What does it feel like when ribs are broken? Changes in the area of ​​the rib injury

Let's start with the fact that a rib fracture is very painful and dangerous injury. Broken ribs can damage internal organs located in the chest - for example, puncture a lung or compress the diaphragm, and this in turn leads to blood loss and disruption of the body's respiratory activity. This outcome suggests that untimely assistance and diagnosis can lead to death.

How can you break a rib?

A fracture can occur even with slight compression chest(when providing first aid to victims, doing artificial massage hearts, often break 1-2 ribs); an awkward fall or hit (even with an ordinary basketball).

What are the symptoms of a broken rib?

What symptoms indicate a rib fracture? One of the signs is pain in the place where the blow itself fell. It gets worse when a person coughs or breathes in and out deeply. A certain stiffness of postures appears, forcing a person to take an unusual position - half-lying, half-sitting (it’s difficult to stand, since broken ribs are displaced and cause sharp pain when breathing).

Usually, during a fracture, the rib fragments do not move, but if such a case occurs, it is very dangerous. Sharp bones can pierce porous lung tissue or the pleural cavity.

If, nevertheless, the broken ribs touched inner fabrics chest, a so-called pneumothorax occurs - a person’s breathing becomes rapid, shallow, shortness of breath begins, and the skin and lips acquire a blue tint due to a lack of oxygen in the blood. An aggravating factor may be internal bleeding- when blood vessels are touched by rib fragments. In this case, to the above symptoms are added an increase in weakness, dizziness, and blood pressure decreases.

First aid for a broken rib

The necessary first aid in such a situation depends on the type of rib fracture.

For closed fractures in simple form It is necessary for the patient to take a semi-sitting position and bend his arms at the elbow. He should be given a special support bandage and one bent arm should be tied to his body, so that pressure is created on the broken rib.

At closed fracture complex form (severe pain, difficulty breathing), the victim must take a half-sitting position and lean towards the broken rib. He needs to make a bandage that would tie the arm tightly to the body, immobilizing the painful part of the body.

To help with broken ribs open form, you need to apply your palm and close the wound, tilting the body towards the fracture, and sit the victim down. Bandage open wound, cover it with airtight material and bandage it. Tie your arm to your body to immobilize the broken rib.

For any type of fracture, you must immediately call an ambulance.

Treatment and diagnosis of rib fracture

For staging accurate diagnosis rib fractures must be done x-ray. With fluoroscopy, it is necessary to show as accurately as possible the place where there is pain and describe the symptoms for a correct diagnosis. A radiologist will tell you for sure whether such an injury occurs only by seeing and describing the image. As a rule, it is the x-ray that shows 100% the location of the rib fracture.

Treatment in this case is based on immobilizing the patient as much as possible for several weeks. Depending on the location of the fracture, plaster corsets may be applied to improve bone healing.

Complex fractures with displacement and formation of fragments require surgical interventions. There are also isolated cases when several ribs are broken, and unpaired ones (climbers and steeplejacks suffer more often - falls from small heights lead to people receiving multiple fractures of the ribs with displacements). Such fractures take a long time to heal.

Rib fracture is the most common type of chest injury, accounting for about 16% of total number fixed fractures. A rib fracture, the symptoms of which we will consider below, consists not only in its damage, but also in damage internal organs, concentrated in the chest area. It is noteworthy that in some cases such a fracture can cause death, so such an injury must be taken seriously.

General description

Uncomplicated fractures, in which 1-2 ribs are damaged, heal quite well, without posing any threat to the victim. The main danger that such an injury poses is usually respiratory failure and damage to internal organs, against which the development of associated complications. These fractures, in which there are no complications, are observed in practice in about 40%, but 60% of the remaining ones are inevitably associated with injuries affecting the pleura and lungs, as well as organs cardiovascular system, which in any case is a serious threat.

There are also situations in which multiple rib fractures occur. This defines a fairly serious injury, which in itself can become dangerous due to the likelihood of developing so-called pleuropulmonary shock, and can also lead to life-threatening complications.

Rib fracture: mechanism of injury

Any impact can provoke a fracture, such as a direct blow aimed at the ribs or a fall, in addition possible reason There may be excessive compression of the chest area. The most common type of fracture is a fracture within the area of ​​greatest bending, that is, along the lateral surfaces of the chest.

In the case of a fracture of one rib, displacement of the fragments is extremely rare. Multiple fractures often occur in combination with the displacement of such fragments, due to the impact of the sharp ends of which the pleura and lungs, as well as intercostal vessels, can, in turn, be damaged.

When the pleura is damaged, and along with it the lungs, complications often develop - and this is one of them.

Hemothorax is the accumulation of blood between the inner and outer pleural layers, while pneumothorax leads to the accumulation of air in the chest. As a result, the lung is compressed, then it decreases in volume, the alveoli collapse, after which their participation in the breathing process ceases.

A fracture of the ribs, which damages the lung, may also be accompanied by air entering the subcutaneous tissue, which determines the condition of subcutaneous emphysema. If damage to the intercostal vessels occurs, this, in turn, can lead to heavy bleeding in the soft fabrics or into the pleural cavity.

Rib fracture: symptoms

A victim of a rib fracture experiences severe pain in the affected area. Pain intensifies when breathing and making movements, as well as when coughing. Pain is reduced at rest, as well as when taking sitting position. Breathing is characterized by superficiality; in its process, there is a lag of the chest on the side where it was damaged.

Palpation (palpation) of a broken rib reveals an area of ​​increased pain; in some cases, bone crepitus is also noted, manifested in the form of a peculiar crunch produced by bone fragments.

It is noteworthy that lateral and anterior fractures of the rib area are especially difficult for patients, accompanied by severe breathing problems. Damage to the ribs in any of the posterior sections Generally it doesn't show up that much.

Multiple rib fractures lead to deterioration general condition patient, his breathing is also characterized by shallowness, and an increase in pulse is noted. With such an injury, the skin turns pale and often becomes cyanotic. The patient strives to take a stationary position, thereby avoiding unnecessary movements.

Examination of the fracture area also reveals the presence of bruising and swelling of the soft tissue. Palpation indicates sharp diffuse pain, as well as bone crepitus. When a fracture is accompanied by emphysema, palpation reveals air crepitus, which, unlike bone crepitus, is similar to a slight creaking.

The appearance of pneumothorax in a patient is indicated by symptoms of rib fractures, such as a deterioration in his general condition in combination with an increase in shortness of breath. The affected area does not detect breathing on its part. At lung damage Symptoms such as hemoptysis may also appear.

These complications, such as hemothorax and pneumothorax, appear mainly in the near future after the patient receives an injury to the area in question. A few days after the fracture, another one often occurs, no less dangerous complication– this is post-traumatic pneumonia, to which elderly patients and patients in the category of old age. In these cases, pneumonia is characterized by a particularly severe course.

The development of post-traumatic pneumonia against the background of a rib fracture is indicated by symptoms such as intoxication and difficulty breathing, and the temperature rises. It is important to consider that weakened elderly patients, as well as patients who have severe concomitant trauma, do not always experience a symptom in the form of fever - often characteristic feature the condition is only its general deterioration.

Post-traumatic pneumonia is caused by reduced ventilation of the lungs, noted on the side of the fracture. A rib fracture is accompanied by painful breathing, for this reason the patient tries to breathe as shallowly as possible.

Worsening of symptoms quite often occurs due to self-medication. Most people assume that proper fusion of the ribs is achieved by limiting their mobility, which is achieved by bandaging the chest. As a result, an even greater restriction of breathing occurs, as a result of which phenomena of a congestive nature are subsequently observed in the lungs, and as a result of this, the corresponding diagnosis is determined - congestive pneumonia.

As for the actual state of affairs, most rib fractures do not require fixation of the affected area at all. The only exceptions may be multiple or complicated rib fractures, and in this case it is necessary to secure exclusively specialized assistance in a hospital setting - any self-medication should be excluded!

If treatment is not promptly performed, complications from a rib/rib fracture can become life-threatening for the victim. To prevent the development of complications or to eliminate the consequences caused by them, as well as at the slightest suspicion of the relevance of a rib fracture, you should consult a doctor.

Diagnosis of the patient's condition is made by radiography; if there is a suspicion of hemothorax or pneumothorax, then fluoroscopic examination, pleural puncture and ultrasound are also performed.

Rib fracture: treatment

A fracture of a rib/ribs, as we noted above, requires complete exclusion of self-medication, because this condition can be life-threatening.

If we're talking about about an uncomplicated fracture (1-2 ribs), then treatment is usually carried out on an outpatient basis. If three or more ribs are fractured, hospitalization becomes mandatory.

As for the features of treatment of an uncomplicated fracture, it consists of local anesthesia at the doctor and consists of a blockade (according to Vishnevsky). Next, analgesics are prescribed in combination with expectorants, physiotherapy procedures and therapeutic exercises, which is designed to improve ventilation.

In some cases, hemothorax and pneumothorax do not appear when the victim is admitted to the traumatology department, but a little later. If this type of complication is suspected, repeat fluoroscopy should be performed.

If a small amount of blood accumulates in the area between the layers of the pleura, then it resolves on its own, but in the case of severe hemothorax, a puncture is required, which involves the introduction by a doctor under anesthesia of a special needle for subsequent removal from the pleura. pleural cavity accumulated blood. In some situations it is possible re-development hemothorax, which requires repeated puncture.

In the case of pneumothorax, it is often enough just to make a puncture aimed at eliminating air. In case of tension pneumothorax, it is necessary to urgently provide drainage of the pleural cavity.

As for the treatment of complications in the form of post-traumatic pneumonia, along with the measures listed above in the form of physiotherapy and antibiotics, therapeutic exercises are used to normalize pulmonary ventilation.

On average, treatment of an uncomplicated rib fracture takes about a month, while treatment of multiple rib fractures and complications caused by them is determined in each case individually, based on the general condition of the patient.

If you suspect a rib fracture and the symptoms inherent in this type of lesion are relevant, you should contact a surgeon.

Is everything correct in the article? medical point vision?

Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Pneumonia (officially pneumonia) is inflammatory process in one or both respiratory organs, which usually has infectious nature and is called various viruses, bacteria and fungi. In ancient times, this disease was considered one of the most dangerous, and although modern means Treatments allow you to get rid of the infection quickly and without consequences; the disease has not lost its relevance. According to official data, in our country every year about a million people suffer from pneumonia in one form or another.

To avoid possible complications, it is important to know what to do if a rib is broken. Firstly, the injury must be recognized in a timely manner, secondly, first aid must be provided to the victim, and thirdly, recovery after it must be taken responsibly.

If you have broken a rib, you need to go to an ambulance, then:

1. Provide temporary immobilization (fixation) of the rib frame. To do this, at home, apply a bandage to the chest using gauze or an elastic bandage. Upper part torso from armpits bandage up to the abdomen in circular rounds during the deep exhalation phase.
2. Apply to the damaged area for 20 minutes ice compress.
3. Do not take: their action will hinder medical diagnostics fracture
4. If a rib is fractured, the patient must sit during transportation. If there is a need to take horizontal position(at feeling unwell), in case of injury anterior section chest, it is correct to lie on your back on a hard surface. If injured lateral surface breasts, lie on the healthy side.

Characteristic symptoms

It is not difficult to recognize a rib fracture. After a blow to the chest, a crunching or clicking sound is heard. It precedes pain and is the first sign of a violation of the integrity of the bones.

An increase in the volume of the chest and stretching of the rib cage causes sharp pain in the broken bone and forces the victim to stop sudden breathing movements. Inability to breathe full breasts called the positive symptom of “interrupted inspiration.” The sign is not typical for a contusion of the chest wall and is detected only with a rib fracture.

Appears shallow breathing: short, albeit painless, exhalation and shallow inhalation. Sharp pain causes coughing.

Consequence pain syndrome is to limit the activity of the victim: he spares the site of injury, slowly changes the position of the body, moves without turning the body.

Possible asymmetry breathing movements in different halves of the chest: the healthy side stretches when inhaling and falls when exhaling, while the affected side “stands still.”

In the area of ​​injury, redness, swelling, bruising are detected, and in some cases part of the rib protrudes noticeably.

A complicated fracture is accompanied by injury from a bone fragment to nearby organs and symptoms indicating a threat to life:

1. Damage to the pleura is indicated by swelling and crunching in the area of ​​injury due to the accumulation of air under the skin.
2. Hemoptysis is characteristic of penetration of a rib fragment into the lung tissue.
3. Sharp abdominal pain, pallor, cold sweat, increased heart rate and drop in blood pressure accompany injury to the spleen, liver or kidneys.
4. Deterioration of consciousness accompanies a fenestrated or floating fracture and is a sign of mediastinal displacement to the healthy side.

Treatment

Doctors begin treating the fracture with pain relief. Paravertebral anesthesia or conductive intercostal blockade is used.

Uncomplicated injury with 1 or 2 broken ribs does not require hospitalization and is treated conservatively. An immobilizing bandage is not used to avoid limiting chest excursion and the risk of developing congestive pneumonia. In addition, the lack of need for a bandage is explained by the low probability of displacement of fragments, since they are closely connected to the periosteum.

Principles of treatment of a single uncomplicated fracture:

• local anesthesia with ointments;
• electrophoresis with novocaine;
• early activation - in case of rib fractures, it is necessary to begin breathing exercises no later than 5 days from the onset of the disease;
• expectorants, mucolytics to facilitate sputum discharge.

Surgical treatment is performed for open rib fractures and associated injuries internal organs. After administration of the anesthetic drug, debridement wounds, removal of non-viable fragments lacking periosteum, suturing the defect. An antibiotic may be prescribed to prevent microbial complications. Good to know - .

A floating fracture is an injury in which, due to 2 fracture lines, part of the bone loses its connection with the rest of the rib and is held together only by the periosteum. When you inhale, the prolapsed rectangular section sinks into the chest, and when you exhale, it is pushed out. This serious look damage accompanied by respiratory and cardiovascular complications. Treatment is carried out in a hospital setting.

To stabilize the fragment use:

1. a plastic splint, which softens at a temperature of 40° and is modeled on the victim’s body, it is sutured to the chest wall, captures the floating portion of the rib and includes it in work along with intact elements;
2. osteosynthesis using wires.

For support respiratory function use oxygen inhalation; to prevent pneumonia, you need to take antibacterial drugs.

Dream

Incorrect position during sleep leads to impaired consolidation of fragments, respiratory disorders and pain.

When treating at home, sleep on a hard mattress to prevent deformation of the spine and chest.

In case of a lateral rib fracture, the optimal position for the patient is lying on the healthy side. If you have a bilateral injury or damage to the anterior surface of the chest wall, you need to sleep on your back.

Nutrition

The diet for fractures should cover the body’s energy costs for bone tissue restoration. The emphasis is on protein, calcium-rich foods. The diet includes:

• lean boiled meat - beef, turkey, chicken breast;
• seaweed rich in microelements;
• boiled sea fish;
• broths for beef bones, jellied meat for the regeneration of cartilage tissue;
• dairy products;
• fish oil is a source of vitamin D;
• nuts, legumes;
• fresh vegetables and fruits.

Limit alcohol intake - it inhibits calcium metabolism and impairs blood circulation at the fracture site.

Rehabilitation

Healing of an uncomplicated fracture lasts 3-4 weeks. Full working capacity is restored within 4-5 weeks after injury. After multiple or complicated injuries to full life start 6-8 weeks from the start of treatment.

The main principle of rehabilitation is training as early as possible. respiratory muscles to prevent the accumulation of sputum in lower parts lungs. It can be carried out already on the 2nd day after the injury. Breathing exercises indicated after the disappearance of intense pain. It includes the following exercises:

1. In a sitting position with your hands on your knees, take breaths - shallow at first. Gradually their depth is increased. By the end of treatment, the inspiratory volume should be the same as it was before the injury.
2. Warm-up for the shoulder girdle - raising your arms above your head, bringing your elbows in and out with your arms crossed behind your head.
3. Shrug, arms wide.
4. Exercise for spinal column– bringing the shoulder blades together, bending forward, backward and sideways.

The exercises are accompanied by deep breathing movements: while inhaling, perform the movement, while exhaling, relax.

Rehabilitation procedures after a rib fracture include wearing a brace while performing physical work to unload the chest. During rest, the bandage is removed.

Traditional treatment

This type of treatment helps when combined with the basic instructions of a traumatologist. It is recommended to use the following means:

1. compresses from raw potatoes on the area of ​​broken ribs;
2. taking rosehip decoction (pour 1 tablespoon of fruit into 500 ml of boiling water, place in a thermos, let it brew overnight) 2 times a day, 1 glass;
3. rubbing oil into the affected area tea tree 2 times a day;
4. 2 tbsp. burdock root, dried dandelion flowers, coltsfoot, pour 500 ml of boiling water, simmer for 20 minutes, drink diluted.

Possible complications

Complications of a fracture that may occur at the site of injury:

• damage to a parenchymal organ;
• subcutaneous emphysema;
• bleeding, wound infection;
• acute respiratory failure;

Delayed complications caused by improper implementation of recommendations or late seeking help:

• malunion, fraught constant pain, limited mobility of the chest, its deformation;
• breathing problems due to limited chest excursion.

It is important to seek medical help in a timely manner and follow all instructions from your doctor. This way you can avoid complications and get better quickly.

The most common chest injury, rib fractures, often leads to damage to the internal organs of the chest ( respiratory system, cardiovascular system, intercostal vessels). Therefore, a rib fracture is quite severe and painful injury, which can sometimes be fatal.

Diagnosis of rib fracture

Symptoms of a rib fracture

A rib fracture manifests itself as severe pain when inhaling and exhaling in the area of ​​chest injury, the formation of hematomas (bruises), bleeding through the upper respiratory organs.

Open injuries occur when the chest is hit, as well as as a consequence gunshot wounds and more.

What are rib fractures?

Damage to the chest is a serious injury and can result not only in broken ribs, but also in damage to internal organs. Such as, respiratory tract, cardiovascular system, and also lead to damage to intercostal vessels.

Like fractures of other bones, rib fractures can be open, closed, or displaced.

IN closed damage The most common injury to the chest is fractured ribs. Most often, fractures occur in the posterior and middle axillary lines. In this case, the ribs break when straight and indirect influence.

During direct impact, the rib bends inward, and a fragment of the rib can damage internal organs.

With indirect impact, compression of the chest occurs; in this case, a fracture occurs around the area of ​​​​compression. This type of impact can cause fractures. more ribs

Structure of the chest

The chest has two boundaries: upper and lower. Upper limit- a line running along the upper part of the sternum and collarbone to the shoulder blades, and at the back it represents the process of the seventh cervical vertebra. Lower limit- a line running along the edge of the costal arches and the edges of the anterior ends of the free lower ribs, and behind this is the twelfth rib and the process of the twelfth thoracic vertebra.

The inside of the chest is covered with intrathoracic fascia (a connective tissue membrane covering organs, blood vessels, nerves and forming sheaths for muscles) with the adjacent parietal layer of pleura (a membrane consisting of two layers: one encircles the lungs, the other covers the walls chest cavity and diaphragm).
The bony base of the chest is covered on the outside pectoral muscles And long muscles backs. It is also supplied with vessels and nerves on all sides.
Injuries to the chest are: open and closed:
Closed injuries occur during an impact, which leads to compression of the chest. As a result, the following occur: bruises, abrasions, hematomas (bruises), rib fractures, compression of the chest.

Symptoms of a rib fracture

Sharp pain in the chest, which intensifies with inhalation and exhalation.
Breathing is shallow - rapid. Conditions arise for stagnation, and post-traumatic pneumonia develops. This is the most main danger and most common complication in patients with rib fractures.

The damaged part of the chest lags behind in breathing.

In case of fractures of the posterior parts of the ribs, the manifestation respiratory disorders little expressed.
Possible heavy bleeding into the chest, which often end in death. Because of untimely application to a specialist. With this damage, you cannot self-medicate. You should immediately consult a doctor and undergo an examination to determine the severity of the damage. If necessary, resort to treatment prescribed by your doctor.

Bleeding through the upper respiratory organs, air and fluid in the chest.
Lateral and anterior fractures are very difficult to bear and are accompanied by pulmonary ventilation disorders. Gas exchange in the body is disrupted.

Complications from rib fractures

A rib fracture often leads to damage to the internal organs of the chest (respiratory system, cardiovascular system, intercostal vessels).
If breathing is shallow and rapid, congestion may occur and post-traumatic pneumonia may develop. This is quite dangerous and the most common complication in patients with rib fractures.

Diagnosis of rib fracture

An x-ray should be taken, which will show whether there are rib fractures or not.

Treatment of rib fractures

Treatment for this injury is as follows: First of all, it is a blockade of the damaged part of the chest - pain relief. If necessary, a puncture is performed to remove accumulated blood from the chest. Another important stage of treatment is rest. The rehabilitation period takes four or more weeks

As mentioned above, with this damage, you should not self-medicate. You need to apply ice to the injury site and see a specialist as soon as possible.
At severe pain To avoid congestion and post-traumatic pneumonia, novocaine blockades are used at the sites of fractures for the first time days after the injury.
Bandages are not applied because they restrict breathing movements, which has a bad effect on recovery period, as a result of which complications such as pneumonia and pleurisy are possible. The rehabilitation period in uncomplicated cases takes 3-4 weeks.

A rib fracture is caused by physical impact on the chest. According to statistics, such injuries are observed in 70% of people who consult a traumatologist regarding suspected chest injury, and in 16% of patients with fractures. More often, the integrity of the IV-VII ribs is compromised, and this fact is explained by the fact that in the area where they are located there is no corset of muscles that protects the remaining ribs, and they do not have the same flexibility as the lower ones.

The severity of rib injuries largely depends on the type of fracture and the presence of damage to the surrounding tissues and organs. In almost 60% of cases, such injuries are accompanied by damage to the lungs, pleura, esophagus, liver, blood vessels and heart. They are the most severe and can cause death. Fractures that are accompanied by a violation of the integrity of several ribs or multiple fractures are also considered dangerous. In such cases, the likelihood of developing severe complications increases significantly. Simple rib injuries usually heal on their own and do not pose a threat to the health or life of the patient.

Injuries to the ribs are more common in adults (especially older people), because the children's chest is more elastic and less susceptible to such injuries. In this article we will introduce you to the causes, types, symptoms, methods of providing first aid to the victim, methods of treating rib fractures and features bed rest and sleep with such injuries.

Types of rib fractures

Depending on the presence of skin damage, a rib fracture may be:

• open - bone fragments violate the integrity of the skin and soft tissues;
• closed - bone fragments are located in the thickness of soft tissues and do not damage the skin.

Depending on the degree of damage to the bone tissue, a rib fracture can be:

• complete – the bone is damaged throughout its entire thickness;
• subperiosteal - damaged bone tissue ribs;
• crack - only the tissue of the rib bone is damaged, and there is no fracture.

Based on the number of fractures, rib fractures can be:

• single – one rib is damaged;
• multiple – several ribs are damaged.

Depending on the location, rib fractures can be:

• unilateral - a violation of the integrity of one or more ribs occurs on one side of the chest;
• bilateral - the ribs of the right and left sides of the chest are damaged.

A fenestrated fracture is damage to a rib in two places, resulting in the formation of a mobile bone fragment.

Depending on the location of the bone fragments, a rib fracture can be:

• no offset;
• with offset.

Reasons

Depending on the condition of the rib bones, experts distinguish two types of rib fractures. The first type includes damage healthy bones caused by mechanical injuries. The second type of rib damage is referred to as pathological fractures, which are provoked by changes in the bones that occur during various diseases and minimal mechanical stress.

The first type of rib fractures is caused by the following injuries:

• traffic accidents;
• blow to the chest (fight, blow with a blunt object);
• falling from a height;
• chest compression;
• sports injuries;
• gunshot wounds.

The second type of fractures is caused by minimal mechanical impact on the ribs in the following diseases:

• primary tumors of the ribs;
• malignant tumors and their metastases;
• genetic diseases.

Symptoms

The severity and nature of symptoms during fractures depends on the area of ​​their localization, severity and the presence of injuries to nearby organs.

Fractures of ribs without damage to internal organs

Pain

After an injury, a dull pain appears in the area of ​​the damaged rib, intensifying with deep breath or cough. It is caused by irritation from bone fragments nerve endings pleura and intercostal muscles. With fractures of the ribs located on the front of the chest, the pain is more intense, and with damage to the rib bones located on the back of the chest painful sensations less pronounced, because during breathing they move less and their fragments hardly move.

Forced posture of the patient

To reduce pain, the victim tries to take a position that minimizes movement in the chest. Usually the patient leans towards the broken ribs or wraps his arms around the chest.

Shallow breathing

This symptom is also associated with pain. Because of its intensification with a deep breath, the patient tries to breathe so that the chest moves minimally. At the same time, on the side of the fracture, the chest lags behind in breathing.

Interrupted inspiration syndrome

When some try to breathe, the patient experiences intense pain and breathing becomes intermittent.

Changes in the area of ​​the rib injury

The skin over the broken rib becomes swollen. At mechanical impact on skin hematomas appear.

Breast deformity

Changes in breast shape occur when several ribs are damaged. This symptom is especially noticeable in thin people - upon examination, not only slight deformation is revealed, but also “erasure” of the intercostal spaces.

Crepitus

At multiple fractures without displacement or fractures with a large number a crunch or a specific sound appears when the fragments come into contact when the bones rub.

Fractures of ribs with damage to internal organs and their complications

The nature of symptoms in rib fractures complicated by damage to internal organs depends on concomitant organ injuries. In addition to the symptoms characteristic of an uncomplicated fracture, the victim experiences a rapid pulse and severe pallor (sometimes with cyanosis).

In addition to the symptoms described above, the patient appears:

• lung injury - the victim develops subcutaneous emphysema, accompanied by a sharp violation breathing and air getting under the skin, when coughing, blood appears from the respiratory tract;
• damage to the aorta - massive blood loss leads to the death of the victim at the scene of the incident (such injuries are observed rarely and usually with a combined fracture of the ribs and spine or with an impact and compression of the chest with the formation of multiple left-sided fractures);
• heart damage - more often observed with a combined fracture of the sternum and ribs, can lead to the patient’s death (immediate, in the first hours or days) or heart contusions, which significantly complicate the patient’s subsequent life, causing dystrophic cardiosclerosis (mortality rate in such cases is up to 70% );
• liver damage - massive blood loss leads to death (every second victim dies 2 hours after such an injury).

Lung injuries due to rib fractures are observed more often. Depending on their severity, they can lead to the development the following complications:

1. . Sharp limitation of movements due to intense pain, inability normal breathing, tight bandaging and damage lung tissue often leads to the development pneumonia.
2. . Damage lung tissue leads to the accumulation of air in the pleural cavity and compression of the chest organs. In the absence of timely medical care A pneumothorax can become tense and cause cardiac arrest and death of the victim. To prevent its development, a closed pneumothorax must be made open (a puncture is performed in the anterior wall of the chest, creating a hole for air to escape out).
3. Hemothorax. Rupture of blood vessels by rib fragments leads to accumulation of blood in the pleural cavity. The patient experiences shortness of breath and difficulty breathing. With massive bleeding and lack of medical care, which consists of stopping it and removing the accumulated blood using a puncture, respiratory failure occurs.
4. Respiratory failure. The victim's breathing becomes intermittent and rapid, the pulse quickens, the skin becomes pale and cyanotic. When performing breathing movements, certain parts of the chest sink, and it becomes asymmetrical. In the absence of urgent medical care, the patient dies.
5. Pleuropulmonary shock. This condition develops with extensive injuries leading to pneumothorax and the entry of a large volume of air (especially cold) into the pleural cavity. The victim develops respiratory failure, a painful cough and cold extremities. In the absence of urgent medical care, the patient dies.

Stages of healing for rib fractures

• I – blood accumulates at the fracture site, containing fibroblasts that produce connective tissue and forming connective tissue callus;
• II – calluses are deposited in connective tissue tissues minerals, and an osteoid callus is formed;
• III – hydroxyapatites accumulate in the tissues of the osteoid callus, making it more dense; at first its dimensions are larger than the diameter of the ribs, but over time they decrease.

First aid to the victim

First first aid is aimed at reducing pain and fixing the body in one position, preventing the occurrence of pain and additional tissue injuries. To provide this, the following activities are carried out:

1. Give the patient a pain reliever.
2. Apply a tight bandage of bandages, towels or cloth to the chest. To reduce pain during this procedure, bandaging should be done while exhaling.
3. Apply ice to the injury site.
4. Give the patient a semi-sitting position: the back should rest on a hard surface, place a cushion under the legs.
5. Call " Ambulance“or transport the victim to the hospital as soon as possible on a stretcher using improvised means that ensure his maximum immobility.
6. When signs appear state of shock provide the necessary assistance.

If you have broken ribs, you should not self-medicate! Application of compresses, ointments and others folk ways can significantly worsen the patient's condition and cause complications.

Diagnostics

A chest x-ray will help confirm the diagnosis of rib fracture.

To diagnose a rib fracture, the following measures are taken:

• interview and examination of the patient - crepitus is determined in the area of ​​injury and the step between the fragments of the rib bone is palpated;
• symptom of interrupted inhalation - when trying to inhale sharply, breathing is interrupted by intense pain;
• Payr's symptom - an attempt to tilt in the direction opposite to the fracture causes pain;
• a symptom of axial loads - when trying to compress the chest, pain occurs on the side of the injury.

To clarify the degree of damage to the ribs and identify blood accumulation and other lesions, the following may be prescribed: additional methods examinations:

• x-rays (in anteroposterior projection);
• Ultrasound of the chest.

Treatment

The treatment tactics for rib fractures are determined by the severity of the injury and the presence of damage to internal tissues and organs.

For minor fractures, a circular bandage of elastic bandages and pain relief is performed using novocaine blockade. To do this, enter into the projection of the fracture local anesthetic and 1 ml 70% ethyl alcohol. Over time, this procedure can be repeated. For extensive injuries, pain relief can be supplemented with narcotic drugs.

In some cases, a plaster corset or bandage is used to more reliably immobilize the chest. For fixation of bone fragments in bilateral fractures, it may be recommended surgery for installing fixing plates that can hold rib fragments in the required position until complete healing.

Surgical treatment is always performed for open rib fractures. During the intervention, the edges of the wound are processed, tissues incapable of restoration are removed, and damaged large blood vessels are ligated. After this, the wound is sutured.

Rib fractures are often complicated by pneumonia. Antibiotics and symptomatic medications are used to treat them.

In case of damage to lung and large tissues blood vessels The patient can undergo the following surgical procedures:

• for pneumothorax - puncture of the pleural cavity is performed to remove air and restore normal pressure in the lungs using a vacuum pump;
• in case of extensive hemothorax, a puncture of the pleural cavity is performed to remove blood (if the volume of blood is small, the puncture is not performed and the blood resolves on its own).

When rib fractures are complicated by pneumothorax, hydrothorax and respiratory failure To stabilize the condition, the necessary drug therapy. To eliminate oxygen starvation oxygen inhalations are carried out.