Rib fracture: causes, symptoms, diagnosis, treatment

ICD-10 code

S22 Fracture of ribs (rib), sternum and thoracic spine.

Epidemiology of fracture of ribs

The fracture of the ribs constitutes from 5 to 15% of all damage to the bones of the skeleton.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

What causes a fracture of the ribs?

Fracture of the ribs can occur both with the direct mechanism of injury, and with the indirect. An example of the latter can serve as compression of the chest in the anteroposterior direction, leading to fracture of the ribs in the lateral sections. Significant displacements of fragments, as a rule, do not occur, as the ribs are well connected to each other by a soft tissue case.

Anatomy of the ribs

The rib is referred to the category of long spongy bones. It consists of the bone part and cartilaginous, located in front and connecting with the breastbone. Cartilages VIII-IX-X ribs do not reach the sternum, but attach to the cartilage of the overlying rib. XI-XII ribs do not reach the sternum and end in soft tissues. Behind the ribs are articulated with vertebrae. Thus, the vertebra, the two ribs and the sternum form a bone ring. Ribs are connected by external and internal intercostal muscles, and in the place of absence - with membranes of the same name, subcutaneous and transverse muscles of the breast. Skin, fatty subcutaneous tissue, superficial muscles, fascia and pleura complete the structure of the chest wall.

[10], [11]

Symptoms of fracture of ribs

Characteristic complaints of severe pain in the place of injury, difficulty breathing - "impossible to breathe." Cough causes extreme pain. Victims move, take off and put on clothes slowly, with fear of pain intensification. For the same reason, breathing becomes shallow. If the broken rib is damaged lung, identify hemoptysis, subcutaneous emphysema in the fracture.

After trauma, the patient can immediately point out typical symptoms of fracture of the ribs: a sharp pain in the chest, which has a tendency to increase with breathing, movement, talking, coughing, decreases at rest in a sitting position. Breathing is superficial, the chest on the side of the fracture lags behind when breathing.

Symptoms of fracture of the ribs in front and sides are difficult to tolerate by patients, accompanied by a violation of breathing. Symptoms of fracture of the ribs behind are less pronounced, pulmonary ventilation disorders, as a rule, are absent.

When several ribs are broken, the patient's condition worsens. Breath is superficial. The pulse is rapid. Skin pale, often bluish. The patient tries to sit still, avoiding the slightest movements. Symptoms of fracture of the ribs are characterized by swelling of the soft tissues, bruising. When palpation is determined diffuse sharp soreness, bone crepitation. If the fracture of the ribs is accompanied by subcutaneous emphysema, palpation of the subcutaneous tissue reveals crepitation of the air, which, unlike bone crepitus, resembles soft creaking.

The appearance of pneumothorax is indicated by worsening of the general condition of the patient, increasing dyspnea. Respiration on the affected side is not audible. Damage to the lung can be accompanied by hemoptysis.

Pneumothorax and hemothorax are complications that tend to develop soon after the symptoms of rib fractures. A few days after the fracture, another dangerous complication may develop: posttraumatic pneumonia. To the development of this complication, elderly and senile patients are more likely to have a pneumonia that is particularly difficult.

The development of pneumonia is indicated by worsening of the general condition of the patient, symptoms of intoxication, difficulty breathing and fever. It should be borne in mind that in weakened elderly patients and patients with severe combined trauma, posttraumatic pneumonia is not always accompanied by an increase in temperature. In a number of cases, only a deterioration in the general condition is noted.

The emergence of posttraumatic pneumonia is due to a decrease in the level of ventilation of the lungs on the side where there is a fracture of the ribs. Breathing with a broken rib is painful, so the patient tries to breathe as superficially as possible.

Complications of fracture of ribs

Bribing simplicity of diagnosis, satisfactory condition of the patient, favorable outcomes of treatment should not tune the doctor to a complacent mood and simplification. For the fracture of only one rib can be accompanied by severe complications: pneumothorax, rupture of the intercostal artery with internal bleeding (for which it is often necessary to perform thoracotomy), injury and a bruise of the lung and / or heart.

At fracture of the lower ribs, damage to the organs of the abdominal cavity (spleen, liver) and retroperitoneal space (kidney) is possible. Therefore, auscultation and percussion of the chest, the determination of pulse and blood pressure, the study of blood and urine should be the minimum that will avoid gross diagnostic errors.

It should be noted that if a single fracture of the ribs can create a threat to the life of the patient, then multiple fractures increase it many times. Especially dangerous are multiple segmental, so-called final, or flotation fractures. They are always accompanied by acute respiratory failure and pleuropulmonary shock.

[12], [13], [14], [15], [16]

How to recognize a broken rib?

Anamnesis

Previous trauma of the chest.

Examination and physical examination

Possible lag of the chest in the act of breathing on the side of damage. Sometimes in the fracture region, a painful swelling is found.

When you try to take a deep breath, pain occurs (in some cases, pain is preceded by a click), resulting in a short chest trip - a positive symptom of an "interrupted inhalation". This sign does not reveal with bruises of the chest.

Another important clinical sign is the symptom of the axial load. It is checked by alternating squeezing of the thorax in the sagittal and frontal planes. The thorax is an osseous ring, the compression of some of its parts strengthens the load on others, so if the ring is damaged, the pain does not appear in the area of compression, but in the area of the bone defect (the symptom is regarded as positive).

With palpation, a sharp local tenderness is revealed, crepitation is possible. Strain in the form of a step at the point of maximum soreness also indicates a fracture of the rib.

To avoid possible complications, palpation of not only the thorax, but also of the abdominal cavity, auscultation, is determined by heart rate and blood pressure.

Good help in diagnosis - radiography. Unfortunately, due to a number of reasons (the shadow of dense internal organs, tangential stratifications, the mismatch of the fracture line and the ray stroke), it is not always possible to recognize fracture of the rib in standard pads. Additional studies are associated with technical difficulties, material costs and do not justify themselves. Therefore, a clinical picture plays a leading role in the diagnosis of fracture of the ribs. If the diagnosis is not in doubt, in some cases, you can do without x-ray.

To eliminate complications, a general blood and urine test is prescribed.

Treatment of fractured ribs

Indications for hospitalization

Rib fractures are treated conservatively. In the conditions of a polyclinic or at home (under the supervision of a family doctor) one can treat patients who have a fracture of one, a maximum of two ribs, without complications and with a satisfactory condition of the patient. In other cases, the victim is hospitalized.

First aid for fracture of ribs

The first medical aid for fracture of the ribs begins with the introduction of painkillers: 1 ml of a 2% solution of promedol. During the transportation of the patient, the chest is tightly bandaged. As a therapeutic immobilization, this method should not be used (especially in the elderly) because of the threat of developing pneumonia.

[17], [18], [19]

Medicamentous treatment of fracture of ribs

Alcohol-procaine blockade is shown. 10 ml of 1-2% solution of procaine are injected into the fracture site, after which 1 ml of 70% alcohol is added without removing the needle. With the right blockade, the pain almost disappears, deep breathing becomes possible, as well as coughing.

Assign methamizole sodium tablets, expectorant medicine, mustard plasters on the chest, respiratory gymnastics, UHF from the 3rd day after the injury. If pain persists, blockade can be repeated after 2-3 days.

Subsequently, electrophoresis of procaine and calcium chloride is applied to the fracture region, therapeutic gymnastics.

Estimated period of incapacity for work

Frenzy fracture occurs after 3-4 weeks. The ability to work is restored in 4-5 weeks. If you turn several edges to work, you can start after 6-8 weeks.

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