Crack in the rib: signs, what to do, how to treat?

Our ribs are a kind of bone frame that holds all the organs inside it, thanks to them the lungs are filled with air when inhaling.

It happens that their integrity is violated - a crack forms, which in medical terminology is defined as an incomplete fracture without displacement. This condition causes certain discomfort, pain and requires treatment.

Epidemiology

Rib fracture is the most common chest injury and is believed to be present in 10% of all traumatic injuries and in almost 40% of patients with severe non-penetrating trauma. [1], [2]

Causes of the cracks in the rib

Like a fracture of any bone, the rib can be damaged due to mechanical stress on the chest area. This is caused by a blow during a transport accident, squeezing it, falling onto a solid protruding object, a fight, and injury. Another reason lies in the pathological processes occurring inside the body, reducing their strength. Among them, tumors inside the thoracic region, chronic osteomyelitis, tuberculosis, rib osteoporosis.

Risk factors

Factors that aggravate the possibility of violating the integrity of the ribs include age (in young people, chest elasticity is much higher), shock force, low muscle mass.

Pathogenesis

In the chest there are 12 pairs of ribs. Their cartilaginous part adjoins the sternum. On the lateral surfaces of the axillary region, the ribs are most convex, it is in this place that fractures most often occur and are prone to it mainly from the fifth to the eighth, 9-12 ribs are mobile, therefore injuries occur less frequently with them.

Symptoms of the cracks in the rib

How does a crack in the rib hurt? Its first signs are soreness at the lesion site, aggravated by inhalation and weakening on exhalation. Other symptoms include:

• feeling of lack of air;
• anxiety;
• dyspnea;
• headache;
• dizziness;
• drowsiness;
• fast fatiguability;
• bruises at the site of injury;
• swelling of tissues.

Complications and consequences

The crack itself without fracture and bone displacement does not carry dangerous consequences or complications, because it does not hurt the nerves, lung, or vessels between the ribs. Usually, after a few weeks it grows together, and the pain goes away even earlier, after 5 days.

Elderly patients who have experienced blunt trauma to the chest and ribs have twice the mortality rate compared to younger patients with similar injuries. With every additional rib fracture in the elderly, mortality increases by 19%, and the risk of pneumonia - by 27%. [3]

Diagnostics of the cracks in the rib

Is it possible to identify a crack of an rib without an x-ray? Yes, but for this you should consult a traumatologist. He will ask a number of leading questions about how the injury occurred, and by examining and some techniques he will make a diagnosis.

To do this, the traumatologist presses on the chest and, according to the reaction of the injured, establishes the location of the crack. He also monitors his breathing to find out if there are any obstacles to the passage of air, he listens to the heart. When tilted to the non-injured side, the other will hurt. It is important to establish whether there are additional injuries - the spine, neck.

An x-ray of the thoracic region is made to confirm the diagnosis, although it does not always show a crack in the rib. [4] A more reliable method of instrumental diagnostics is computed tomography.

Differential diagnosis

The task of a traumatologist is to differentiate a crack with a fracture, bruise, damage to internal organs.

Treatment of the cracks in the rib

Cracked ribs without complications do not require inpatient treatment, especially surgical intervention. It can be carried out at home, subject to restrictions on movement. In addition, you need:

• In the first few days, regularly place an ice pack on the affected ribs to reduce swelling.
• Have a rest.
• Breathe normally and cough when you need to - this helps remove mucus from the lungs to prevent chest infections
• Walk and sometimes move your shoulders to clear your lungs of mucus
• Take 10 slow deep breaths every hour to clear your lungs
• In the first few nights, try to sleep more.
• Take painkillers.

Medication

Ibuprofen, a non-steroidal anti-inflammatory drug, is recommended as a painkiller. The maximum period for taking the drug is 5 days. Children are prescribed it, starting with 20 kg of body weight (from about 6 years old). Avoid taking ibuprofen within 48 hours after the injury, as this may slow healing. [5]

The daily dose is calculated as follows: 20-30 mg per kilogram of weight. At 30 kg or more, 1 tablet is recommended once, it can be repeated no earlier than 6 hours. Adults take 1-2 pieces every 4-6 hours.

Contraindicated in case of increased individual sensitivity to the drug, in the third semester of pregnancy, peptic ulcer, severe renal, cardiac, and liver failure.

Of the adverse reactions, allergies, increased blood pressure, nausea, diarrhea, shortness of breath, bronchospasm, and a decrease in hemoglobin levels are possible.

For severe pain, they resort to injections of novocaine, a drug for local anesthesia. Its use requires caution for patients with cardiovascular disease, the elderly, pregnant and lactating women. It does not apply to children at all.

The dose to adults on average ranges from 50-70 ml of a 0.5% solution of novocaine. Side effects inherent in it are in the form of weakness, dizziness, drowsiness, arrhythmia, bradycardia, skin rash, itching. From local reactions, pain and swelling at the injection site is possible.

If a hematoma develops externally, you can use heparin ointment, but only for adults. It will not only accelerate the disappearance of the bruise, but also have an analgesic and anti-inflammatory effect. It should be applied in a thin layer to a bruised area several times a day.

Fastum gel will help relieve pain. Not applicable for open wounds, in the 3rd trimester of pregnancy, allergies to its components. It is applied to the skin 1-3 times a day and is easily rubbed into its surface.

Vitamins

To strengthen the bones, accelerate their healing, calcium, magnesium, zinc, phosphorus are needed. Vitamin D helps them digest it.  [6]  The body also needs ascorbic acid, vitamins B6, B12, K2 during fractures. It is necessary to ensure that these elements are present in food, as well as take multivitamin complexes. It should be remembered that coffee, alcohol leaches calcium from bones. [7]However, in postmenopausal women, moderate alcohol consumption is positively correlated with bone mineral density, as well as serum estradiol levels. [8]

Physiotherapeutic treatment

Usually, in the first 2 weeks of bone damage, physiotherapeutic treatment is aimed at relieving pain, resorption of hematomas, elimination of edema, for which ultraviolet irradiation, electrophoresis, interference currents are used - procedures that require presence in a medical institution. [9] With a cracked rib, rest and staying at home are prescribed, so their appointment with such an injury is not relevant.

Alternative treatment

Among the people, a very popular recipe for accelerating bone splicing is egg shell powder. Clinical and experimental studies have shown that egg shell powder has a positive effect on bones and cartilage and is suitable for the prevention and treatment of osteoporosis. [10] It is taken once a day in a spoon, previously mixed with lemon juice.

Jellied meat from beef bones is also boiled for a long time, digesting the liquid and not adding salt. A gelled broth promotes collagen production in the body.

A compress from a mixture of raw yolk and 0.5 teaspoon of salt can be applied to the injured area. For lotions, decoctions of herbs are also used: the roots of stomach and comfrey, and inside take chamomile, valerian, St. John's wort.

Homeopathy

Homeopathic medicines such as arnica, symphitum (from comfrey), eupatorium, calcium phosphoricum (calcium phosphate diluted in 3D and 6D) accelerate bone healing. Doses and method of application are determined by the homeopath individually. Further high-quality studies are needed to confirm the results of the effectiveness of homeopathic remedies. [11]

Prevention

A healthy lifestyle will help prevent fractures, including playing sports at least 3-4 times a week for half an hour, proper nutrition, which provides all the trace elements necessary for bones, smoking cessation (bone density is reduced in smokers), and alcohol consumption in reasonable amounts (contributes to the development of osteoporosis).

To prevent bone damage, maintaining a healthy weight is also important. Risk factors are not only superfluous, but also excessive thinness.

Forecast

Cracks in the ribs heal together safely, and hematomas resolve.