Rib fractures symptoms
Fractures of the ribs are quite frequent, occur as a result of violation of the integrity of the bone or cartilage of one or more ribs.Fracture of rib fractures or a small number of edges that are not accompanied by complications, and other injuries, usually fused independently and do not require major surgery, or immobilization.
breast lesions directly responsible for 25% of 50-60 thousand. Fatalities annually recorded as a result of road accidents, and have a significant impact on the outcome still in the 25-50% of accidents.Rib fractures account for about 16% of the total number of fractures.
broken ribs - the most common damage to the rib cage.Older people
rib fractures are more common due to the decrease in the age-elasticity of the bone structures of the chest.
Not complicated fractures of one or two edges of a well fused and of themselves do not pose a threat to human life and health.
main danger at this injury is associated with respiratory failure, damage to internal org
uncomplicated rib fractures occur in 40% of cases.The remaining 60% are accompanied by damage to the pleura, lung and mediastinal organs.
Multiple rib fractures - injury which can be dangerous, both because of the possible development plevropulmonalnogo shock, and because of the dramatically increasing the likelihood of life-threatening complications.
noted not only the increase in the number of thoracic injuries, but also faster delivery teams ambulance patients in critical condition who previously would have died before arrival at the hospital.
Most patients with chest trauma can be saved with the rapid provision of adequate ventilation with endotracheal intubation and (or) drainage of the pleural cavity, as well as the timely infusion of fluids.Only 5-15% of patients admitted to the ED with chest trauma, requires a thoracotomy.
chest - called the bone frame that protects the heart and lungs.The rib cage is formed by 12 pairs of ribs.Ribs located between the intercostal muscles, blood vessels and nerves.The chest has two boundaries: the upper and lower.
upper boundary - a line that runs along the top of the breastbone and the collarbone to the shoulder blades, and behind it is a process of the seventh cervical vertebra.
The lower boundary - a line running along the edge of the costal arches and the edges of the front ends of the free lower edges, and the rear is the twelfth rib and the process of the twelfth thoracic vertebra.
Behind all the edges connected to the backbone.In its front portion ten pairs of upper end edges cartilages.
elastic rib cartilage provide the mobility of the chest.The cartilage of the upper seven pairs of ribs connect to the sternum.Cartilage VIII-X edges connected to each other, and XI and XII edges lie free, not articulated in front of the other bone structures.
Inside the chest is lined by a connective tissue sheath (hilar fascia) just below the fascia is the pleura, consisting of two sheets of smooth.Between sheets there is a thin layer of grease, which allows to freely slide the inner layer of the pleura during respiration relative to the outer.
lung tissue formed tiny hollow bubbles - the alveoli, which, in fact, gas exchange occurs.
are two types of causes of rib fractures, rib fractures resulting from sudden exposure to significant mechanical bone strength in people with intact bone system - called mechanical, and as a result of pathological processes that lead to a decrease in bone strength.
The first type causes of rib fractures, referring the following reasons:
1. Fractures of the ribs in the fall.
2. Fractures of the ribs with a direct blow to the chest.
3. Fractures of the ribs with compression of the thorax.
The second type causes of rib fractures, attributing the following reasons:
1. Rib fractures in osteoporosis (a condition in which calcium salts leached from the bone).
2. Rib fractures in chronic inflammation of the rib bone tissue.
3. Rib fractures in tuberculosis ribs.
4. Fractures of the ribs in the development of tumors in the chest.
5. Fractures of the ribs with blood diseases (multiple myeloma).
themselves rib fractures are not dangerous and heal quickly enough, the danger are related damage to internal organs.
most common fractures VII-X ribs in the lateral parts (up to 75% of all fractures of the ribs).This is due to the fact that it is here that the thorax has the greatest width.
There are direct and indirect mechanisms of rib fracture.In the direct mechanism of damage to one or more edges in the scene of the traumatic factor bend in the cavity of the chest, and broken, with possible damage to the pleura and lung.The number of broken ribs at the same time depends on the force of impact, and on the area of traumatic surface.If a strong stroke traumatic surface of large area forms a double rib fractures.Such fractures are called conclusive, since formed a "window" - separated from the general frame segment of the thorax.In the indirect mechanism is a strong compression of the chest and rib fracture occurs on either side of the operation force.Such lesions are characteristic sandwiched between two planes (torso grip between the wheel and the seat during vnutriavtomobilnyh accidents; clamping the chest between the car body and the wall, squeezing the breast wheel motor vehicles; heavy load, etc.).When compressing with great force, as a rule, are formed multiple bilateral fractures, complicated by damage to internal organs - the so-called "crushed chest" or "crushed his chest."Especially dangerous are the so-called floating rib fractures, resulting in severe respiratory failure.Because of multiple double or bilateral fractures formed separated from the thoracic segment, which violates the normal process of respiration.Clinically it is expressed in the so-called flotation chest - during inspiration segment separated sinks, and on the exhale - vybuhaet.When you graduate from fractures observed so-called paradoxical breathing.At the moment of inspiration when zapadenii graduate segment lung on the affected side collapses, and the air rushes out of it in a healthy lung.On an exhalation segment protrudes, lung on the affected side is straightened and filled with exhaust air from a healthy lung.When sufficiently large "window" is not only a violation of the respiratory function, and pendulum movement (flotation) of the heart and great vessels in breathing, which leads to disruption of the heart.The most dangerous front and left-sided bilateral anterolateral fenestrated fractures.Mortality in this kind of damage, even in the conditions of modern medical institutions can reach 40%.At rear fractures forecast is more favorable as a result of fixing the role of the musculature of the back and affected the situation mainly on the back.
etiology fractures are divided into: a traumatic and pathological fractures.
Traumatic fractures are due to the fact that bone acts brief, but powerful enough force.
Pathologic fractures - it's the action of various diseases that affect the bone, destroying it.The turning point in this case, happens by chance, you do not even notice it.
Mechanical or traumatic fractures are divided into the following types of fractures:
1. On the mechanism of injury Rib fractures are divided into:
straight - rib breaks where directly applied traumatising force, damaging also the soft tissue of the chest.
indirect - indentation fractured rib comes into the angular displacement of bone fragments.If an external force acts on the edge closest to the spine, it causes a fracture at the shear type: central otlomok remains in place, and peripheral - mobile and long - is shifted to the inside.
avulsion fractures of edges (with IX and below) are characterized by a large displacement of the fragment, detached from the rib.
2. The classification of fractures, depending on the damage to the skin:
1. Open fractures:
2. Closed fractures:
Pervichnootkrytye fractures - the skin is damaged by traumatic force, breaking bones.Vtorichnootkrytye fractures - soft tissue and perforated leather inside the sharp end of the bone fragments.
wound at vtorichnootkrytom fracture, usually small (equal to the diameter of the end of the fragment, perforating the bone).As with pervichnootkrytom, and in turn holds vtorichnootkrytom initial microbial contamination of the fracture zone and the subsequent development of suppuration and osteomyelitis.
not broken (perforated, marginal fractures, cracks, detachments bone tubercles) are incomplete fractures the integrity of the entire bone.At full
violation occurs bone fracture in its intact whole thickness being damaged bone fragments may be separated from each other.
3. The nature of damage to the rib fractures are divided into:
- isolated rib fractures without joining other skeletal injuries,
- rib fractures, which are combined with the injuries of the chest and fractures of other parts of the skeleton,
- not heavy rib fractures, which are combined with injuriesother parts of the body.
4. The nature of the fracture distinguish fractures:
When fractures is always a few bone fragments - fragments or debris.The most common fracture is accompanied by the presence of two fragments, the double turn there are three fragments, in a three or four fragments.Damage for which there are two or more lines of fracture, called polifokalnym fracture.
however, often form small fragments, called fragments, called a comminuted fracture, and the number of fragments called odnooskolchatye fractures and comminuted.
In turn, depending on the size of the fragments are broken krupnoskoolchatye, sredneoskoolchatye and melkooskolchatye.
5. According to the localization of the bone defect distinguish fractures:
- of diaphyseal
With respect to the joint, fractures are divided: on the extra-articular and intra-articular, differences on long bones fractures diaphyseal and metaphyseal (extra-articular) by epiphyseal (intra-articular).In the latter group, especially allocate epiphysiolysis separation epiphyseal bone through neokostenevshego sprout cartilage.For greater clarification localization of fractures also are the terms: subcapital, supracondylar, fractures, etc. nadlodyzhkovy
6. Types of bias depending on the displacement factor:
- Primary (there is at the moment under the influence of traumatic fracture strength)..
- Secondary (arises under the influence of muscle contractions after fracture).
7. Depending on the spatial orientation of the fragments distinguish bias:
- In length
- Justified or sideways when the fragments are displaced in the direction of the longitudinal axis of the limb;
- along the axis or angle when the fragments are at an angle to each other
- On the periphery, when the distal fragment is rotated, ie,It rotates around the longitudinal axis of the limb;
angular displacement of bone in the segment with two long bone (upper arm, thigh) is also called axial displacement.
8. Classification of fracture on the clinical condition:
With stable fractures observed transverse fracture line.
In unstable fractures (oblique, helical) appears secondary displacement (due to the rise of post-traumatic muscle retraction).
The history of previous chest injury.Pain at the site of impact, which increases during inhalation and exhalation or cough.Rib fractures are characterized by the appearance of symptoms "ragged breaths," an attempt to breathe slowly and deeply, and the pain is accompanied by a sudden breath stops.Often the victim posture while fractured ribs are forced, well, themselves constrained movement.Visual inspection of the chest is clearly evident that it is lagging behind in the damaged part of the breath.Typically, the injury site become visible bruising and swelling.Complete rib fractures, usually accompanied by the displacement of bone fragments and their subsequent goeth down at the time of exhalation and inhalation during unfolding.On palpation reveals a sharp local pain, crepitus possible.Deformation in a step at the point of maximum tenderness also indicates rib fracture.If broken ribs followed by subcutaneous emphysema, subcutaneous tissue palpation revealed crepitation air, which, unlike bone crepitations resembles a soft creak.
1. Subcutaneous emphysema
1. Subcutaneous emphysema - the accumulation of air in the subcutaneous tissue of the chest wall, extending to other areas of the body.It is a symptom of damage to the lung or airways.
Subcutaneous emphysema, depending on the size divided into: a limited, distribution, total.
Clinic subcutaneous emphysema
depends on the magnitude of emphysema.In emphysema there is limited local tenderness at the site of injury and palpable characteristic crunch in places where the air in the tissue.With widespread emphysema Clinic brighter.Visually defined areas of swelling of subcutaneous tissue palpation which arises subcutaneous crepitus, auscultation resembling the sound of crunching of dry snow.Breath-side weakened by injuries.In severe emphysema of the neck there is shortness of breath, cyanosis of the skin.
2. Hemoptysis or gemoptizis - coughing up phlegm with blood from the larynx, bronchi or lungs.
Blood scarlet with hemoptysis and frothy.
3. Pneumothorax - is the accumulation of air between the parietal and visceral pleura.
1. In connection with the environmental distinction:
- Closed pneumothorax.In this form of the pleural cavity falls small amount of gas, which does not increase.Communication with the environment is absent.It is considered the easiest kind of pneumothorax because air could potentially own gradually disappear from the pleural cavity, with a slight crushes.
- open pneumothorax.With an open pneumothorax, pleural cavity communicates with the external environment, so the pressure is created in it, equal to atmospheric pressure.This easy collapses, as an essential condition for the unfolding of the lung is a negative pressure in the pleural cavity.Sleeping off a slight out of breath, there is no gas exchange, the blood is not oxygenated.It may be accompanied with hemothorax.
- valve pneumothorax.This type of pneumothorax occurs in the case of the formation of the valve structure, breathable in the sole direction of the light or from the environment into the pleural cavity, and preventing his exit back.At the same time with each respiratory movement of the pressure in the pleural cavity increases.It is the most dangerous type of pneumothorax, as to turn off the light of respiratory irritation joins the nerve endings of the pleura, leading to plevropulmonalnomu shock, as well as the displacement of the mediastinal organs, which impairs their function, especially compressing large vessels.
2. As the volume of air in the pleural cavity pneumothorax divided into:
1. Limited - easy constricted to 1/3 volume.
2. Medium - easy constricted to half volume.
3. Large - lung constricted by more than half the volume.
4. total - in the collapse of the entire lung.
3. In addition, pneumothorax can be:
- the near-wall (the pleural cavity contains a small amount of gas / air, light is not fully extended, usually a closed pneumothorax).
- Full (completely easy sleeping).
- encysted (occurs when there are adhesions between the visceral and parietal pleura, limiting the area of pneumothorax, less dangerous, may be asymptomatic, but can also cause additional fractures and lung tissue adhesions in the place).Art.