Cracked rib: signs, what to do, how to treat?

Our ribs are a kind of framework of bones that hold all the organs located in the chest, thanks to them the lungs are filled with air when we inhale.

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

Epidemiology

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

Causes rib cracks

Like any bone fracture, a rib can be damaged due to mechanical impact on the chest area. This can be caused by a blow during a transport accident that compresses it, a fall on a hard protruding object, a fight, or an injury. Another reason is the pathological processes occurring inside the body that reduce their strength. Among them are tumors inside the thoracic region, chronic osteomyelitis, tuberculosis, and osteoporosis of the ribs.

Risk factors

Factors that increase the risk of rib integrity damage include age (young people have much higher elasticity of the chest), the force of the impact, and low muscle mass.

Pathogenesis

There are 12 pairs of ribs in the chest. Their cartilaginous part adjoins the sternum. On the lateral surfaces of the axillary region, the ribs are most convex, this is where fractures most often occur and are mainly subject to them from the fifth to the eighth, the 9-12 ribs are mobile, so injuries occur with them less often.

Symptoms rib cracks

How does a cracked rib hurt? Its first signs are pain at the site of the lesion, which increases when inhaling and weakens when exhaling. Other symptoms include:

• feeling of shortness of breath;
• anxiety;
• dyspnea;
• headache;
• dizziness;
• drowsiness;
• rapid fatigue;
• bruises at the site of injury;
• tissue swelling.

Complications and consequences

The crack itself, without a fracture or displacement of the bone, does not pose any dangerous consequences or complications, since it does not affect the nerves, lungs or vessels between the ribs. Usually, it heals in a few weeks, and the pain goes away even earlier, in about 5 days.

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

Diagnostics rib cracks

Is it possible to determine a rib fracture without an X-ray? Yes, but you should see a traumatologist. He will ask a number of leading questions about how the injury occurred and will make a diagnosis through examination and some techniques.

To do this, the traumatologist presses on the chest and, based on the injured person's reaction, determines the location of the crack. He also monitors breathing to find out if there are any obstacles to the passage of air, listens to the heart. When leaning to the uninjured side, the other side will hurt. It is important to determine if there are any additional injuries - spine, neck.

To confirm the diagnosis, an X-ray of the chest is taken, 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 the traumatologist is to differentiate a crack from a fracture, bruise, and damage to internal organs.

Treatment rib cracks

A rib fracture without complications does not require hospital treatment, much less surgery. It can be done at home, subject to movement restrictions. In addition, you need to:

• Apply an ice pack to the affected ribs regularly for the first few days to reduce swelling.
• Take a rest.
• Breathe normally and cough when you need to - this helps clear mucus from your lungs to prevent chest infections
• Walk and move your shoulders occasionally to clear mucus from your lungs.
• Take 10 slow, deep breaths every hour to clear your lungs.
• Try to get more sleep during the first few nights.
• Take painkillers.

Medicines

Ibuprofen, a non-steroidal anti-inflammatory drug, is recommended as a pain reliever. The maximum period of taking the drug is 5 days. It is prescribed to children starting from 20 kg of body weight (approximately from 6 years). Avoid taking ibuprofen for 48 hours after the injury, as it can slow down healing. [ 5 ]

The daily dose is calculated as follows: 20-30 mg per kilogram of weight. For 30 kg and more, 1 tablet is recommended once, repeating 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 trimester of pregnancy, peptic ulcer, severe renal, cardiac, hepatic insufficiency.

Side effects may include allergies, increased blood pressure, nausea, diarrhea, shortness of breath, bronchospasm, and decreased hemoglobin levels.

In case of severe pain, injections of novocaine are used - a drug for local anesthesia. Its use requires caution for patients with cardiovascular insufficiency, the elderly, pregnant and lactating women. It is not used for children at all.

The average dose for adults ranges from 50-70 ml of 0.5% novocaine solution. It has side effects such as weakness, dizziness, drowsiness, arrhythmia, bradycardia, skin rash, and itching. Local reactions may include pain and swelling at the injection site.

If a hematoma has formed from a blow, heparin ointment can be used externally, but only for adults. It will not only speed up the disappearance of the bruise, but will also have an analgesic and anti-inflammatory effect. It should be applied in a thin layer to the bruised area several times a day.

Fastum gel will help relieve pain. Do not use on open wounds, in the 3rd trimester of pregnancy, or if you have an allergy to its components. Apply to the skin 1-3 times a day and rub gently into the surface.

Vitamins

Calcium, magnesium, zinc, and phosphorus are needed to strengthen bones and speed up their healing. Vitamin D helps them to be absorbed. [ 6 ] The body also needs ascorbic acid, vitamins B6, B12, and K2 in case of fractures. It is necessary to ensure that these elements are present in food products, and also to take multivitamin complexes. It should be remembered that coffee and alcohol wash calcium out of bones. [ 7 ] However, in postmenopausal women, moderate alcohol consumption positively correlates with bone mineral density, as well as with serum estradiol levels. [ 8 ]

Physiotherapy treatment

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

Folk remedies

A very popular folk recipe for accelerating bone fusion is eggshell powder. Clinical and experimental studies have shown that eggshell powder has a positive effect on bones and cartilage and that it is suitable for the prevention and treatment of osteoporosis. [ 10 ] It is taken once a day, one spoonful, pre-mixed with lemon juice.

They also cook jellied meat from beef bones, boiling the liquid for a long time and not adding salt. The jellied broth promotes the production of collagen in the body.

A compress made from a mixture of raw yolk and 0.5 teaspoon of salt can be applied to the injured area. Herbal infusions are also used for lotions: larkspur and comfrey roots, and chamomile, valerian, and St. John's wort can be taken internally.

Homeopathy

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

Prevention

A healthy lifestyle, including exercising at least 3-4 times a week for half an hour, proper nutrition that provides all the necessary microelements for bones, quitting smoking (smokers have reduced bone density), and drinking alcohol in reasonable amounts (contributes to the development of osteoporosis) will help prevent fractures.

Maintaining a healthy weight is also important for preventing bone damage, as not only excess weight but also excessive thinness are risk factors.

Forecast

Rib fractures heal successfully and hematomas resolve.