Rib fracture
There are 12 pairs of ribs, equally divided on both sides of the chest, connected to the sternum in front and to the thoracic vertebrae in the back, forming a complete foot outline. Rib fractures are most common in thoracic injuries, whether closed or open, and account for about 90% of thoracic fractures. In children, the ribs are elastic and not easily broken, while in adults, especially the elderly, they are less elastic.
Etiology
1, rib fracture is usually caused by external violence, when direct violence acts on the chest, rib fracture often occurs at the site of the blow, the fracture end is broken inward, while the thoracic organs cause damage.
2.When indirect violence acts on the chest, such as chest crushing violence, rib fracture occurs at a site other than the point of violence, the fracture end is outward, which can easily damage the soft tissue of the chest wall and produce chest hematoma.
3.Open fractures are mostly seen in direct injury by firearms or sharp instruments. In addition, when fractures occur on the basis of pathological changes in the ribs such as osteoporosis, osteochondrosis or primary and metastatic rib tumors, they are called pathological rib fractures.
Clinical manifestations
1. Local pain is the most obvious symptom of rib fracture, and it is aggravated by coughing, deep breathing or body rotation and other movements.
2, pain and thoracic stability is damaged, can make the respiratory dynamics is limited, shallow and fast breathing and alveolar ventilation is reduced, the patient dare not cough, sputum retention, thus causing lower respiratory secretion obstruction, pulmonary solidification or pulmonary atelectasis, this in the elderly and weak patients or patients with pre-existing lung disease should be paid particular attention to.
3, when the presence of shackle chest inspiration, the negative thoracic pressure increases, softening part of the chest wall inward depression; exhalation, the thoracic pressure increases, the injured chest wall floating projection, which is the opposite of other chest wall movement, called “paradoxical respiratory movement”, paradoxical respiratory movement can make both sides of the chest pressure imbalance, mediastinum with breathing and move back and forth to the left and right This is called “mediastinal oscillation”, which affects blood return and causes circulatory disorders, and is one of the important factors leading to and aggravating shock.
Examination
Most of the X-ray chest films can show rib fractures, but for rib cartilage fractures, “willow fractures”, fractures without dislocation, or mid-rib fractures are not easily detected on chest films because the ribs on both sides overlap each other, further examinations such as CT should be performed and combined with clinical manifestations to avoid missing the diagnosis.
Diagnosis
The diagnosis of rib fracture is mainly based on the history of injury, clinical manifestations and X-ray chest film examination. If there is a history of chest trauma, local pain and pressure pain in the chest wall, and positive thoracic squeeze test, the possibility of thoracic fracture should be thought of, and the diagnosis can be confirmed by combining with X-ray examination, and if friction sounds can be palpated at the pressure pain point, the diagnosis can be established, and if there is abnormal respiratory movement in the chest wall.
Treatment
The principles of treatment for rib fracture are analgesia, clearing respiratory secretions, fixing the thorax, restoring chest wall function and preventing complications.
1. Treatment of single closed rib fracture
Both ends of the fracture are supported by the upper and lower ribs and intercostal muscles, so dislocation and activity are rare and can mostly heal automatically. The main purpose of fixing the thorax is to reduce the activity of the fracture end and alleviate the pain, and the methods are: wide adhesive tape fixation, multi-strip chest cloth fixation or elastic chest band fixation. The principles of treatment for simple rib fractures are pain relief, immobilization, and prevention of pulmonary infection. Pain relievers can be administered orally or intramuscularly if necessary.
2.Treatment of continuous shackle chest
Correction of paradoxical respiratory movements, anti-shock, prevention and control of infection and treatment of combined injuries. When the softening of the chest wall is small or located in the back, the paradoxical respiratory movement may not be obvious or serious, and local clamp pads can be used to apply pressure bandages. However, when the floating amplitude reaches more than 3 cm, it can cause serious respiratory and circulatory dysfunction, and when it exceeds 5 cm or is bilateral hypothorax syndrome, it can rapidly lead to death and must be treated urgently.
3.Treatment of open fracture
Early and thorough debridement treatment should be performed. Remove broken bone fragments and lifeless tissues and bite flat the fracture break end to avoid puncturing the surrounding tissues. If there are intercostal vessels broken, the distal and proximal ends of the ruptured vessels should be sutured separately. Cutting a section of intercostal nerve is helpful to reduce postoperative pain. Pleural rupture should be treated as open pneumothorax. Postoperatively, tetanus antitoxin serum is routinely injected and antibiotics are given to prevent infection.
Rib fractures can mostly heal on their own within 2-4 weeks, and the treatment does not emphasize the alignment of the broken ends as much as it does for limb fractures.