When the ribs are broken what sensations. Changes in the area of ​​damage to the rib

To begin with, a rib fracture is very painful and dangerous injury. Broken ribs can damage the internal organs located in the chest - for example, pierce the lung or squeeze the diaphragm, and this in turn leads to blood loss and impaired respiratory activity of the body. This outcome suggests that untimely assistance and diagnosis can lead to death.

How can you break a rib

Fracture can occur even with slight pressure. chest(when providing first aid to victims, making artificial massage hearts, often break 1-2 ribs); awkward fall or hit (even with a regular basketball).

What are the symptoms of a broken rib

What are the symptoms of a broken rib? One of the signs is soreness in the place where the blow itself fell. It gets worse when a person coughs or takes a deep breath and exhales. A certain stiffness of postures is manifested, forcing a person to take an unusual position - reclining, half-sitting (it is difficult to stand, because broken ribs are displaced and cause sharp pain when breathing).

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

If, nevertheless, broken ribs hurt internal tissues chest, a so-called pneumothorax occurs - in a person, breathing becomes frequent, shallow, shortness of breath begins, and the skin and lips become blue due to a lack of oxygen in the blood. An aggravating factor may be internal bleeding- when the blood vessels are affected by fragments of the ribs. In this case, an increase in weakness, dizziness, and arterial 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 uncomplicated form it is necessary that the patient takes a semi-sitting position, bending his arms at the elbow. He should apply a special support bandage and tie one bent arm to his body in such a way that pressure is created on the broken rib.

At closed fracture complex form (severe pain, difficulty in breathing) it is necessary that the victim takes a half-sitting position and leans towards the broken rib. He needs to make a bandage that would tie his hand tightly to the body, immobilizing the diseased part of the body.

To help with broken ribs open form, it is necessary to attach a palm and close the wound, tilting the body towards the fracture, plant the victim. Bandage open wound, cover it with an airtight material and bandage it. Tie the arm to the body to immobilize the broken rib.

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

Treatment and diagnosis of a rib fracture

For staging accurate diagnosis rib fractures are a must 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. The radiologist will tell you for sure whether such an injury is taking place only by seeing and describing the picture. As a rule, it is the x-ray that shows 100% of the site of the fracture of the ribs.

Treatment in this case is based on the maximum possible immobilization of the patient for several weeks. Depending on the site of the fracture, plaster corsets may be applied for better bone fusion.

Complex fractures with displacement and the formation of detrital parts require surgical interventions. There are also isolated cases when several ribs are broken, and unpaired ones (climbers and steeplejacks suffer more often - falls from low heights lead to the fact that people get multiple fractures of the ribs with displacements). Such fractures are treated for a long time.

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

general description

Uncomplicated fractures, in which 1-2 ribs are damaged, grow together quite well, without posing any threat to the victim. The main danger posed by such an injury is usually respiratory failure and damage to internal organs, against which 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 of cardio-vascular system, which is a serious threat anyway.

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

Rib fracture: mechanism of injury

Any impact can provoke a fracture, as such it can be a direct blow directed to the area of ​​​​the ribs or a fall, in addition possible cause there may be excessive compression of the chest area. The most common fracture variant is a fracture within the region of greatest fold, that is, along the lateral surfaces of the chest.

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

When the pleura is damaged, and with it the lungs, complications often develop - and acts as such.

Hemothorax is the accumulation of blood between the inner and outer pleural sheets, pneumothorax also 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, in which the lung is damaged, may also be accompanied by the ingress of air to subcutaneous tissue, which determines the state of subcutaneous emphysema. If damage to the intercostal vessels occurs, this, in turn, can lead to profuse bleeding in soft tissues or into the pleural cavity.

Rib fracture: symptoms

The victim of a fractured rib experiences severe pain in the affected area. Increased pain occurs when breathing and making movements, as well as when coughing. Reduced pain at rest and in taking sitting position. Breathing is characterized by superficiality, in its process there is a lagging of the chest from 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, which manifests itself in the form of a kind of crunch produced by bone fragments.

It is noteworthy that lateral and anterior fractures of the rib region are especially difficult for patients, accompanied by severe respiratory failure. Rib injury in any of posterior divisions basically it doesn't show up that much.

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

Examination of the fracture area also reveals the presence of bruising and swelling that soft tissues acquire. Palpation indicates a sharp diffuse soreness, as well as bone crepitus. When a fracture is accompanied by emphysema, palpation reveals air crepitus, which, unlike bone crepitus, looks like a slight creaking.

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

These complications, such as hemothorax and pneumothorax, appear mainly in the near future from the moment the patient receives an injury to the area in question. A few days after the fracture, there is often another one, at least dangerous complication is post-traumatic pneumonia, which is most prone to elderly patients and patients of the category old age. In these cases, pneumonia is characterized by a particular severity of its course.

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

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

The aggravation of symptoms quite often occurs against the background of self-medication. Most people assume that proper fusion of the ribs is ensured by limiting their mobility, which is achieved by bandaging the chest. As a result, there is an even greater restriction of breathing, as a result of which congestive phenomena are subsequently noted 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. Exceptions can only be multiple or complicated fractures of the ribs, and in this case it is necessary to enlist exclusively specialized care in a hospital - any self-treatment should be excluded!

If timely treatment is not performed, then complications of a fracture of the rib / ribs can become a danger to the life of 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 X-ray, if there is a suspicion of hemothorax or pneumothorax, then X-ray examination, pleural puncture and ultrasound are also performed.

Rib fracture: treatment

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

If we are talking about an uncomplicated fracture (1-2 ribs), then treatment is usually performed on an outpatient basis. With a fracture of three or more ribs, hospitalization becomes mandatory.

As for the features of the treatment of an uncomplicated fracture, it is under local anesthesia at the doctor and consists in blockade (according to Vishnevsky). Further, analgesics are prescribed in combination with expectorant drugs, physiotherapy procedures and physiotherapy to improve ventilation of the lungs.

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

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

In the case of pneumothorax, it is often enough to just make a puncture focused on eliminating air. In the case of a tension pneumothorax, it is urgent to provide drainage of the pleural cavity.

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

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

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

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Diseases with similar symptoms:

Inflammation of the lungs (officially pneumonia) is inflammatory process in one or both respiratory organs, which usually has infectious nature and called various viruses, bacteria and fungi. In ancient times, this disease was considered one of the most dangerous, and although modern facilities treatment allows you to quickly and without consequences get rid of the infection, the disease has not lost its relevance. According to official figures, 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, to provide the victim with first aid, and thirdly, to responsibly approach recovery after it.

If you break a rib, you need to contact an ambulance, then:

1. Provide temporary immobilization (fixation) of the rib cage. To do this, at home, bandage the chest with a gauze or elastic bandage. top torso from armpits bandage to the abdomen with circular tours in the phase of deep exhalation.
2. Apply to the damaged area for 20 minutes ice compress.
3. Cannot be taken: their action will make it difficult 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 correctly will lie on your back on a hard surface. If injured side surface breasts lie on a healthy side.

Characteristic symptoms

Recognizing a broken rib is not difficult. After a blow to the chest, a crunch or click 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 a sharp pain in the broken bone and forces the victim to stop sudden respiratory movements. Inability to inhale full chest referred to as a positive symptom of "interrupted inspiration". The sign is not typical for a bruise of the chest wall and is detected only with a fracture of the ribs.

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

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

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

In the area of ​​injury, redness, swelling, bruising is found, in some cases a part of the rib protrudes noticeably.

Complicated fracture is accompanied by a bone fragment injury to nearby organs and symptoms that indicate 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 the penetration of a fragment of the rib into the tissue of the lung.
3. Sharp pain in the abdomen, pallor, cold sweat, increased heart rate, pressure drop 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 to treat the fracture with anesthesia. Paravertebral anesthesia or conduction blockade of intercostal spaces 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 restriction of chest excursion and the risk of developing congestive pneumonia. In addition, the absence of the need for a bandage is explained by the low probability of displacement of fragments, since they are closely associated with 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 start breathing exercises no later than 5 days from the onset of the disease;
• expectorants, mucolytics to facilitate sputum discharge.

Surgical treatment is performed with an open fracture of the ribs and associated injuries internal organs. After the administration of an anesthetic drug, debridement wounds, removal of nonviable fragments devoid of periosteum, suturing of 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 lines of fracture, part of the bone loses its connection with the rest of the rib and is held only by the periosteum. On inhalation, the dropped out rectangular area sinks into the chest, and on exhalation it is pushed out. This serious look damage, accompanied by respiratory and cardiovascular complications. Treatment is carried out in a hospital.

To stabilize the fragment, use:

1. a plastic splint that softens at a temperature of 40° and is modeled on the body of the victim, it is sutured to the chest wall, captures the floating section of the rib and puts it into operation on a par with undamaged elements;
2. osteosynthesis with pins.

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.

During the home treatment regimen, sleep on a firm mattress to prevent deformity of the spine and chest.

With a lateral fracture of the ribs, the optimal position for the patient is the supine position on the healthy side. In case of 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 energy costs of the body for the restoration of bone tissue. The emphasis is on protein, calcium-rich foods. The diet includes:

• lean boiled meat - beef, turkey, chicken breast;
• seaweed rich in trace elements;
• boiled sea fish;
• broths on beef bones, aspic for cartilage tissue regeneration;
• 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

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

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

1. In a sitting position with hands on their knees, they take breaths - at first shallow. Gradually increase their depth. 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 the arms above the head, bringing the elbows together and spreading with the arms crossed behind the head.
3. Shrugging, wide spread of arms.
4. Exercise for spinal column- reduction of the shoulder blades, tilting forward, backward and sideways.

Exercises are accompanied by deep breathing movements: when inhaling, they perform a movement, while exhaling, they relax.

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

Alternative treatment

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

1. compresses from raw potatoes on the area of ​​broken ribs;
2. taking a decoction of wild rose (1 tbsp. Pour 500 ml of boiling water over the fruit, 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 can occur at the site of injury:

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

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

• maladjustment, fraught with constant pain, restriction of mobility of the chest, its deformation;
• respiratory failure due to restriction of chest excursion.

It is important to seek medical help in a timely manner and follow all the instructions of the attending physician. Thus, complications can be avoided and recovery can be made quickly.

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

Rib fracture diagnosis

Rib fracture symptoms

A fracture of the ribs manifests itself as severe pain during inhalation and exhalation in the area of ​​\u200b\u200bdamage to the chest, the formation of hematomas (bruises), bleeding through the upper respiratory organs.

Open injuries occur when the chest is struck, and also as a result of gunshot wounds and not only.

What are rib fractures?

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

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

IN closed injuries The most common chest injury is a broken rib. Most often, fractures occur in the posterior and middle axillary lines. In this case, the ribs break under direct and indirect impact.

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, a fracture in this case occurs around the area of ​​compression. This impact causes fractures. more ribs.

The structure of the chest

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

The inner part of the chest is covered with intrathoracic fascia (a connective tissue membrane covering organs, vessels, nerves and forming sheaths for muscles) with an adjacent parietal pleura (a membrane consisting of two sheets: one fits the lungs, the other covers the walls chest cavity and aperture).
The bone base of the chest is covered on the outside pectoral muscles And long muscles back. It is also supplied with blood vessels and nerves from all sides.
Chest injuries are: open and closed:
Closed injuries occur upon impact, which leads to compression of the chest. As a result, there are: bruises, abrasions, hematomas (bruises), fractures of the ribs, compression of the chest.

Rib fracture symptoms

Sharp pains in the chest, which increase with inhalation and exhalation.
Breathing is superficial. There are conditions for congestion, and post-traumatic pneumonia develops. This is the most main danger and most frequent complication in patients with rib fractures.

The damaged part of the chest lags behind in breathing.

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

Bleeding through the upper respiratory organs, air and fluid in the chest.
Lateral and anterior fractures are very difficult to tolerate, accompanied by disorders of pulmonary ventilation. Disturbed gas exchange in the body.

Complications of fractured ribs

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 a rather dangerous and most common complication in patients with rib fractures.

Rib fracture diagnosis

An x-ray should be taken, which will show whether there is a fracture of the ribs or not.

Treatment of rib fractures

The treatment of this injury is as follows: First of all, it is a blockade of the damaged part of the chest - anesthesia. If necessary, perform a puncture, remove the accumulated blood from the chest. It is also an important stage of treatment - rest. The rehabilitation period takes four or more weeks

As mentioned above, with this damage, you should not self-medicate. Cold should be applied to the injury site and seen by a specialist as soon as possible.
At severe pain to avoid congestion and post-traumatic pneumonia, for the first time after the injury, novocaine blockades are used at fracture sites.
Bandages are not applied because they restrict breathing movements, which is bad for recovery period resulting in possible complications in the form of pneumonia and pleurisy. The rehabilitation period in uncomplicated cases takes 3-4 weeks.

Rib fracture is caused physical impact on the chest. According to statistics, such injuries are observed in 70% of people who visit a traumatologist for suspected chest injury, and in 16% of patients with fractures. The integrity of the IV-VII ribs is more often violated, and this fact is explained by the fact that in the area of ​​\u200b\u200btheir location there is no corset of muscles that protects the remaining ribs, and they do not have such flexibility as the lower ones.

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

Rib injuries are more common in adults (especially the elderly), because the children's chest is more elastic and less prone to such injuries. In this article, we will acquaint you with the causes, varieties, symptoms, first aid methods for the victim, methods for treating rib fractures and features bed rest and sleep with such injuries.

Varieties of rib fractures

Depending on the presence of skin lesions, a rib fracture can 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 thickness;
• subperiosteal - damaged bone ribs;
• crack - only the tissue of the costal bone is damaged, and there is no fracture.

According to the number of fractures, rib fractures can be:

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

At the site of localization, rib fractures can be:

• unilateral - 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.

Fenestrated fracture - damage to the 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 an offset.

Causes

Depending on the condition of the costal bones, experts distinguish two types of rib fractures. The first type is damage healthy bones caused by mechanical trauma. The second type of rib injury 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 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 in fractures depends on the area of ​​their localization, severity and the presence of injuries to nearby organs.

Rib fractures without damage to internal organs

Pain

After an injury, a dull pain appears in the area of ​​\u200b\u200bthe damaged rib, aggravated by deep breath or cough. It is caused by irritation of bone fragments nerve endings pleura and intercostal muscles. In case of fractures of the ribs located on the front of the chest, the pain is more intense, and in case of damage to the costal bones located on the back of the chest pain less pronounced, because during breathing they move less and their fragments almost do not 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 covers the chest with his hands.

shallow breathing

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

Broken breath syndrome

With some attempts to inhale, the patient experiences intense pain, and breathing becomes intermittent.

Changes in the area of ​​damage to the rib

The skin over the broken rib becomes edematous. At mechanical action on skin hematomas appear.

Breast deformity

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

Crepitus

At multiple fractures without displacement or fractures big amount fragments there is a crunch or a specific sound that comes into contact when the bones are rubbed.

Rib fractures with internal injuries 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 develops a rapid pulse, severe pallor (sometimes with cyanosis).

In addition to the above symptoms, the patient develops:

• lung injury - the victim develops subcutaneous emphysema, accompanied by a sharp violation breathing and getting air 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 (such injuries are rare and usually with a combined fracture of the ribs and spine or with 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 death of the patient (immediate, in the first hours or days) or heart contusion, which significantly complicate the subsequent life of the patient, causing dystrophic cardiosclerosis (mortality 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 in rib fractures are more common. Depending on their severity, they can lead to the development following complications:

1. . Sharp restriction of movements due to intense pain, impossibility normal breathing, tight bandaging and damage lung tissue often leads to the development lung inflammation.
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 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 chest wall, creating a hole for air to escape).
3. Hemothorax. Rupture of vessels by fragments of ribs leads to accumulation of blood in the pleural cavity. The patient develops shortness of breath and breathing becomes difficult. With massive bleeding and the lack of medical care, which consists in stopping it and removing the accumulated blood with a puncture, respiratory failure occurs.
4. Respiratory failure. The victim's breathing becomes intermittent and frequent, the pulse quickens, the skin becomes pale and cyanotic. When making respiratory movements, certain parts of the chest sink, and it becomes asymmetric. In the absence of urgent medical care, the patient dies.
5. Pleuropulmonary shock. This condition develops with extensive injuries leading to pneumothorax and the ingress 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 in rib fractures

• I - blood accumulates at the fracture site, containing fibroblasts that produce connective tissue and forming connective tissue callus;
• II - in the tissues of the connective tissue corns are deposited minerals, and an osteoid callus is formed;
• III - hydroxyapatites accumulate in the tissues of the osteoid callus, making it denser, 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 It is aimed at reducing pain and fixing the body in one position, preventing the appearance of pain and additional tissue injuries. To provide it, the following activities are carried out:

1. Let the patient take pain medication.
2. Apply a tight bandage of bandages, towels or cloth to the chest. To reduce pain during this procedure, bandage should be performed on the exhale.
3. Apply ice to the injury site.
4. Give the patient a semi-sitting position: the back should rest on a hard surface, put a roller under the legs.
5. Call " ambulance” or transport the victim to the hospital as soon as possible on a stretcher made from improvised means, ensuring maximum immobility.
6. When symptoms appear state of shock provide the necessary assistance.

With fractures of the ribs, you can not self-medicate! The use of compresses, ointments and other folk ways can significantly worsen the patient's condition and cause the development of complications.

Diagnostics

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

To diagnose a fracture of the ribs, the following measures are taken:

• questioning and examining the patient - crepitus is determined in the area of ​​injury and a step is felt between fragments of the costal bone;
• a symptom of an interrupted breath - when you try to inhale sharply, your breath is interrupted by intense pain;
• Payr's symptom - an attempt to tilt in the opposite direction from the fracture causes pain;
• a symptom of axial loads - when trying to squeeze the chest, pain occurs from the side of the injury.

To clarify the degree of damage to the ribs and to identify the accumulation of blood and other lesions, such additional methods examinations:

• x-rays (in the anteroposterior projection);
• Chest ultrasound.

Treatment

The tactics of treating rib fractures is determined by the severity of the injury and the presence of damage to internal tissues and organs.

In case of mild fractures, a circular bandage of elastic bandages and anaesthesia, with novocaine blockade. To do this, in the projection of the fracture is introduced local anesthetic and 1 ml 70% ethyl alcohol. Over time, this procedure can be repeated. With extensive injuries, anesthesia can be supplemented with narcotic drugs.

In some cases, for more reliable immobilization of the chest, a plaster corset or bandage is used. For fixation of bone fragments in bilateral fractures, it may be recommended surgery to install fixing plates that can hold fragments of ribs in the required position until complete fusion.

Surgical treatment is always performed for open fractures of the ribs. In the process of intervention, the edges of the wound are processed, tissues incapable of recovery are removed, and damaged large blood vessels are tied up. After that, the wound is sutured.

Rib fractures are often complicated by pneumonia. Antibiotics and symptomatic agents are used for their treatment.

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

• with pneumothorax - a puncture of the pleural cavity is performed to remove air and restore normal pressure in the lungs with a vacuum pump;
• with extensive hemothorax, a puncture of the pleural cavity is performed to remove blood (with a small amount of blood, 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 state, the necessary drug therapy. For elimination oxygen starvation oxygen inhalations are carried out.