What to do with a broken rib

Author: Surgeon Denisov M.М.

The publication briefly provides information on what needs to be done with a broken rib. So, on average, fractures of the ribs account for 15% of all types of bone injuries. The mechanism of injury in this pathology can be either direct or indirect. An example of an indirect mechanism is the fracture of the ribs in the lateral sections with compression of the thorax in the anteroposterior direction. In view of the fact that the ribs are well connected to each other, displacement of fragments in significant volumes does not occur.

Clinic.

Immediately after the fracture, the victim complains of shortness of breath, which he describes as an inability to breathe, and severe pain localized at the site of injury. With a cough, the pain intensifies and takes on a sharp character. Therefore, the whole behavior of the patient is gentle: he moves slowly, takes off his clothes, breathes superficially to reduce the volume of respiratory movements. In the event that the fractures of the ribs involve the lungs in the process, hemoptysis starts, and subcutaneous emphysema develops in the fracture region. Detailed information in the material is an emergency aid for pulmonary hemorrhage .

Diagnostics.

When a victim addresses a doctor, the conditions and nature of injury (on what side fell, from what height, what the blow was struck and the like) are evaluated and clarified. On examination, attention is drawn to the involvement of the chest in the act of breathing, namely the uniformity of the right and left halves.

Often in the fracture region, a painful swelling is found. The doctor asks the victim to take a deep breath. At this attempt at the height of the inspiration there is a sharp pain, in connection with which the patient stops the continuation of the inspiration. This symptom was called "interrupted inhalation." It should be noted that with rib bruises this symptom is absent.

At palpation the doctor reveals soreness, at the point of maximum soreness - a deformation in the form of steps, which indicates a fracture.

In the event that a doctor suspects complications, in addition to examination and palpation, ultrasound examination of the chest and abdominal organs is performed. The best method is radiography.

Complications.

The main complications are: pneumothorax (accumulation of gases in the pleural cavity), wound and bruise of the lung and heart, rupture of the intercostal artery, leading to internal bleeding. Qualitative material about the symptoms of internal bleeding will help to avoid mistakes.

In addition, it is possible to damage the organs of the abdominal cavity and retroperitoneal space (spleen, kidney, liver). Therefore, in order to avoid diagnostic errors, minimal manipulations should include a study of the state of the chest, pulse, blood pressure, blood and urine analysis.

Particular attention is paid to multiple fractures, as they pose a huge threat to the life of the victim, leading to the development of acute respiratory failure and pleuropulmonary shock.

Treatment.

If the patient's condition is satisfactory, fractures of no more than two ribs and no complications are possible, treatment at home is possible. In other cases, the patient must be hospitalized.

The first medical aid begins with the administration of pain medications (for example, promedol). During transportation it is necessary to tightly bandage the thorax. In elderly people, this manipulation should not be carried out, in view of the high risk of developing pneumonia.

Therapeutic treatment is the use of alcohol-procaine blockade, which consists in introducing into the place of fracture procaine and alcohol, after which the pain completely disappears. Obligatory is the appointment of expectorants (bromhexine, tussin), respiratory and therapeutic gymnastics.

Fingering of the ribs occurs within one month.

In the event that the fusion does not occur for a long time, the ribs fix the plastic bus. For this, a special polyethylene plate is heated in hot water and applied to the chest in the fracture region, modeling its shape along the contour of the body surface. Then, by piercing the skin with a semi-oval surgical needle, the seam is sealed. The tire is removed after 3 weeks.

In the event that a fracture of the ribs occurred to the left or right of the sternum, resort to skeletal traction. The essence of this procedure is that, using a needle under local anesthesia, a wire with anticorrosive properties around the sternum is conducted around the sternum and transferred to the block. The stretching is carried out for two to three weeks.

Isolate the so-called final fractures, which are characterized by fracture of the rib in several places, which leads to the loss of its smaller part. An effective method of treatment in this situation is osteosynthesis, which is carried out with the help of a special device, thanks to which the free part is fixed. By stitching in this way even half of the broken ribs along two lines, a good fixation of the mobile segment is ensured.