The article examines fractures of the ribs, their classification, as well as what needs to be done in the first place if there is a suspicion of such an injury.
What it is?
Rib fracture (ICD-10 code - S22) is one of the most common injuries in the chest area . It may arise as a result of direct or indirect force exposure.
A 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 overlapping of their fragments on each other.
In rare situations, an axis shift occurs. Very severe consequences are caused by comminuted or, as it is also called, “fenestrated” fracture of the ribs (code according to ICD-10 - S22). In this case, there is a violation of the anatomical and functional unity of the skeleton of the chest, which leads to disruption of the normal breathing process. In this area, paradoxical movements of the ribs occur. This leads to a decrease in the respiratory amplitude and a decrease in the normal capacity of the lungs, quantitatively increasing the volume of residual air.
The most common fracture
The most common fracture occurs in the fourth to eighth rib area. The first, axillary and posterior parts of the second and third are damaged in rarer cases due to the anatomical structure. In elderly people who have a history of chronic cough, fracture of the lower rib often occurs spontaneously. A broken 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, collarbone and humerus.
So, how does a fracture of the ribs manifest (ICD-10 code - S22)? Let's figure it out.
Clinical signs
Fractures of the ribs are characterized by severe chest pain, which in a calm state is dull aching in nature, and when inhaled, it becomes sharp, cutting. The pain can also increase with coughing. The movement of the chest in the affected area is limited. In the area of injury, there is usually a swelling, accompanied by severe pain on palpation. If a rib fracture is accompanied by a lung injury, then there is hemoptysis and signs of subcutaneous emphysema at the site of injury. But a closed fracture of the ribs (ICD-10 code - S22) is not characterized by this.
Roentgenography
If there is a suspicion of a fracture of the ribs, it is imperative to conduct a chest x-ray. If possible, fluoroscopy should also be done. The image will allow you to determine the fracture, confirm or exclude the fact of displacement. But minor hemothorax or pneumothorax in some situations can be easier to see in the process of transillumination, since the middle and upper ribs are completely visible, and the lungs are filled with air. Organ injuries are usually clearly defined in chest scans. In some cases, the pulmonary pattern projecting onto the costal bones can be mistaken for damage lines or hinder their identification, therefore, often a computed tomography is prescribed for a fracture. For this reason, multiple rib fractures (ICD-10 code - S22) are considered the most dangerous.
In order for the pulmonary pattern not to prevent 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 the motor activity of the chest.
If the picture is taken in direct projection, then the lateral parts of the costal bones may appear shorter, which is due to their angular structure. In addition, in order to eliminate the error in the diagnosis, it is necessary to take into account the possibility of projection crossing when conducting a study. It is necessary to deploy the patient so as to improve visibility in the area of the rib angle. Specialists take pictures of the lower ribs (they are projected just below the diaphragm) using the Bucca hood. Such an injury can cause damage to the kidney and spleen.
Comminuted fractures
As already mentioned, in case of suspected rib fracture (code according to ICD-10 - S22), it is necessary to take radiographic images. In the case of the comminuted type of injury, this is a vital measure, since it is not otherwise possible to notice rib fractures. As a rule, with such injuries, lateral pieces of bones break out with displacement. Sharp fragments protrude freely. It is also possible to superimpose several ribs on top of each other, which deliberately 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 a reliable assessment of the clinical picture is possible only in dynamics. This can be achieved by conducting x-ray studies with the necessary frequency.
How is a rib fracture treated (ICD-10 code - S22)? This will be discussed later.
Treatment
The patient is prescribed 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 blockade in the area of damage. In addition, often there is a need for the appointment of expectorants, performing respiratory gymnastics. In the presence of multiple fractures, a paravertebral blockade is prescribed with a 0.5% procaine solution or a vagosympathetic blockade according to A.V. Vishnevsky. In addition, with complex injuries of the ribs, it is possible to use the method of skeletal traction over the sternum.