In the article, we will consider how to determine a fracture of the ribs. This pathology is a violation of the integrity of several ribs or one of them due to traumatic effects. The condition is accompanied by intense chest pain, which leads to a significant restriction 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. Multiple fracture of the ribs can be combined with various injuries of organs located in the chest, and pose a significant danger to life. The diagnosis of rib fracture is made on the basis of data obtained after radiography. If necessary, an ultrasound diagnosis of the pleural cavity is carried out, as well as its puncture. Symptoms and treatment of rib fracture are interconnected.
This is the most common damage to the chest area. Such injuries account for approximately 16% of the total number of fractures. In older patients, they are more common, and this is due to an age-related decrease in the elasticity of bone structures.
Uncomplicated fractures of the ribs of the rib cage are quickly fused and pose no threat to life. The main danger with such an injury is associated with a violation of the respiratory process, organ damage and the development of combined complications. Simple fractures are observed only in 40% of cases. The remaining injuries of this nature are accompanied by damage to the pleura, lungs and structures of the cardiovascular system. Multiple rib fractures represent a serious injury and are very dangerous in that they can contribute to the occurrence of 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 find out how to determine the fracture of the ribs, we first understand the reasons. The main causes most often become 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 greatest bend - along the lateral surface of the chest. During a fracture of one rib, the displacement of fragments occurs very rarely. As for multiple fractures, they are more often combined with the displacement of fragments. In this case, fragments can damage the sharp ends of the lungs, pleura and intercostal vessels.
The most common causes of rib fractures are road traffic accidents, domestic situations and industrial accidents.
Symptomatology
Sharp pain during fracture of the rib is noted in the chest, aggravated by movements, coughing, breathing, talking and decreases at rest, in a sitting position. While breathing is superficial, the chest on the affected side lags behind when breathing. When feeling a broken rib, a site of severe soreness is determined, in some cases - bone crepitus (a characteristic crunch of bone fragments).
Lateral and front fractures of the ribs (in ICD-10 they are assigned the code S22) are difficult for patients to carry, accompanied by respiratory disorders. In case of damage to the posterior sections, impaired 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 bluish. The patient tries to sit still, avoids the slightest movements.
In the fracture zone of the 9th rib, for example, bruising, severe swelling of the soft tissues are observed. On palpation, you can notice spilled sharp pain, bone crepitus. If the fracture is accompanied by a problem such as subcutaneous emphysema, then in the case of palpation of the subcutaneous tissue, crepitation of the air is determined, which resembles soft creaking.
Possible complications
How to determine the fracture of the ribs, it is important to know in advance. The development of pneumothorax is indicated by a deterioration in the general condition of the patient, increasing shortness of breath. Breathing on the affected side of the chest is not audible. In addition, with lung damage, 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 arise - post-traumatic pneumonia. Elderly people are more prone to its occurrence, in whom pneumonia proceeds, as a rule, very seriously.
The development of pneumonia may indicate a deterioration in 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 combined injuries, post-traumatic pneumonia is not accompanied by hyperthermia each time. In some situations, only a general deterioration is noted.
The development of post-traumatic pneumonia is due to inhibition of lung ventilation. 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 fusion of the ribs you need to limit their mobility, bandage the chest. As a result of this, breathing is even more limited, congestion develops in the lungs, and congestive pneumonia occurs. In fact, with such injuries in most cases, fixation is not required. An exception is some multiple and complex rib fractures, in which help 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 to stop their consequences, you need to seek medical help as soon as possible.
How to determine a fracture of the ribs?
Diagnosis of the disease and existing complications is carried out by a traumatologist mainly on the basis of x-ray studies. If you suspect hemo- and pneumothorax, an ultrasound of the pleural cavity, lung fluoroscopy, and pleural puncture are additionally performed.
Thus, the only methodology for determining fracture of the ribs (according to ICD-10 code above) is high-quality radiography today.
Treatment
Uncomplicated damage to the ribs is treated on an outpatient basis, i.e. at home. An injury of more than three ribs is considered an indication for emergency hospitalization in the Department of Orthopedics and Traumatology. In case of an uncomplicated rib fracture at the time the patient enters the hospital, the traumatologist performs local anesthesia or vagosympathetic blockade. After this, the patient is prescribed analgesics, some expectorant drugs, physiotherapy and therapeutic exercises to improve lung ventilation.
Sometimes hemothorax and pneumothorax develop not at the stage of patient admission to the hospital, but somewhat later. If there are suspicions of the development of these complications, additional fluoroscopy is performed during therapy. During the treatment of complex rib fractures, additional therapeutic measures are carried out simultaneously with standard medical procedures (taking analgesics, fracture anesthesia, therapeutic exercises and physiotherapy). A small amount of blood in the pleural cavities dissolves on its own. If the patient has severe hemothorax, the doctors perform a puncture of the pleural cavity. Under local anesthesia, a specialist inserts a special needle into the pleural cavity and removes blood accumulated in this area. Sometimes hemothorax occurs repeatedly, therefore, during therapy, a puncture has to be performed several times.
With pneumothorax, in certain cases, a puncture is sufficient to remove air from the pleural cavities. Stressed 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 introduced into this section. Its other end is lowered into a jar of liquid. It is imperative that the can is below the patient’s chest level. Air accumulating in the pleural cavity is discharged through the tube, and the lung begins to expand. Pleural drainage, as a rule, is maintained for several days until all the air comes out. Then a control fluoroscopy is done and the drainage is removed.
In the treatment of post-traumatic pneumonia along with general therapeutic measures (physiotherapy, antibiotics) it is very important to conduct therapeutic exercises to restore proper ventilation of the lungs. It is extremely rare to fix fractures, and this is done, as a rule, with multiple injuries of the sternum, which are accompanied by unstable rib fractures.
Home Therapy
The algorithm for treating rib fracture at home depends entirely on the severity of the injury. However, it should be borne in mind that at home those patients are diagnosed with a fracture of one or a maximum of two ribs, otherwise the treatment takes place in a hospital. To speed up recovery at home, you need to take medications, especially anti-inflammatory and painkillers. If the patient has to breathe superficially due to severe pain, then an infectious process develops in the sternum. You can eliminate the pain syndrome with the help of “Ibuprofen”, “Ketorol”, “Naproxen” drugs.
Medications should be taken regularly, and not only during the onset of pain. Gradually, with a decrease in the severity of pain, the dosage of the drugs decreases until they are completely canceled. In addition to taking medications, breathing exercises should be performed, which consists of 10 slow breaths every hour. It is useful to periodically apply cold compresses, which reduce the swelling of the chest and help absorb hematomas. For the same purpose, absorbable cooling ointments with anti-inflammatory effects can be used. During 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 fracture of the ribs at home is quite possible. During wakefulness, it is recommended to perform simple gymnastic exercises that will help maintain the tone of the body. It is not recommended to constantly be in bed. This can provoke the development of stagnation, the development of pneumonia and other serious complications.
How to determine - rib fracture or bruise?
Rib bruising is a fairly common phenomenon, and it is especially relevant in the 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 can increase, and during diagnosis, not only a bruise is detected, but also a crack in the rib.
To determine the nature of the injury, in particular a fracture or contusion of the rib, you need to see a doctor and take a chest x-ray. Symptoms of these injuries are also very different. With a fracture of the rib, the pain is more intense than with a bruise. In no case, if you suspect a similar injury, you can not stay at home and ignore the symptoms. The same applies to self-medication. In case of a bruised or fractured rib, you must 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 x-ray rib fracture can be seen? Let's 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 fracture of the rib is:
- subperiosteal when rib bone is damaged;
- full, in which the bone is damaged throughout its thickness;
- a crack, when only bone tissue damage is observed, and there is no fracture.
At the place of localization:
- unilateral rib fractures - a violation of the integrity on one side of the sternum;
- bilateral - damaged ribs on both sides of the chest.
There is also a fissured fracture of the 6th rib, for example, which is characterized by damage to the bone simultaneously in two places, as a result of which there is a mobile fragment.
By the number of faults:
- single, when one rib is damaged;
- multiple - several edges are damaged.
How to sleep?
There are twelve rib pairs in the human chest, and their fractures account for, according to statistics, about 15% of other bone injuries. Such trauma occurs during road crashes, domestic accidents and fights.
How to sleep with a fractured rib and lead a normal lifestyle? In patients in a similar condition, there is a significant limitation of mobility, increased soreness 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 fracture of the rib gives a lot of unpleasant sensations. Patients develop traumatic insomnia, a person cannot sleep for a long time, often wakes up trying to roll over on his side.
Medical advice is to choose the most suitable posture for sleeping. With such an injury, it is best to sleep on your back, but many patients feel better when they fall asleep on their sides. In such poses, it becomes easier for a person to breathe.
A good solution to this problem is to sleep on a reclining chair. If a person sleeps on the bed, then for convenience you can use pillows. They should be placed in such a way as not to wake up at night from pain during involuntary movements of the body. You can put a pillow under your knees, which 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 most favorable. In case of multiple rib injuries, especially complicated ones, the prognosis depends on the adequacy and timeliness of the start of therapeutic measures. The approximate incapacity for simple injuries is 1 month. The duration of treatment for complex and multiple fractures is determined by their severity and general condition of the patient.
The primary prevention of these injuries is to carry out activities to reduce injuries. A reduction in the risk of complications is observed with immediate medical attention and the early start of medical procedures.
When driving in a car, it is recommended to use seat belts and follow the rules of the road.