Of all the injuries of the chest is most often found broken ribs.The frequency of this injury is 10-15% of all fractures.An important aspect is that the internal organs can be damaged in such a fracture.Sometimes it can lead to death, so this issue is much more important than it might seem.
broken ribs - a violation of the integrity of the cartilage and bone of the rib or more edges.If one or two damaged edges, then usually it does not require hospitalization or immobilization.If the damage is more ribs, frequently observed complications and damage of the chest.In this case, in hospital treatment under medical supervision.
Anatomy of the chest and ribs
Thorax represented 12 thoracic vertebrae, which are connected by means of joints 12 pairs of ribs.In front is the sternum, to adjoin the cartilaginous portion of the ribs.
ribs are divided into true (1-7 pair), false (8-10 pair) and fluctuating (11-12 pair).True ribs connect to the sternum own cartilaginous plates.False ribs have no direct connection to the breastbone, part of the cartilage fused with cartilage overlying ribs.A cartilaginous part of oscillating fins has no joints or anything.
ribs are part of the bone and cartilage.The anatomical structure of the ribs isolated head, neck, body and bump.On the inner surface of the ribs has a groove in which lies the neurovascular bundle.At the turn of the ribs it is often damaged, which leads to bleeding and malnutrition intercostal muscles.
The cause rib fractures, usually becomes the fall on a hard object protruding rib cage, hit in the chest or compression.Also, there are pathological fractures, they are formed by the flow of other diseases such as tumor, osteoporosis, osteomyelitis.
Classification rib fractures.
|In the presence of damaged skin:|| |
|According to the degree of damage:|| |
|by the number of fractures:|| |
|-stock displacement of bone fragments:|| |
injury most common fracture site is the largest bending zone, that is, along the axillary line on the sides of the chest.The most common fractures of the ribs 5-8.Rarer are damaged ribs 9-12.This is due to the fact that these edges have greater mobility, especially in the distal portions.
fractures in the back of the costal arch have greased the clinical picture.This is due to lower mobility of bone fragments in the area during breathing.Fractures in the side and front of the costal arch, and transferred the most difficult symptoms when they are expressed very clearly.3 Consider the most common type of fracture depending on the mechanism of injury.
fracture restricted area arc
rib injury occurs when a small heavy object angular shape.Damage occurs in the same place and had a traumatic impact.The turning point comes in.First, it damaged the inside of the ribs, and then - outside.
Full rib fracture
most often occurs in the fall of his chest.This forms ribs otlomok it moves during breathing movements.Often there is damage to the pleura, lung and intercostal vessels and nerves.
Indentation rib fragment
When exposed to high force on the chest portion of a larger area cells observed indentation rib fragments inside the chest.It is often injured pleura, vessels, nerves, lung.Such fractures are called graduate.If damaged several edges, with this mechanism of injury formed a large movable portion in the chest wall, and he called the rib valve.
consider what are the symptoms of broken ribs.
- Pain - it arises in the field of fracture increases with movement, inhale and exhale, cough.The reduction of pain may in peace and in a sitting position.
- Shallow breathing and backlog in the breath of the part of the chest, where there is injury.
- tissue edema in the area of damage.
- Hematoma at the site of the fracture - acute traumatic fracture, yavivshemsya result of direct mechanical action
- Sound rubbing bones crunching or during travmirovaniya- true for fractures with a large number of fragments, or for multiple fractures of the ribs without shifting partsdamaged bone
when multiple and complicated fractures may include the following symptoms:
- Subcutaneous emphysema - if damaged lung air can gradually get under your skin.
- Hemoptysis - blood from the respiratory tract is released when coughing.This symptom indicates damage to the lung tissue.
- pneumothorax - air into the pleural cavity.In the absence of timely treatment can go into tension pneumothorax, after which it may be cardiac arrest.
- Hemothorax - blood from entering the pleural cavity.As is the case with pneumothorax happens compression of the lung, the patient experiences difficulty in breathing, shortness of breath.With the progression of the state of developing a complication following.
- Respiratory failure. appears very frequent shallow breathing, paleness and cyanosis of the skin, increased heart rate.When breathing is evident retraction portions of the chest and its asymmetry.
- Plevropulmonalny shock - occurs when the pneumothorax and a large wound area, when the pleural cavity gets large amounts of air, especially fast shock occurs when the air is cold.It shows symptoms of respiratory failure, painful cough and cold extremities.
- Pneumonia. At low motor activity, inability to perform normal breathing movements and damage to lung tissue, often pneumonia.
rib fracture healing stages
- 1 stage - connective corn.At the site of injury accumulates the blood, which migrate from the bloodstream to the cells that produce connective tissue (fibroblasts).
- 2 stage - osteoid callus.There is deposition of inorganic substances, mineral salts in connective tissue and callus formed osteoid.
- 3 stage - to lay osteoid hydroxyapatite increases the strength of corn.At first, the corn is still loose, the size is larger than the diameter of the ribs, and then decreases to its normal size.
- Examination and history taking .On palpation of the injury, you can feel the crepitus of bone fragments and to detect strain in the form of a step.
- Symptom interrupted inhalation - patient interrupt a deep breath because of the pain.Symptom
- axial loads - while squeezing the chest in different planes, soreness will fracture site, and not in the pressure field.
- symptom Payra - pain in the fracture when bending in a healthy way.
- Radiography - the most common and accurate method of diagnosis.
general should not engage in any self-treatment, do not apply ointments, herbs, compresses it all can only worsen the situation.If a person is in serious condition, he has an open fracture, shortness of breath, weakness, you should call an ambulance.You can help make it semi-sitting position, as if it would be easier.If you suspect a closed fracture of the rib can take pain medication, make ice, apply a pressure bandage on the chest and contact the emergency room.
- main methods of treatment of uncomplicated rib fractures is pain relief and immobilization.
- The hospital patients were spirtoprokainovuyu blockade.The projection
- fracture administered procaine and 1 ml of 70% ethanol.
- Thorax fixed circular bandage elastic bandage.
- If there are signs of respiratory failure are held oxygen inhalation.
- When pneumothorax and hemothorax conducted extensive puncture of the pleural cavity, thus averting the air or blood.
- For a small amount of blood at the puncture is not required hemothorax, resorption takes place without interference.
- terms of treatment of fracture of ribs varies from 3 to 4 weeks on average.
M. patient entered the emergency room with complaints of weakness, pain in the right side of the chest and difficulty breathing.From history: The intoxicated fell to the pavement, hitting the chest of a big rock.
- On examination: In the 5-8 ribs on the right axillary line on the skin bruising, slight swelling of soft tissues.Pale skin.On palpation tenderness and crepitus in the 6-7 edge.Shortness of breath up to 20 breaths per minute, breathing is shallow, heart rate - 88 beats per minute.The examination revealed a right-sided hemothorax and fracture of the ribs 6 and 7 on the right.
- Treatment: relief of pain, immobilization of the chest, infusion therapy, oxygen inhalation, the puncture of the pleural cavity with the abduction of 80 ml of blood.