of the body. Pain will be greatly enhanced by breathing, coughing, talking, and even a small movement. It is impossible to take a deep breath, shallow breathing. Sometimes there is a dropping of the affected area during breathing or multidirectional movement. A light touch on broken ribs causes an incredibly sharp pain, sometimes a crunch of bone fragments is heard.
In case of multiple rib fractures, rapid pulse and blanching of the skin are almost always added to the above symptoms. In the area of injury, bright bruising and significant soft tissue swelling can be seen. Victims more easily tolerate fractures of the posterior ribs. In this case, less often there is a strong violation of pulmonary ventilation. Fractures of the ribs in the front and side sections almost always cause serious breathing problems.
Immediately after the occurrence of a multiple rib fracture, pneumothorax and hemothorax may develop. With pneumothorax, palpitations and high blood pressure are observed. In hemothorax from the injured side, breathing is not heard, the pulse is quickened, filiform, and the pressure is reduced.
First aid for multiple rib fractures
First you need to call an ambulance. In the meantime, experts get, try to help the victim ease breathing. Seat the person in a more comfortable position for him. Unzip or remove clothing. Constantly monitor the health of the victim. If there is an anesthetic drug, it can be given in the indicated dose. Just be sure to write down the name of the medicine, the dosage and time of admission This information may be necessary for ambulance doctors.
If the wound is open, an occlusive (airtight) dressing may be necessary. To do this, the wound edges should be treated with any modern antiseptic, apply a simple sterile napkin, a layer of cotton wool and close with polyethylene. The entire structure must be secured with a plaster or bandage.
Treatment of multiple rib fractures
Dangerous multiple rib fractures in most cases are treated in a hospital. In some particularly difficult situations, it is necessary to connect the patient to a ventilator or surgery. Any fracture of the ribs causes severe pain, so doctors resort to the Novocainic intercostal nerve blockade. Such a procedure not only relieves and relieves breathing - while the lung straightens and expectorated mucus. Thus, blockade is a necessary prevention of post-traumatic pneumonia.
This dangerous complication most often occurs in people over 40 years of age, and is particularly difficult. Post-traumatic pneumonia arises from the fact that the injured lung does not work in full. This is because the victim experiences pain with deep breathing and tries to breathe superficially.
Another cause of post-traumatic pneumonia is self-medication. Many believe that the pain will decrease, and fractures will heal faster if the chest is bandaged. This is mistake. Thus, breathing is limited even more, and dangerous stagnation in the lungs occurs.
Education: Diploma in "General Medicine" received in 2009 at the Medical Academy. I.M. Sechenov. In 2012, completed a postgraduate course in the specialty "Traumatology and Orthopedics" in the City Clinical Hospital. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.