In traumatology, rib fractures occur in 16% of cases. are not harmless, because nearby are the lungs and heart, as well as large vessels. The most dangerous is a comminuted gap, when bone structures tear apart soft tissues and cause damage to the arteries and large vessels. In this case, there is a violation of pulmonary activity, often there are internal bleeding. The condition of the victim instantly becomes critical. Delaying medical attention can result in death.

Injuries vary in severity and extent of damaged structures. Paired bones are often injured, and with them - internal organs, cartilage, blood vessels. Classification will more accurately characterize rib fractures. There are rib fractures with and without displacement, open and closed rib fractures. If the injury occurred a long time ago, and its consequences were not eliminated, they speak of a chronic, or rather, chronic injury.

Types of rib fractures according to the degree of traumatization include:

• full- involves one or more fault lines bone tissue;
• - implies partial destruction of bone tissue;
• crack- the least dangerous of all types of injuries, occurs in the most rigid part of the costal arch.

According to the localization of damage, injuries of the ribs on the right and left are distinguished ( left-hand side, according to statistics, is damaged less often), as well as double and multiple fractures of the ribs. A fenestrated fracture of the ribs is understood as a paired destruction of bone structures, due to which a mobile fragment is formed. The injury is also known as a floating (cusp) fracture of the ribs. Such a pathology is considered extremely dangerous and threatens with complications.

If we are talking about re-rupture structures, they speak of a consolidated fracture of the rib. When the injury is received by squeezing the chest cavity, a compression fracture is formed.

Closed rib fractures account for the majority of injuries. Fracture of the first rib is rare. Often there are fractures of the 6th and 7th ribs. In case of injury lower section sternum dangerous consequences minimal. If rib structures 4 and 5 are broken, there is a high probability of damage to the lung tissue, when 10 and 11 are damaged, you need to look at the nature of the injury. Ribs 9 to 12 are mobile, and their fracture can cause complications in the presence of fragments. With the destruction of 10-12 rib structures, more often minor violations, but a fracture with a displacement of the 8th rib is fraught with dangerous complications.

ICD 10 injury code

Injuries of the sternum are coded according to ICD 10 - S22. This category includes rib injuries and thoracic spine.

Causes

Multiple rib fractures occur when strong blows on a large hard surface. Road traffic injuries are considered the most severe due to aggravating factors. Other causes of rib fractures include falls from a height, diseases skeletal system, gunshot wounds. With Bechterew's disease, ossification of the vertebral ligaments occurs and the risk of injury increases.

The most dangerous are front bilateral injuries, which are typical when interacting with a fast-moving object - when falling from a height or when colliding with a car. In the event of a side impact, damage to the costal arches is possible, up to their crushing.

Sometimes the smallest impact is enough to cause injury. Due to the weakness of the bone tissue, it is not necessary great strength for injury - the bones break almost by themselves. Provocateurs are such diseases as osteomyelitis, tumor and tuberculosis of the ribs, multiple myeloma, osteoporosis.

Symptoms

As a rule, minor injuries do not imply damage internal organs. In this case, signs of a rib fracture include:

• periodic pain when coughing or inhaling, and in case of pair damage - constant;
• forced posture - the patient seeks to take a position in which the pain is not so pronounced, and breathing is relatively free;
• inability to breathe deeply;
• swelling and bruising in the affected area;
• crepitus on movement and breathing;
• disturbances in the work of the heart due to pendulum movements of the organ (flotation).

The symptoms of a rib fracture are aggravated in the case of a complicated injury. You can understand that the sternum is injured by palpation of the bruised area. The main sign of bone tissue destruction in case of displacement of bone fragments in chest cavity- blood from respiratory tract. If the aorta is damaged, rapid blood loss develops. The victim dies before reaching the hospital.

Immediate death occurs with damage to the heart, and in case of liver injury, death occurs after 2 hours in the absence of assistance. Sometimes the pain gives back, and with the onset of the inflammatory process, the body temperature rises.

Treatment for a rib fracture relies on both external symptoms, so on hidden manifestations. That is why it is important to know the exact symptoms of a rib fracture. If the side hurts after a bruise, this does not mean that the bone is broken. For a classic fracture of the ribs, deformation of the sternum is characteristic. Such a symptom is a sign of trauma to several ribs that form the sternum.

First aid

The provision of first aid by an amateur in case of a fracture of the ribs is unacceptable. The risk of complications, even death, is too high. First aid is to immobilize the victim and deliver him to the emergency room. In the case of a closed injury, a non-narcotic anesthetic may be given.

The presence of pathological mobility of individual segments requires stabilization of the overall skeleton of the chest. This is achieved by applying a tight bandage, however, only a doctor should provide assistance for fractured ribs. Even the wrong dressing can cause serious complications injury.

What to do with a broken rib

If one or two bones are injured, the victim can be taken to the hospital on their own. Transportation in case of fracture of the ribs is carried out in sitting position. It is necessary to tighten the chest, but breathing remains deep enough. Other transport immobilization is necessary in case of rib fracture with complications. The victim is transported in a semi-recumbent or lying position. For superficial wounds, an aseptic dressing is required.

lighten pain syndrome will be able to novocaine blockade. Anesthetize with a 1% solution of novocaine, which is injected into the intercostal nerves. In the case of a penetrating wound with a rib fracture, first aid involves the application of an occlusive dressing. The victim must lie correctly - on healthy side or remain seated if possible.

What should be done in case of fracture of the ribs, the traumatologist will explain. He will pick optimal position in which the victim with fractures of the ribs should be transported, and will carry out the following therapeutic manipulations: puncture in case of high pressure in the pleural cavity, oxygen therapy in case of impaired airway patency.

Only an experienced doctor will be able to take adequate measures and drain the victim if he has broken the sternum and damaged the pleura. When fluid accumulates between the pleural sheets, the likelihood increases respiratory failure until complete cessation of breathing.

How to identify a broken rib

Diagnosis of a fractured rib is to conduct x-rays. Behind the apparent may be a crack or a break. It will not be difficult to see a fracture of the rib of any localization on the x-ray. Examination of the bones provides comprehensive information, but says nothing about the condition of the soft tissues.

If information x-ray insufficient and more detailed diagnosis is required, CT is prescribed. This method allows not only to recognize the destruction of the bone, but also associated injuries.

How to find out which organs suffered from bone fragments? In this case, an MRI is indispensable. To determine the state of the heart, electrocardiography is prescribed.

How to treat a broken rib

Anesthesia for fractured ribs is used in most cases. Can't give narcotic analgesics without a doctor's prescription, but you can use analgin painkillers in the form of tablets and injections, as well as inject anesthetics. If the side in the area of ​​the broken bone is very sore, alcohol-procaine blockade is done in a hospital.

Treatment of a rib fracture involves immobilization. For the period of therapy, the patient tries to move less, wears a circular bandage or an immobilizing belt for the ribs. The duration of treatment is 21-28 days.

A little more difficult is the treatment of fractures of several ribs. When the injury is without mixing, it is possible to get by with a closed reduction, if the ribs have shifted, it may be necessary surgery. The doctor will choose the best one for fracture of the ribs and the method of reposition. In the future, with a fracture of the ribs, bandaging is carried out, anti-inflammatory drugs are offered, and a bandage is worn. A corset may be required to fix the sternum and spine in case of rib fractures. This method of immobilization is appropriate for fractures of the cartilaginous part of the rib.

Before the damage can be cured, the patient is given sick leave for 21-48 days, depending on the severity of the injury. During the recovery period, steam is useful, especially when visiting the bath and sauna, but these procedures are available only after returning to normal physical activity.

Surgical treatment

Surgical treatment is necessary for multiple rib fractures with displacement and injury to internal organs - this will reduce the risk of fatal complications. A gunshot fracture of the ribs and concomitant damage to the lung is a direct indication for surgery.

Used as anesthesia general anesthesia. Facilitate access to the ends of the ribs and resect damaged tissues. In injuries with damage to the lung, pleural shock occurs, in which case vagosympathetic blockade is necessary.

Displaced rib fractures are successfully treated surgically. With extensive incisions practice standard methods stitching, but more often the skin is not sutured.

How long does it take for ribs to fuse after a fracture?

Uncomplicated rib fractures heal in 21 days. During this period, it is important not to overload and sleep properly. In case of damage to the front of the ribs, rest on the back. When one side is injured, they sleep on the healthy side.

How long the injury heals depends on the age of the victim, the nature of the damage, and concomitant diseases. Complicated fracture grows together for about 8 weeks. The timing may be extended if there is a consolidated fracture that takes longer to heal. In order for the bones to grow together faster and the recovery time to be shorter, UHF and magnetotherapy are performed. With persistent pain syndrome, electrophoresis with novocaine is indicated.

Even a doctor cannot say exactly how much the breast bones are fused. Allows you to control the process beam methods research. Rib healing is facilitated by interference currents - the number of procedures ranges from 7-12.

How many ribs heal after a fracture in a person, statistics will tell. With an isolated injury, about 3 weeks are required. Complicated injuries at a young age heal in 5-6 weeks, in the elderly - in 8.

Regardless of the complexity of the injury, recovery takes place in three stages:

1. there is a formation connective tissue- the future basis for callus;
2. connective tissue hardens due to changes in the mineral composition;
3. completed the formation of bone marrow. At first, it exceeds the costal bone in volume, but over time it takes on an anatomically correct shape.

Rehabilitation

To speed up recovery, physiotherapy is carried out. Folk remedies and home remedies are not the mainstay of treatment, but help speed up rehabilitation. Has useful properties. It is used for grinding. Folk medicines include homemade ointments based on spruce resin. It stimulates reparation and improves the condition of the musculoskeletal system.

As for useful physiotherapy, for the formation of callus are shown:

• UHF- relieves pain and swelling, accelerates the restoration of bone structures and cartilage tissues, improves nutrition of the affected area;
• UV irradiation- stimulates blood circulation, enhances reparation and tissue metabolism, increases the absorption of vitamin D;
• amplipulse therapy- improves regeneration, stimulates the fusion of bone tissue, normalizes blood microcirculation;
• alternating currents- increase muscle tone, activate blood circulation. May be harmful in muscle hypertonicity.

At the same time, foods rich in calcium and dishes with gelatin are introduced into the diet. Good to eat pig ears and jelly, fermented milk products and fresh fruits. .

TO therapeutic gymnastics proceed only after the approval of the doctor. Loads increase gradually. It is recommended to do exercises to activate general blood circulation, strengthen muscles and increase the flexibility of the spine. Due to the immobilization of the ribs, the spine suffers from a lack of mobility. One of the safest and effective methods recovery is considered swimming.

Complications and consequences

The consequences of a rib fracture include the accumulation of air in chest. A decrease in the functions of the pleura and lung can be the result of comminuted damage. An injury increases the risk of death. Pneumothorax (accumulation of air) with a fracture of the ribs is a serious complication. To prevent death, the doctors of the clinic perform a puncture of the pleural cavity.

Other complications of rib fractures include:

• pneumonia- occurs due to respiratory failure due to a fracture of the ribs. In the case of squeezing the internal organs with a tight bandage (especially the lungs), congestion develops. The lung on the side of the fracture becomes inflamed;
• hemothorax- implies the accumulation of blood due to rupture of blood vessels. In some cases, hemothorax provokes respiratory arrest due to compression of the lung. Then there is a decline in the alveoli and their exclusion from respiratory activity;
• respiratory failure- develops after a fracture of the ribs due to concomitant injuries;
• pleuropulmonary shock- rare and dangerous complication due to severe injuries. The development of pleuropulmonary shock is facilitated by damage to soft and hard structures, through wounds.

Hemothorax and pneumothorax do not appear immediately. If the patient receives timely assistance, then complications can be prevented. In the event that a hemothorax develops, which involves the accumulation of blood in the pleural cavity, a puncture is necessary. If many complications are intractable, then along with pneumonia, other inflammatory processes successfully treated with medication.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you survived a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

Article author:| orthopedic doctor Education: Diploma in the specialty "Medicine" received in 2001 in medical academy them. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty "Traumatology and Orthopedics" in the City clinical hospital No. 29 im. N.E. Bauman.

Among all injuries of the chest, fracture of the ribs is the most common. The frequency of this injury is 10-15% of all fractures. An important aspect is that with such a fracture, internal organs can be damaged. Sometimes this can lead to death, so this issue is much more important than it might seem.

Rib fracture is a violation of the integrity of the cartilaginous or bone part of the rib or several ribs. If 1 or 2 ribs are damaged, then, as a rule, this does not require hospitalization and immobilization. If more ribs are damaged, complications and damage to the chest organs are often observed. In this case, treatment in a hospital under the supervision of a doctor is necessary.

Anatomy of the chest and ribs

The chest is represented by 12 thoracic vertebrae, with which 12 pairs of ribs are connected with the help of joints. The sternum is located in front, the cartilaginous parts of the ribs adjoin it.

The ribs are divided into true (1-7 pairs), false (8-10 pairs) and oscillating (11-12 pairs). The true ribs are connected to the sternum by their own cartilaginous plates. False ribs do not have a direct connection with the sternum, their cartilaginous parts fuse with cartilage above the lying ribs. And the cartilaginous part of the oscillating ribs has no articulation with anything at all.

Ribs have bone part and cartilage. IN anatomical structure the ribs secrete the head, neck, body, and tubercle. On the inner surface of the ribs there is a groove in which the neurovascular bundle lies. When a rib is fractured, it is often damaged, leading to bleeding and malnutrition of the intercostal muscles.

Etiology of the disease

The cause of a rib fracture is usually a fall on a protruding solid object with the chest, a blow to the chest or its compression. Pathological fractures also occur, they are formed as a result of the course of other diseases, for example, a tumor process, osteoporosis,.

Classification of rib fractures.

According to the presence of damage to the skin:	Closed fracture - no skin damage Open fracture - with skin damage
By degree of damage:	Complete fracture - the entire thickness of the rib is damaged. The most common type of fracture Subperiosteal fracture - damage to bone tissue Crack
By localization:	Fenestrated fracture - damage to the ribs in two or more places on one side of the chest Bilateral fracture - damage to the ribs on the right and left sides. Often complicated by impaired ventilation
Number of fractures:	Single - fracture of one rib Multiple fractures - fracture of several ribs
By the presence of displacement of bone fragments:	Displaced rib fracture. No offset.

Mechanism of injury

The most common fracture site is the zone of greatest bend, that is, along the axillary line on the lateral surfaces of the chest. The most common fractures are 5-8 ribs. Least of all there are injuries of 9-12 ribs. This is due to the fact that these ribs have greater mobility, especially in the distal parts.

Fractures in the back of the costal arch have a lubricated clinical picture. This is due to the lower mobility of bone fragments in this area during breathing. Fractures in the lateral and anterior part of the costal arch are most difficult to tolerate and the symptoms are very pronounced. Consider the 3 most common types of fracture, depending on the mechanism of injury.

Fracture of a limited section of the arch of the rib Occurs when an injury occurs with a small, heavy object of an angular shape. Damage occurs in the same place where there was a traumatic effect. The fracture is inward. Damaged first inner part ribs, then - external.

Complete rib fracture Most often occurs when falling on the chest. In this case, a fragment of the rib is formed, it moves during respiratory movements. Often there is damage to the pleura, lung and intercostal vessels and nerves.

Indentation of a broken rib When exposed high strength on the area of ​​the chest of a larger area, there is an indentation of a fragment of the rib into the chest. In this case, the pleura, blood vessels, nerves, and lungs are often injured. Such fractures are called fenestrated. If several ribs are damaged at once, then with this mechanism of injury, a large mobile area is formed in the chest wall and it is called the costal valve.

Clinical picture

Consider what are the symptoms of a broken rib.

• Pain - it occurs in the fracture area, increases with movement, inhalation and exhalation, coughing. Decrease pain possible at rest and in a sitting position.
• shallow breathing and lag in breathing of that half of the chest where there is an injury.
• Swelling of tissues in the area of ​​damage.
• Hematoma at the fracture site- relevant for traumatic fracture resulting from direct mechanical impact
• The sound of rubbing bones or crunching during injury - relevant for fractures with big amount fragments, or for multiple fractures of one rib without displacement separate parts damaged bone

With multiple and complicated fractures, the following symptoms may be:

• Subcutaneous emphysema- in case of damage lung air may gradually penetrate the skin.
• Hemoptysis - coughing up blood from the respiratory tract. This symptom indicates damage to lung tissue.

Complications

• Pneumothorax is the entry of air into the pleural cavity. With absence timely treatment may turn into a tension pneumothorax, after which it may occur.
• Hemothorax is the entry of blood into the pleural cavity. As in the case of pneumothorax, compression of the lung occurs, the patient experiences difficulty in breathing, shortness of breath. With the progression of the condition, the following complication develops.
• Respiratory failure. There is a very frequent shallow breathing, pallor and cyanosis of the skin, increased heart rate. When breathing, the retraction of sections of the chest and its asymmetry are visible.
• Pleuropulmonary shock- occurs with pneumothorax and a large wound area, when it enters the pleural cavity a large number of air, shock occurs especially quickly if the air is cold. Presents with symptoms of respiratory failure painful cough and cold extremities.
• Pneumonia. At low motor activity, the inability to make normal respiratory movements and damage to the lung tissue, inflammation of the lung often occurs.

Rib fracture healing stages

• Stage 1 - connective tissue callus. Blood accumulates at the site of damage, where cells that produce connective tissue (fibroblasts) migrate with the blood flow.
• Stage 2 - osteoid callus. There is a deposition of inorganic substances, mineral salts in the connective tissue callus and osteoid is formed.
• Stage 3 - hydroxyapatites are deposited in the osteoid, the strength of the callus increases. At first, this callus still remains loose, it is larger in size than the diameter of the rib, then it decreases to normal sizes.

Diagnosis of the disease

• Examination and history taking. On palpation in the area of ​​injury, crepitus of bone fragments can be felt and a deformity in the form of a step can be detected.
• Broken breath symptom The patient interrupts a deep breath due to pain.
• Symptom of axial loads- when squeezing the chest in different planes, the pain will be at the fracture site, and not at the pressure points.
• Payr's symptom - pain in the area of ​​the fracture when tilted to the healthy side.
• Radiography is the most common and accurate diagnostic method.

First aid to the victim

In general, you should not engage in any self-treatment, you should not use ointments, herbs, compresses, all this can only worsen the situation. If a person is in serious condition, he has an open fracture, shortness of breath, weakness, then you should call ambulance. You can help him take a semi-sitting position, if it makes it easier for him. If you suspect closed fracture ribs, you can take painkillers, apply ice, apply a tight bandage on the chest and go to the emergency room.

Treatment

• The main methods of treatment for uncomplicated rib fractures are anesthesia and immobilization.
• In the hospital, the patient is given an alcohol-procaine blockade.
• In the projection of the fracture, procaine and 1 ml of 70% ethyl alcohol are injected.
• The chest is fixed with a circular bandage with an elastic bandage.
• With signs of respiratory failure, oxygen inhalations are carried out.
• With pneumothorax and extensive hemothorax, a puncture of the pleural cavity is performed, thus removing air or blood.
• With a small volume of blood with hemothorax, puncture is not required, resorption occurs without intervention.
• Treatment times for rib fractures vary from 3 to 4 weeks on average.

Clinical case

Patient M. was admitted to the emergency room with complaints of weakness, pain in right side chest and difficulty breathing. From the anamnesis: able alcohol intoxication fell to the asphalt, hitting his chest on a large stone.

• On examination: In the area of ​​5-8 ribs on the right along the axillary line, there is a bruise on the skin, a slight swelling of the soft tissues. Paleness of the skin. On palpation, pain and crepitus in the area of ​​6-7 ribs. Shortness of breath up to 20 respiratory movements per minute, shallow breathing, pulse - 88 beats per minute. The examination revealed a right-sided hemothorax and a fracture of the 6th and 7th ribs on the right.
• Treatment: pain relief, chest immobilization, infusion therapy, oxygen inhalation, puncture of the pleural cavity with the removal of 80 ml of blood.

Traumatic chest injuries often end in ribs. The problem is due to the specific anatomy of these bones. The arcuate and rather fragile connection with the spine and sternum makes them vulnerable. Of the 12 pairs of ribs, only the 1st to 7th pairs are fused with bone structures. The 8th, 9th and 10th pairs are attached to the sternum with cartilaginous tissue, and the 11th and 12th pairs are not fused with it at all. Especially increased trauma in people in the elderly and old age, when cartilage tissues more and more "ossify" (ossify) and become brittle. Among the general structure of fractures, costal fractures occur in 10-15 percent.

The danger of this type of injury lies in the proximity of important internal organs - the heart, lungs, blood vessels. In some cases, the person who has received a fracture does not even suspect that he has this injury. In other cases, developing severe conditions(injuries to organs), which, if left untreated, can result in complications.

What causes a broken rib

The main reasons can be attributed to 2 groups: traumatic and pathological.

note

Traumatic ones occur as a result of the action of a direct damaging factor, and pathological ones occur against the background of the development of certain diseases.

Traumatic injuries are caused by:

Pathological rib fractures occur when:

• Some connective tissue diseases, in particular -.
• Metastatic lesions of costal bone structures with primary foci oncological process but different bodies. Penetration into bone structures cancer cells occurs through the lymphogenous pathway, and through the bloodstream.
• Tumors localized directly in the bone tissue.
• Processes that cause osteoporosis - violations of the anatomical and morphological properties of osteoid cells, leading to their increased fragility and fragility. The mechanism of this ailment is based on calcium metabolism disorders, hormonal problems, and heredity. Separately, senile can be distinguished.
• Anomalies in the structure of the sternum - complete absence, or deformation on the background congenital diseases, the consequences of certain types surgical intervention.
• Hereditary pathologies leading to excessive bone fragility. The consequence of these ailments is increased fragility bones, including ribs.

Features of rib fractures in children

IN childhood bone tissue is more elastic and consists mainly of cartilaginous elements. This gives her elasticity. . That's why, Bone fractures are much less common in children than in adults. More often they take the form - "green branch" - breaks.

If a rib fracture is determined in young patients, this means that it has undergone a sufficiently strong mechanical impact.

Mechanism and classification

When diagnosing, the doctor immediately determines a number of provisions in order to subsequently apply the correct treatment tactics.

For this, a fracture is classified:

In addition, rib fractures can be multiple(several different ribs, or a fracture of one rib in two or more places - fenestrated) and single. The presence or absence of displacement is determined.

With a fracture, the rib always "falls" into the chest.

This can only happen at the site of impact:

• "failure at both ends" of the fracture site;
• “indentation” of a rib fragment, in case of violation of the bone cover in two or more places;
• combined, or multiple fragmentary fracture with "falling through".

Complaints, manifestations and symptoms of rib fracture

The picture of this type of damage can be varied, depending on the location and severity of the patient's condition. Let us note the most frequent clinical markers of this type of traumatic and pathological process.

Rib fracture is accompanied by:

• Pain sensations. The focus of pain is at the site of injury, of a permanent nature, with intensification when trying to move quickly, with deep breathing (“a symptom of a broken breath”), with coughing shocks. On examination, the specialist draws attention to the "lag" in the volume of respiratory movements (excursions) on the affected side.
• Swelling of soft tissues. The fracture zone, and often around it swells, turns red. A hematoma may develop under the skin. When the victim moves, you can determine the bone crunch (crepitus).
• Deforming changes in the chest.
• subcutaneous emphysema. This sign can be attributed to complications of the closed type. It manifests itself when the pleura sheets are damaged, which causes air to enter under the skin.
• Hemoptysis. This complaint is typical for damage to lung tissue and blood vessels.

At heavy sports Fracture can cause the following complications:

Fracture healing goes through a series of successive stages. At the beginning of the process, connective tissue strands (with blood cells, fibroblasts) grow from the site of the bone fracture, gradually completely covering the bone defect. Further, the emerging callus is added with bone elements. The deposition of inorganic substances, salts in them, forms ossificate (ossifying callus). This formation is supplemented with osteoid elements and acquires the density and structure of normal bone.

note

The volume of the callus exceeds the size of an ordinary rib, but over time it returns to normal limits.

Rib fracture diagnosis

When examining a patient (injured), one should conduct an examination, palpation of the chest along the ribs. This will determine the symptoms pain zone("interrupted breath"), crepitus, characteristic deformity of the chest. The doctor checks for a specific Payr's syndrome (pain at the site of injury against the background of torso tilt in the opposite direction). Axial pressure on different areas chest gives severe pain in the injured area.

Inspection and palpation are supplemented by:

• . Most Informative diagnostic method, allowing you to determine all the details of the fracture.
• CT scan. This survey allows to clarify doubtful and complicated variants of traumatic injury.
• Diagnosis by these methods is recommended if it is impossible (or contraindicated) to X-ray methods.
• Ultrasound diagnostics will allow to control the healing process.
• Other methods( , angiography).

How to provide first aid

In any condition, if there is a suspicion of a possible fracture of the ribs, you should see a doctor (traumatologist, surgeon).

If the condition worsens - pain increases, the area of ​​​​edema increases, difficulty in breathing develops, then you should resort to calling an ambulance and transporting the patient to the hospital. To do this, the victim is seated with support on a soft pillow, blanket, clothes, they give him an anesthetic drug at hand. If necessary, a compressive bandage is applied and cold is applied to the fracture site.

If there is an open wound on the damaged area, then to prevent the development of external (valvular) pneumothorax, the skin around the wound should be treated disinfectant. It is then covered with clean paper, plastic wrap, or any clean airtight material that needs to be sealed to prevent air from entering the chest cavity. This will avoid a very life-threatening complication - lung collapse.

Rib fracture treatment

With uncomplicated options, it is enough to observe the rest mode, to create the most gentle conditions for self-restoration of bone integrity. Complete healing occurs after 3, 4 weeks after the injury. In elderly and debilitated patients, the recovery process can take up to 4, 5 weeks.

In the hospital, victims are provided with:

To speed up healing and reduce pain, the victim (patient) needs to sleep in a semi-lying or semi-sitting position, depending on how it is easier for him, on the volume and location of the injury.

Pathological fractures imply the need to treat the underlying disease.

Rehabilitation and preventive measures

You should not expose your body to physical activity before the expiration of 1-2 months post-traumatic period. Recovery should begin with low-intensity exercises, gradually increasing their strength and amplitude.

Physical exercises should be combined with breathing exercises.

The prognosis of this type of injury is positive.

Lotin Alexander, doctor, medical commentator

Such a condition of the body as a fracture of the ribs is an injury to the chest. Such a phenomenon is dangerous for the body. As a result of the lack of integrity of the chest, there is a possibility of damage to internal organs.

IN medical practice often there is a fracture of the ribs 5, 6, 7 of the structural element of the chest. Due to this prevalence pathological condition it seems appropriate to study the essence of this phenomenon.

The concept of rib fracture

A fracture is commonly understood as the loss of the bones of the ribs and cartilage of their original integrity. This condition occurs in people old age, as well as in patients with a history of previously noted diseases in chronic stage leaks. This pattern is associated with the influence of the time factor. So, after a long period of time, the bones that form the skeleton of the chest are subject to wear and become with a lower level of elasticity.

In the event that damage occurs without further complication, then there is only damage to the integrity of a few ribs. This condition is not life threatening. This is due to the ability of the bones to fuse with each other.

increased attention requires a situation in which a broken rib affects an internal organ with its subsequent damage. In this case, the usual course of the respiratory process is difficult. As a result of exposure, the functioning of the lungs, heart vessels, and pleural cavity is disrupted. The formation of multiple lesions can cause death or irreversible consequences for the state of health.

Condition symptoms

In the event that there is a fracture of the 5-7th rib or other structural elements of the chest, specific symptoms appear. Depending on the injury received, it is customary to distinguish the following classification of symptoms:

In the absence of violation of the integrity of internal organs:

• Pain sensations of a muffled nature, which can increase only during the manifestation of a cough;
• The desire of the patient to take postures that were previously not characteristic of him;
• Absence of the usual respiratory process due to existing pain;
• Hyperemia of the skin at the site of a hypothetical lesion with the formation of edematous phenomena on the skin in the radius of the lesion;
• The presence of a crunch in the chest area as a result of contact and friction of damaged bones;

In case of damage to internal organs:

• Pronounced pale skin;
• The presence of a rapid heartbeat;
• The occurrence of skin emphysema;
• Violation of the respiratory process;
• The appearance of coughing attacks, which are accompanied by sputum discharge with bloody clots;
• Possible development pneumothorax, pneumonia, hemothorax, pleuropulmonary shock and respiratory failure;
• Fatal outcome(as a result of significant blood loss against the background of aortic damage; with damage to the heart; in case of liver damage).

Causes of the condition

The generally accepted causes that provoke a fracture of 7, 8, 9 ribs, as well as 5, 6 elements, are:
Mechanical damage:

• As a result of an accident;
• Due to a fall from a height;
• gunshot wounds;
• Injuries as a result of playing sports;
• Diagnosis of beatings;

Particularly severe diseases:

• Manifestations rheumatoid arthritis and osteoporotic symptoms;
• Detection of primary neoplasms and osteomyelitis;
• Presence malignant neoplasms;
• The presence of diseases of a genetic nature.

Damage classification

Injury to the chest manifests itself in the form of a fracture of the 7th, 8th, 9th ribs, as well as 5th and 6th links. There is the following classification of damage:

Depending on skin lesions:

• Open view (the structure of the skin and tissues is broken);
• Closed view (no skin lesions, noted deep defeat soft tissues)
• Depending on the bone damage:
• Complete (completely broken bone integrity);
• Subperiosteal (only bone tissue is damaged);
• With a cracked rib (there is no fracture at all, there is only a violation of tissue integrity);
• Rib bruise;

Depending on the break:

• Single (for example, there may be a fracture of the 7th rib or only a fracture of the 8th rib);
• Multiple (for example, a fracture of the 5th and 7th ribs or a fracture of the 7th and 9th ribs appears);

Depending on the violation:

• On the one hand (for example, a fracture of the 7th rib on the left and a fracture of the 8th rib on the left are diagnosed);
• On both sides (for example, there is a fracture of the 8th rib on the right and a fracture of the 9th rib on the left).

Provision of medical care

In the event that there is a fracture of 7-9 ribs or other structural elements, first aid is expected.

The patient is given pain medication. In most cases, it applies medicinal product Ibuprofen.

A fixing bandage is applied to the existing fracture of the ribs. If there is damage to 6 ribs, then it is necessary to apply a towel with its subsequent fixation.

A prerequisite for the successful provision emergency care is to provide the affected area with cold exposure in the form of a compress with ice.

It is important to remember that the conditions for safe transportation of the patient are observed. If necessary, circular and occlusive dressings can be used, transport tire. The recommended position for moving the victim is the semi-sitting position.

Damage Diagnosis

In order to protect the life of the patient from potential danger, an immediate diagnostic studies. Receipt qualified assistance possibly as a result of a visit to an orthopedic specialist.

The diagnostic set of measures to determine potential damage includes the following steps in its structure:

Visual examination, collection of complaints, study of anamnesis:

• The damaged area is palpated to determine the presence of bone fragments;
• The patient may need to take a deep breath;
• In the presence of a fracture, this will be almost impossible to carry out as a result of unbearable pain;

Implementation of Payr's method:

• The patient should lean to the side that is opposite to the injured area;
• Against the background of the lack of integrity of the bones, such an action will be difficult to perform.

As additional methods, the following diagnostic options can be used:

• Ultrasound examination of the state of the chest;
• X-ray.

Complex of therapeutic measures

Upon completion diagnostic measures the victim will need to undergo treatment. This stage is often passed by the patient within the medical institution.

Compulsory hospitalization is expected in case of:

• Turning events in the region of the base of the spine;
• The presence of numerous injuries;
• Detection of fractures of the endings with the simultaneous presence of insufficiency of the respiratory process;
• Rib fracture diagnosis pathological manifestations.

To stabilize the patient's condition, rest is created. During the first days should form callus. For this, the patient is prohibited from any movement, he must observe only bed rest.

After a 2-3-day interval, he begins to gradually sit on the surface of the bed, make attempts to get up and walk around within the hospital ward. Depending on the location of the damage, the side on which it is allowed to spend time at rest is determined. The indication for switching to a normal regimen is the completion of a 2-3-week period.

An important step in the treatment is the use of painkillers. medications. Their main goal is to stabilize the respiratory process, which guarantees the preventive aspect of pneumonia and the prevention of respiratory failure.

To maintain a state of rest until the moment full recovery bandage is applied. It is an effective tool in the detection of multiple and fenestrated fractures. Due to this method, the leveling of pain syndromes is ensured, and the risk of displacement of bone fragments is also reduced.

Upon detection characteristic symptoms should immediately seek medical attention. Otherwise, death is possible.

Rib fractures in traumatology are very common. Treatment cannot be done on your own - it is important to properly apply a bandage, organize a diet and take medication.

What are rib fractures?

A fracture occurs at the time of a bruise, blow, fall or other physical impact on the region of the rib or several ribs. The injury of 4-6 ribs is most often diagnosed, since there is no strong muscular corset in this anatomical zone. Up to half of the cases of fractures are accompanied by damage to adjacent organs - the heart, esophagus, lungs, etc. Rib injuries in children a rare thing due to the elasticity of the bone.

The mechanism of rib injury can be as follows:

If the skin is not damaged during a fracture, it is considered closed, if the integrity of the soft tissues is violated, it is open. Most often, injuries occur in road accidents, when falling from a bicycle, from a height, in a fight, and in sports injuries.

Fracture symptoms

The intensity of the symptoms will greatly depend on the number of broken bones, the location of the injury, and the presence of complications. If the injury did not lead to damage to the lungs or other internal organs, then the symptoms are usually mild. Pain appears - it is localized right in the area of ​​​​a fracture or crack, dull, aggravated by movement, coughing, sneezing, deep inspiration. The pain is usually worse if the bones in the front of the chest are damaged.

The cause of the pain is compression of the nerve roots in the area of ​​the broken rib.

A person with the described injury tends to be in a more comfortable position then the pain is felt less. The tilt towards the protrusion of the rib allows you to reduce the compression of the soft tissues, thereby reducing the pain. Other possible symptoms:

Pain can occur even when talking or any movement, but a rib injury from the back can be completely painless.

Complicated fracture signs

At home, it is difficult to determine how severe the injury is - for this it is important to conduct instrumental methods examinations. The relevance of diagnosis is great, because many cases of fracture are complicated and give unpleasant consequences. Some complications are deadly if the severity of damage to internal organs is great.

Lung injury is the most common complication of a rib fracture.

Even minor damage to the lung in the coming days can cause an infectious disease - pneumonia. Stagnation in the lung tissue occurs even without direct damage organ - due to wearing a tight bandage and limitation of respiratory activity against the background of pain. If the lung is damaged, may develop:

Any complication described can lead to death without adequate care. Also, the patient is able to die from injury to other organs and hemorrhages with damage to the aorta, heart, liver. Symptoms of complications - pallor and cyanosis of the skin, increased heart rate, shortness of breath, wheezing in the lungs.

First aid rules

First aid should be given to the victim at the site of injury. If the symptoms and signs of a rib fracture are obvious, it is important to take all measures to reduce pain and fix the body. The latter is necessary to exclude damage to internal organs. To relieve pain, you can give a person a pill:

If possible, a fixing bandage should be made - using a handkerchief, elastic or regular bandage, gently wrap the chest area. Before applying a bandage, ice should be applied to the injury site, especially if a hematoma has appeared. Health care with such an injury is necessary, therefore, as you provide first aid, you should go to the emergency room or admission department hospitals. The person should be transported sitting or lying down.

At the slightest suspicion of a complicated fracture of the rib, it is necessary to lay the victim down, exclude any movements, call an ambulance. He is taken to the hospital on a stretcher. shock states require resuscitation. open wounds must be treated with Chlorhexidine, Miramistin or other antiseptic.

Fundamentals of treatment

Pathology can be treated at home or in a hospital - depending on the severity. To begin with, they do x-rays, CT, conduct a survey and examination of the patient. You may also need to study the internal organs - ultrasound of the heart, arteries, CT of the lungs, MRI of the liver.

With a slight fracture, a tight bandage of an elastic bandage is applied and released home.

If the pain syndrome is not relieved with the help of tablets, a local novocaine blockade is done - they are injected Novocaine directly to the fracture site. Significant damage that causes unbearable pain requires the introduction of stronger analgesics in injections and droppers. Features of treatment in individual cases are as follows:

• with a fracture of several ribs, the imposition of a plaster corset is indicated;
• in the presence of fragments in the chest, an operation is performed with the installation of fixing plates until the final fusion;
• at open fracture be sure to perform surgical treatment, sew up damaged vessels and tissues, and carry out antiseptic treatment.

Complicated fractures also often require surgery. from pneumonia or open injuries The patient is prescribed antibiotics for 10-14 days. In parallel, oxygen therapy is carried out to prevent hypoxia.

Folk remedies

In order for the fracture to heal faster, in folk medicine There are a number of recipes for internal use. Rosehip infusion is especially popular - you need to pour 2 tablespoons of ground berries into 400 ml of boiling water in a thermos, take 100 ml four times a day in a day, the course is 14 days. An infusion of pomegranate bark is also useful for the patient - 2 tablespoons of the bark are boiled for half an hour in 500 ml of water, after cooling, they drink 50 ml three times / day for 2 weeks.

From a hematoma, you can make ointments:

• mix vaseline and fir oil equally, apply to the skin twice a day;
• darken an hour in the oven 100 g of juniper twigs and the same butter, filter, smear the hematoma area.

It is also useful to take tinctures of comfrey, cinquefoil, meadow cornflower, consume mummy - all these remedies accelerate the healing of fractures.

Rehabilitation for broken ribs

Sleeping with a broken rib can be a problem and cause a lot of inconvenience. But for the entire healing period, you should adapt to sleep strictly as indicated by the doctor:

Usually, recovery after an injury without complications lasts up to 1.5 months, in children, the ribs grow together in 21 days. In an elderly person, in the presence of fragments, after operations or with multiple injuries, rehabilitation will last up to 8-10 weeks. Usually the doctor forbids physical activity in the first month, but breathing exercises and special types of exercise therapy are required. Physiotherapy, nutrition with the inclusion of an increased amount of meat, fish, eggs, and dairy foods on the menu will help to recover sooner.

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