Symptoms of rib fracture, how to render the firsthelp and further treatment

Update: October 2018

Among all chest injuries most common
rib fracture. The frequency of this injury is 10-15% among all
fractures. An important aspect is that with such a fracture
internal organs may be damaged. Sometimes it can lead to
fatal, so this question is much more important than
it could seem.

Rib fracture – violation of the integrity of the cartilage or bone part
ribs or multiple ribs. If 1 or 2 edges are damaged, then
As a rule, it does not require hospitalization and immobilization. With
damage to more ribs, complications are often observed
and damage to the organs of the chest. In this case it is necessary
hospital treatment under the supervision of a doctor.

Anatomy of the chest and ribs

The chest is represented by 12 thoracic vertebrae, with which
12 joints of ribs are connected by joints. Located in front
sternum, cartilaginous parts of the ribs are adjacent to it.

The ribs are divided into true (1-7 pair), false (8-10 pair) and
oscillating (11-12 pair). True ribs connect to sternum
own cartilaginous plates. False ribs do not have
непосредственного соединения с грудиной, их хрящевые части
grow together with cartilage above the lying ribs. And the cartilaginous part
oscillating ribs generally have no articulation with anything.

The ribs have a bone part and cartilage. In the anatomical structure
ribs secrete head, neck, body and tubercle. On the inside
the surface of the ribs has a groove in which lies
сосудисто-нервный пучок. With переломе ребра он часто
damaged, leading to bleeding and malnutrition
intercostal muscles.

Etiology of the disease

Withчиной перелома ребер, как правило, становится падение на
protruding hard object chest, punch in the chest
or its compression. Also found pathological fractures, they
are formed as a result of the course of other diseases, for example,
tumor process, osteoporosis, osteomyelitis.

The classification of rib fractures.

By the presence of damage to the skin:
  • Closed fracture – without damaging the skin
  • Open fracture – with skin damage
By damage rate:
  • A complete fracture – a rib is damaged throughout the thickness. Most
    frequent type of fractures
  • Subperiosteal Fracture – Bone Damage
  • Crack
By localization:
  • Broken fracture – damage to the ribs in two or more places with
    one side of the chest
  • Bilateral fracture – damage to the ribs with the right and left
    parties. Often complicated by impaired ventilation
By the number of fractures:
  • Single – single rib fracture
  • Multiple fractures – multiple rib fracture
By the presence of displacement of bone fragments:
  • Fractured ribs with offset.
  • No offset.

Injury mechanism

The most frequent fracture site is the zone of greatest
bending, that is, along the axillary line on the lateral surfaces
chest. Чаще всего встречаются переломы 5-8 the ribs. Less often
total damage 9-12 ribs. This is because these
the ribs have greater mobility, especially in the distal parts.

Fractures at the back of the costal arch are lubricated
clinical picture. This is due to the lower mobility of the bone.
fragments in this area when breathing. Fractures in the lateral and anterior
parts of the costal arch are tolerated most severely and the symptoms associated with them
expressed very brightly. Consider the 3 most common types.
fracture depending on the mechanism of injury.

Fracture of a limited area of ​​the rib arch 

Occurs when injured with a small, heavy, angular object.
forms. Damage occurs in the same place where the injury was
impact. Fracture occurs inside. Damaged first
the inside of the rib, then the outside.

Complete rib fracture 

Most often occurs when falling on the chest. With этом
fragment of rib is formed, it moves during respiratory
movements. Often there is damage to the pleura, lung and
intercostal vessels and nerves.

Indentation of a fragment of an edge

With воздействии высокой сила на участок грудной клетки большей
indentation of the fragment of the rib inside the thoracic
cells With этом часто травмируется плевра, сосуды, нервы, легкое.
Such fractures are called fenestrated. If damaged immediately
several edges, then with such a mechanism of injury a large
movable section in the chest wall and it is called costal
valve.

 Clinical picture

Consider what are the symptoms at the turn of the ribs.

  • Pain – it occurs in the area of ​​the fracture, increases with
    movements, inhaling and exhaling, coughing. Pain reduction
    possibly at rest and in a sitting position.
  • Shallow breathing and the lag in breathing of that half
    chest where there is injury.
  • Swelling of tissues in the area of ​​damage.
  • Hematoma at the fracture site is relevant in traumatic
    fracture resulting from direct mechanical
    impacts
  • The sound of rubbing bones or crunching during injury
    important for fractures with a large number of fragments, or for
    multiple fractures of one ribs without shifting individual parts
    damaged bone

For multiple and complicated fractures, the following may occur.
signs:

  • Subcutaneous emphysema – if the lung is damaged, air can
    gradually get under the skin.
  • Hemoptysis – when coughing, blood is released from the respiratory
    ways. This symptom indicates lung tissue damage.

Complications

  • Pneumothorax – air entering the pleural cavity. With
    lack of timely treatment can turn into stressful
    pneumothorax, after which cardiac arrest may occur.
  • Hemothorax – blood entering the pleural cavity. As in
    in case of pneumothorax, there is a compression of the lung, the patient
    has difficulty breathing, shortness of breath. With прогрессировании
    condition develops the following complication.
  • Respiratory failure. Appears very often
    shallow breathing, pallor and cyanosis of the skin,
    increased heart rate. With дыхании видно западение участков грудной
    cells and its asymmetry.
  • Плевропульмональный шок – возникает при пневмотораксе и
    the extensive area of ​​the wound, when a large
    the amount of air especially fast shock occurs if the air
    cold. It manifests symptoms of respiratory failure,
    painful coughing and cooling of the limbs.
  • Pneumonia. With низкой двигательной активности, невозможности
    perform normal respiratory movements and damage to the pulmonary
    tissue, often there is inflammation of the lung.

Stages of healing of a rib fracture

  • 1 стадия – соединительнотканная мозоль. In place
    damage accumulates blood, where migrate to the blood stream
    cells that produce connective tissue (fibroblasts).
  • Stage 2 – osteoid callus. Deposition occurs
    inorganic substances, mineral salts in
    соединительнотканной мозоли и формируется остеоид.
  • Stage 3 — hydroxyapatites are deposited in the osteoid,
    increases the strength of the corn. At first this corn is still
    loose, in size it is larger than the diameter of the ribs, then
    reduced to normal size.

Diagnosis of the disease

  • Inspection and collection history. With пальпации в области травмы, можно
    feel the crepitus of the bone fragments and detect the deformation in the form
    steps
  • The symptom of an interrupted breath – the patient interrupts a deep breath.
    because of the pain.
  • Symptom axial loads – when squeezing the chest in
    different planes, the pain will be in the place of the fracture, and not in
    ground pressure.
  • Symptom Payra – pain in the area of ​​the fracture when bending in
    healthy side.
  • Radiography – the most common and accurate method
    diagnostics.

First aid to the victim

Generally it is not necessary to engage in any self-treatment, it is not necessary
apply ointments, herbs, compresses, all this can only worsen
the situation. If a person is in serious condition, he has an open
fracture, shortness of breath, weakness, then you should call an ambulance. Can
help him to take a half-sitting position, if it will be easier for him.
With подозрении на закрытый перелом ребра можно принять
painkiller, apply ice, put a tight bandage on the chest
cage and contact the emergency room.

Treatment

  • The main treatments for uncomplicated rib fractures
    is anesthesia and immobilization.
  • В стационаре пациенту проводят спиртопрокаиновую
    blockade.
  • In the projection of the fracture, procain is introduced and 1 ml of 70% ethyl
    alcohol.
  • The chest is fixed by a circular bandage elastic
    bandage.
  • With признаках дыхательной недостаточности проводятся
    oxygen inhalation.
  • With пневмотораксе и обширном гемотораксе проводят пункцию
    pleural cavity, thus withdrawing air or blood.
  • With малом объеме крови при гемотораксе пункция не требуется,
    resorption occurs without intervention.
  • The duration of treatment for rib fracture varies from 3 to 4 weeks per
    average.

Clinical case

Patient M. entered the emergency room with complaints of weakness,
pain in the right side of the chest and difficulty breathing. Of
history: In a state of intoxication fell on the asphalt,
hitting his chest against a large rock.

  • With осмотре: В области 5-8 ребер справа по подмышечной линии на
    skin bruise, slight swelling of soft tissue. Pallor of skin
    covers. With пальпации болезненность и крепитация в области 6-7
    the ribs. Dyspnea up to 20 respiratory movements per minute, breathing
    superficial, pulse – 88 beats per minute. With обследовании выявлен
    right-sided hemothorax and fracture of the 6th and 7th rib on the right.
  • Treatment: купирование болевого синдрома, иммобилизация грудной
    cells, infusion therapy, oxygen inhalation, puncture
    pleural cavity with discharge of 80 ml of blood.

Автор: Ревус Олеся Григорьевна врач-невролог

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