How to determine a rib fracture? Symptoms and treatment of rib fracture

In this article we will look at how to determine a rib fracture. This pathology is a violation of the integrity of several ribs or one of them due to traumatic exposure. The condition is accompanied by intense chest pain, which leads to a significant limitation of the mobility of the chest area. In this regard, the patient’s breathing becomes shallow, which can provoke disruption of pulmonary ventilation processes. Multiple rib fractures can be combined with various injuries to organs located in the chest and pose a significant threat to life. The diagnosis of rib fracture is made on the basis of data obtained after an x-ray. If necessary, ultrasound diagnostics of the pleural cavity is performed, as well as its puncture. The symptoms and treatment of a rib fracture are interrelated.

This is the most common injury to the thoracic area. Such injuries account for approximately 16% of the total number of fractures. They occur more often in older patients, and this is due to an age-related decrease in the elasticity of bone structures.

Uncomplicated fractures of the thoracic ribs heal quickly and do not pose a threat to life. The main danger with such an injury is associated with disruption of the respiratory process, damage to organs and the development of associated complications. Uncomplicated fractures are observed in only 40% of cases. Other injuries of this nature are accompanied by damage to the pleura, lungs and structures of the cardiovascular system. Multiple rib fractures are a serious injury and are very dangerous because they can contribute to the occurrence of pleuropulmonary shock, which is considered an extremely life-threatening complication. Multiple rib fractures with displacement of bone fragments often occur, which also seriously affects the patient’s condition and treatment methods.

Causes

To find out how to determine a rib fracture, let's first look at the reasons. The main causes most often are a direct blow to the sternum, a fall or compression of the chest. The most common situation is when the ribs break in the area of ​​greatest bending - along the lateral surface of the chest. During a fracture of one rib, displacement of fragments occurs very rarely. As for multiple fractures, they are more often combined with displacement of fragments. In this case, the fragments can damage the lungs, pleura and intercostal vessels with their sharp ends.

The most common causes of rib fractures are road traffic accidents, domestic situations and industrial accidents.

Causes

Rib fractures are observed mainly in adulthood, since the child’s chest has high elasticity and mobility. Provoking factors are classified into 2 groups: traumatic and pathological.

Traumatic ones provoke:

• A blow to the chest area with a blunt object, with a fist.
• Motor vehicle accidents. In such a case, the body will be subjected to strong compression and collision.
• A fall.
• Sports-related injuries.
• Compression effects (during the penetration of a person between two compressible surfaces).

Pathological rib fractures are caused by:

• Certain scar tissue diseases (for example, rheumatoid arthritis).
• Metastatic lesions of the rib bones, which have primary foci of oncological changes in the internal organs.
• Neoplasms that are localized in bone tissue.
• Processes that provoke osteoporosis. It is caused by calcium metabolism disorders, hormonal imbalances, and hereditary factors.
• Deviations in the structure of the chest.
• Hereditary diseases that lead to bone fragility. The result is fragility in the ribs.

Traumatic rib fractures appear as a result of exposure to a direct damaging factor, and pathological ones - when certain pathologies develop.

Symptoms

Sharp pain from a rib fracture is noted in the chest, intensifies with movement, coughing, breathing, talking and decreases at rest, in a sitting position. Breathing in this case is superficial, the chest on the affected side lags behind when breathing. When palpating a broken rib, an area of ​​severe pain is identified, in some cases – bone crepitus (characteristic crunching of bone fragments).

Lateral and anterior rib fractures (in ICD-10 they are assigned code S22) are difficult for patients to endure and are accompanied by breathing problems. With injuries to the posterior sections, the impairment of pulmonary ventilation is usually less pronounced. With multiple rib fractures, the patient's condition deteriorates sharply. His breathing is shallow, his pulse is rapid, his skin is markedly pale or even bluish. The patient tries to sit still and avoids the slightest movements.

In the area of ​​the fracture of the 9th rib, for example, bruising and severe swelling of the soft tissues are observed. On palpation, you may notice diffuse, sharp pain and bone crepitus. If the fracture is accompanied by a problem such as subcutaneous emphysema, then in this case, upon palpation of the subcutaneous tissue, air crepitus is detected, which resembles a soft creaking.

Anatomy and structural features of the ribs

The bony frame that protects the internal organs in the upper torso (particularly the heart and lungs) from damage is called the rib cage. The chest, in turn, consists of twelve pairs of ribs, between which muscle tissue, nerves and vascular networks are laid.

In the back, the ribs are connected by the spine, in the front - by cartilage tissue. The cartilages, in turn, connect to the sternum and provide elasticity and some mobility to the costal plates.

If the chest is damaged, the integrity of one or more ribs, as well as soft tissues, skin and internal organs may be damaged.

Possible complications

It is important to know in advance how to determine a rib fracture. The development of pneumothorax is indicated by a deterioration in the patient’s general condition and increasing shortness of breath. Breathing on the affected side of the chest is not audible. In addition, if the lung is damaged, hemoptysis may occur. Pneumothorax and hemothorax are conditions that develop in the immediate period after injury. A few days after the fracture, another dangerous condition may occur - post-traumatic pneumonia. Elderly people, in whom pneumonia is usually very severe, are more prone to its occurrence.

The development of pneumonia may be indicated by a deterioration in general condition, signs of intoxication, difficulty breathing and an increase in temperature. It must be taken into account that in weakened elderly patients and patients with severe combined injuries, post-traumatic pneumonia is not always accompanied by hyperthermia. In a number of situations, only a general deterioration of the condition is noted.

The development of post-traumatic pneumonia is caused by inhibition of pulmonary ventilation processes. Breathing during a fracture is very painful, so the patient tries to breathe more shallowly. This problem is also often aggravated by self-medication. Many people believe that in order to fuse the ribs, they need to limit their mobility and bandage the chest. As a result, breathing is further limited, congestion develops in the lungs, and congestive pneumonia occurs. In fact, most injuries of this type do not require bracing. The exception is some multiple and complex rib fractures, for which care should be provided exclusively in a hospital setting. In the absence of timely treatment, complications are life-threatening. In order to prevent the development of complications or stop their consequences, you need to seek medical help as soon as possible.

Diagnostic methods

Diagnosis and identification of signs of rib fractures in a person are carried out in several stages:

1. Questioning and inspection. At this stage, the patient’s information and complaints are collected, as well as a detailed examination of the affected area using palpation.
2. Test for the symptom of interrupted inspiration. The patient is asked to inhale sharply. If there is bone damage, inhalation is interrupted due to severe pain.
3. Test for Payra's symptom. The patient is asked to lean in the direction opposite to the injury. Sharp pain indicates the presence of a fracture.
4. On the symptom of axial loads. The patient's chest is noticeably compressed. The occurrence of pain localized in the affected area indicates the presence of a fracture.

After carrying out all these procedures, the doctor makes a primary conclusion.

To clarify the diagnosis and identify possible complications, the following procedures are additionally prescribed:

• Radiography. Pictures are taken in an anteroposterior projection. With their help, it is possible to determine the very presence of a rib fracture, the number of broken bones, as well as the number of fragmentation elements.
• Computer and magnetic resonance imaging, less often ultrasound. Necessary for more detailed visualization of the chest, as well as determining the presence of soft tissue lesions and bleeding.

Treatment for a rib fracture is prescribed based on the results of diagnostic studies. The treatment methods are chosen by the attending physician based on the clinical picture and individual characteristics of the patient.

How to determine a rib fracture?

Diagnosis of the disease and existing complications is carried out by a traumatologist mainly on the basis of x-ray studies. If hemo- and pneumothorax is suspected, an ultrasound of the pleural cavity, fluoroscopy of the lungs, and pleural puncture are additionally performed.

Thus, the only method for determining rib fractures (according to ICD-10 code, see above) today is high-quality radiography.

Symptoms of bruised ribs

A chest injury can lead not only to a fracture, but also to severe bruising of the ribs - these two conditions must be properly differentiated so that the treatment is selected correctly.

Both of these conditions are characterized by severe pain - the patient will complain of the inability to take a deep breath and increasing pain when changing body position.

How to determine whether there is a rib fracture or bruise in each specific case? It's simple - you need to know exactly the unconditional symptoms of a violation of bone integrity:

• pain at the site of injury is non-localized, has the ability to “spill out”, but the most acute point is determined;
• with rest the pain subsides;
• the patient’s breathing is intermittent and shallow, and the chest drops significantly lower precisely at the site of the fracture;
• palpation makes the pain more intense;
• When examining the patient and palpating, crepation may be observed - the crunching of bone fragments can be heard.

Signs of a fracture of the anterior and posterior ribs of the chest will differ in their intensity - if the integrity of the ribs of the anterior chest is broken, the pain syndrome will be much stronger, but otherwise the patient may notice only mild discomfort.

Children are quite often susceptible to various fractures, including rib fractures. If a rib is broken in children, it has the following symptoms:

• complaint of pain in the chest area during inhalation or exhalation;
• the child may refuse to move because it causes him pain;
• covers a sore spot;
• breathes shallowly.

If you notice such behavioral symptoms in a child, he probably has broken ribs. Examine his body carefully and carefully, you may find a hematoma in the bruised area. Provide complete rest to the child and be sure to go to the nearest hospital.

Chest injuries are not uncommon. It is easy to get a bruise at home, as a result of an accident or in a street fight. If one or more ribs are damaged, you should immediately consult a traumatologist. The doctor will send the patient for an x-ray, and after carefully studying the image, he will be able to accurately determine the severity of the injury and prescribe the necessary treatment. You can independently diagnose a rib bruise at home if the following symptoms are pronounced:

• the injury is accompanied by intense pain, the peak of which occurs at the time of injury to the rib;
• the bruise causes pain for a long time when moving and breathing;
• pain is felt during inhalation, and the condition is similar to a lack of air, as a result of which breathing is difficult;
• due to damage to blood vessels upon impact, a large hematoma appears around the bruise;
• swelling may appear around the bruised area; palpation of the swelling will intensify the pain;
• increased skin temperature or redness at the site of the injury.

What to do if you have a bruised rib?

If the bruise is correctly diagnosed, there are no protrusions or dents around the injured area that accompany a rib fracture, you should proceed to first aid.

Treatment

Uncomplicated rib injuries are treated on an outpatient basis, that is, at home. Injury to more than three ribs is considered an indication for emergency hospitalization in the orthopedics and traumatology department. In case of an uncomplicated rib fracture, at the time the patient is admitted to the hospital, the traumatologist performs local anesthesia or vagosympathetic blockade. After this, the patient is prescribed analgesics, some expectorants, physiotherapeutic procedures and therapeutic exercises to improve pulmonary ventilation.

Sometimes hemothorax and pneumothorax develop not at the stage of the patient’s admission to the hospital, but somewhat later. If there is a suspicion of the development of these complications, additional fluoroscopy is performed during therapy. During the treatment of complex rib fractures, additional therapeutic measures are carried out simultaneously with standard medical procedures (analgesics, fracture anesthesia, therapeutic exercises and physiotherapy). A small amount of blood in the pleural cavities resolves on its own. If a patient experiences severe hemothorax, doctors perform a puncture of the pleural cavity. Under local anesthesia, the specialist inserts a special needle into the pleural cavity and removes the blood that has accumulated in this area. Sometimes hemothorax occurs repeatedly, so during therapy the puncture has to be performed several times.

For pneumothorax, in certain cases, puncture is sufficient to remove air from the pleural cavities. Tension pneumothorax is considered an indication for emergency drainage. Under local anesthesia, the doctor makes a small incision in the second intercostal space along the midclavicular line. A drainage tube is inserted into this incision. Its other end is lowered into a jar of liquid. It is extremely important that the can is positioned below the patient's chest level. The air that accumulates in the pleural cavity is removed through the tube, and the lung begins to expand. Pleural drainage is usually maintained for several days until all the air is released. Then a control fluoroscopy is done and the drainage is removed.

When treating post-traumatic pneumonia, along with general therapeutic measures (physiotherapy, antibiotics), it is very important to carry out therapeutic exercises to restore proper ventilation of the lungs. Fixation of fractures is required extremely rarely, and this is done, as a rule, with multiple injuries to the sternum, which are accompanied by unstable rib fractures.

Treatment in hospital

What to do if you break a rib, and which doctor should you contact? Traumatologists treat injuries. In case of multiple and complicated fractures, hospital treatment may be required. For example, if 10 rib fractures are observed, treatment is carried out only in a hospital. Long-term treatment for a rib fracture may be necessary if complications are diagnosed, as well as if there is serious difficulty breathing. As a rule, patients are prescribed to wear a medical rib brace. The special bandage comes in several types: hard, medium hard and soft. Thanks to these types, a properly selected bandage fixes broken ribs. In cases of complicated fractures, a bandage is necessary

.

Procedures performed in the hospital:

• vagosympathetic blockade – used in the treatment of pleuropulmonary shock;
• anesthesia;
• physiotherapy;
• puncture of the pleural cavity - relevant when blood accumulates between the layers of the serous membrane;
• drainage of the pleural cavity - installation of drainage, which facilitates the removal of pathological contents.

For complex rib fractures, the duration of treatment depends on the severity of the complications and the general well-being of the patient.

Therapy at home

The algorithm for treating rib fractures at home depends entirely on the severity of the injury. However, it should be borne in mind that those patients who are diagnosed with a fracture of one or a maximum of two ribs are treated at home, otherwise treatment takes place in a hospital. To speed up recovery at home, you need to take medications, primarily anti-inflammatory and painkillers. If the patient has to breathe shallowly due to severe pain, then an infectious process develops in the sternum area. Pain syndrome can be eliminated with the help of drugs “Ibuprofen”, “Ketorol”, “Naproxen”.

Medicines should be taken regularly, and not just when pain occurs. Gradually, as the severity of pain decreases, the dosage of drugs is reduced until they are completely discontinued. In addition to taking medications, you should perform breathing exercises, which consists of 10 slow breaths every hour. It is useful to periodically apply cold compresses, which reduce swelling of the chest and help resolve bruises. For the same purpose, you can use absorbable cooling ointments with anti-inflammatory effects. During therapy, you should try to breathe fully. The patient must also follow a diet, wear a special corset, and follow all medical recommendations.

Treatment of rib fractures at home is quite possible. While awake, it is recommended to perform simple gymnastic exercises that will help maintain body tone. It is not recommended to stay in bed all the time. This can provoke the development of congestion, the development of pneumonia and other serious complications.

Treatment at home

How to treat broken ribs at home and is it possible? The most common question among people. Many patients, not knowing how to treat a rib fracture, assume that it is impossible. However, treatment at home is possible.

As a rule, fixation of damage is required only for serious fractures. If an uncomplicated bone injury is registered, the doctor will prescribe outpatient treatment. To treat a rib fracture at home, a specialist draws up a treatment program, which includes:

• medication regimen;
• certain bed rest;
• daily therapeutic exercises;
• diet.

It is mandatory to take medications. A specialist may also recommend wearing a bandage, which promotes rapid fusion of bone tissue. The bandage must be correctly selected and fit snugly to the body, thereby creating a fixing effect. These measures contribute to anatomically correct comparison of fragments, adequate fusion of bones and restoration of vital functions.

How to determine whether a rib is fractured or bruised?

Bruised ribs are a fairly common phenomenon, and it is especially important in winter, when the number of provoking factors (strong wind, ice) increases. At first glance, it seems that there is no serious danger in such an injury and therapy is not necessary. In many cases, the pain in the damaged area may increase, and upon diagnosis, not only a bruise is detected, but also a rib crack.

To determine the nature of the injury, in particular a rib fracture or bruise, you need to see a doctor and take a chest x-ray. The symptoms of these injuries also vary greatly. With a rib fracture, the pain is more intense than with a bruise. Under no circumstances should you suspect such an injury to stay home and ignore the symptoms. The same applies to self-medication. If a rib is bruised or broken, you should immediately go to the hospital, where a traumatologist will accurately determine the nature of the injury and prescribe the most appropriate treatment.

What type of rib fracture can be seen on x-ray? Let's look further.

First aid

First aid for rib fractures is necessary to reduce pain and prevent complications. First of all, if a problem is detected, you should call a doctor at home.

After this, you need to perform the following steps:

• Fix the patient's body in the most appropriate position to reduce pain and prevent collateral damage. It is best if your back rests against a hard surface. It is recommended to place a cushion under your feet;
• Give the patient an analgesic and herbal sedative (motherwort, valerian extract);
• Apply a thick and tight bandage of bandages or rags to the chest;
• Apply dry or regular ice to the damaged area.

It is not recommended to move the patient on your own, including to send him to the hospital, and you should also not start therapy at home.

Types of rib fractures

Depending on the presence of skin damage, rib fractures are:

• open – the integrity of soft tissues and skin is disrupted by bone fragments;
• closed - fragments are located in soft tissues and do not damage the skin.

Depending on the complexity of the damage, a rib fracture occurs:

• subperiosteal, when the costal bone tissue is damaged;
• complete, in which the bone is damaged throughout its entire thickness;
• a crack when only bone tissue is damaged and there is no fracture.

By location:

• unilateral rib fractures – violation of integrity on one side of the sternum;
• bilateral – the ribs on both sides of the chest are damaged.

There is also a fenestrated fracture of the 6th rib, for example, which is characterized by damage to the bone in two places at the same time, resulting in a movable fragment.

By number of faults:

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

Physiotherapy

The basis for the rapid fusion of ribs is the implementation of therapeutic exercises. It is more advisable to start exercising when the pain when moving stops. Exercises must be performed daily.

Recommended set of exercises to be done at home:

1. Take a position sitting on a chair. Raise your arms above your head and hold this position for 1-3 seconds. Then slowly lower your hands. Perform five repetitions.
2. Starting position – sitting on a chair. Raise your shoulders and hold the position for 5 seconds. Then slowly lower your shoulders. Perform five repetitions.
3. The exercise must be performed while standing. Raise your arms up, slowly stretch upward. Perform 3-4 times.

The number of repetitions must be increased gradually up to 10 times. In the future, you can increase the number of approaches and bring it to 4–5. It is also necessary to perform exercises aimed at training breathing. Breathing exercises prevent possible oxygen starvation and have a beneficial effect on the entire body.

Set of exercises:

1. Take a comfortable position. Take a deep, controlled breath. Hold your breath for 5 seconds. Exhale slowly.
2. Starting position: sitting. Place your hands on your knees. Inhale and exhale evenly for 10-15 minutes.

A complex of physical therapy and breathing exercises must be selected depending on the severity of the injury.

How to sleep?

There are twelve pairs of ribs in the human chest, and their fractures, according to statistics, account for about 15% of other bone injuries. Such injuries occur during road accidents, domestic accidents and fights.

How to sleep with a broken rib and lead a normal life? Patients in this condition experience significant limitation of mobility, increased pain when changing body positions, and a constant feeling of discomfort. If a person still suffers some pain while awake, then during sleep a rib fracture causes a lot of unpleasant sensations. Patients develop traumatic insomnia, the person cannot fall asleep for a long time, and often wakes up trying to roll over on his side.

Medical advice is to choose the most suitable sleeping position. With this injury, it is best to sleep on your back, but many patients feel better sleeping on their side. In such poses, it becomes easier for a person to breathe.

A good solution to this problem is to sleep on a reclining chair. If a person sleeps on a bed, then pillows can be used for comfort. They should be placed in such a way that you do not wake up at night from pain due to involuntary body movements. You can place a pillow under your knees, which is effective in relaxing your back.

In addition, experts recommend taking painkillers or even sleeping pills before going to bed.

Features of the rehabilitation period

The peculiarities of rib fractures and their treatment create some difficulties for patients while leading their usual lifestyle. Many people have problems sleeping and putting on clothes. In order to simplify the recovery process, you must use the following recommendations:

1. Lying and sleeping when the front part of the ribs is fractured is allowed only on a hard surface and on the back;
2. If the fracture occurs on the back of the chest, resting is only possible on the opposite side.

Physical activity during the rehabilitation period should be limited. It is recommended to take daily walks in the fresh air, as well as enrich your diet with foods rich in calcium and vitamins.

Prevention and prognosis

So, we looked at the symptoms and treatment of rib fractures. The prognosis for uncomplicated single injuries is most favorable. With multiple rib injuries, especially complicated ones, the prognosis depends on the adequacy and timeliness of the start of treatment measures. The approximate period of disability for simple injuries is 1 month. The duration of treatment for complex and multiple fractures is determined by their severity and the general condition of the patient.

Primary prevention of these injuries involves taking measures to reduce injuries. A reduction in the risk of complications is observed with immediate consultation with a doctor and early initiation of medical procedures.

When driving in a car, it is recommended to use seat belts and follow traffic rules.

Symptoms

Rib fractures are a violation of integrity that is caused by physical force or pathologies. The symptoms of this injury are varied, taking into account the location and severity of the victim’s well-being. When a rib is broken, the following general symptoms are observed:

• Painful sensations. After a fracture, dull discomfort occurs that increases with inhalation or coughing. It is triggered by irritation of the nerves of the pleura and muscles between the ribs by bone fragments.
• Forced position of the victim. To reduce discomfort, a person takes a position that minimizes movement in the chest. Basically, the victim bends towards the side where the broken ribs are located.
• Shallow breathing. This manifestation is also associated with pain. During inhalation, a person breathes so that the chest moves to a minimum.
• Interrupted inspiration syndrome. Sometimes, during the process of inhalation, the victim experiences severe discomfort and breathing becomes intermittent.
• Changes at the site of injury. The skin over the broken rib swells. Mechanical action on the skin causes bruises.
• Breast deformity. Occurs in the process of damage to two or more ribs. In particular, this manifestation is noticeable in people with a thin physique.
• Crepitus. With a multiple fracture without displacement or with a large number of fragments, a characteristic click occurs when the bones come into contact during friction.

The nature of the symptoms of a rib fracture, which is complicated by organ damage, will depend on adjacent injuries. In addition to the manifestations that are characteristic of an uncomplicated fracture, the victim has a rapid pulse and pallor.

In addition to the described symptoms of rib injury, the patient experiences:

• Lung damage. A person develops subcutaneous emphysema, which is associated with breathing problems and air penetration under the skin. When you cough, blood is released.
• Aortic lesions. Significant blood loss leads to the death of the victim.
• Heart damage. Often observed with a combined fracture of the chest and ribs. They can cause death or heart contusions, complicating future life.
• Liver lesions. Large loss of blood causes death.

This list of signs of a rib fracture is not exhaustive and will depend on the location of the injury.

Diagnostics

When a person comes to the hospital, doctors conduct an initial examination and use various diagnostic methods. They are necessary to determine the severity of the injury, the presence or absence of pneumothorax and other complications.

Diagnostic methods:

• Palpation and auscultation are physical methods of medical diagnosis, characterized by palpating the patient’s body and listening to sounds produced during the functioning of internal organs and their damage;
• Clinical and biochemical blood test;
• Pleura puncture, its study;
• X-ray and MRI of the chest.

After receiving the diagnostic results, treatment is prescribed on an outpatient basis or sent to a hospital.

Mechanism of injury

The most common location for a fracture is the area of ​​greatest bending, that is, along the axillary line on the lateral surfaces of the chest. The most common fractures are the 5th-8th ribs. Damage to ribs 9-12 occurs most rarely. This is due to the fact that these ribs have greater mobility, especially in the distal parts.

Fractures in the posterior part of the costal arch have a blurred clinical picture. This is explained by less mobility of bone fragments in this area during breathing. Fractures in the lateral and anterior parts of the costal arch are the most difficult to tolerate and the symptoms are very pronounced. Let's look at the 3 most common types of fractures depending on the mechanism of injury.

Rehabilitation period

During the rehabilitation period, the victim is prohibited from physical activity for 1-2 months.

He is prescribed physical therapy and breathing exercises to develop his lungs and prevent the development of pneumonia. The success of therapy depends on the patient’s self-discipline and compliance with the recommendations of the attending physician.

Medicines

Medicines for fractures are aimed at eliminating symptoms and healing bone tissue.

Painkillers are used to relieve pain. The type of analgesic will depend on the intensity of the pain syndrome and the pain threshold of the victim (Analgin, Ketorol, Pentalgin, Solpadeine).

If the patient experiences an inflammatory process in damaged tissues, anti-inflammatory drugs (Ibuprofen, Nurofen, Nimesil) are prescribed. They have a complex effect: they relieve pain, swelling and act as an antipyretic.

To relieve severe swelling, diuretics are used (Furasemide, Veroshpiron, Indapamide).

To strengthen the body and regenerate bone tissue, vitamin and mineral complexes are prescribed. The main elements in this process are calcium and vitamin D, necessary for its absorption (Calcemin, Calcium Gluconate, Calcium D3 Nycomed).

For local effects, ointments are used for fractures of rib cartilage with a distracting and analgesic effect. Products with warming properties provide blood flow and have an anti-inflammatory effect. They can be used only a day after the injury. Cooling - relieve pain and can be used at any period of treatment ("Fastum gel", "Menthol ointment", "Apizatron").

Physiotherapy

Physiotherapy is carried out to speed up the healing process. Methods of laser therapy, ultrasound, magnetic therapy, electrophoresis with anti-inflammatory and absorbable agents and phonophoresis are used. They improve tissue permeability and promote the active penetration of medicinal substances into cells, trigger natural regeneration processes, improve blood circulation and lymphatic drainage, reduce pain and relieve swelling.

Nutrition

To strengthen the body after an injury, the patient benefits from a diet high in vitamins, minerals (primarily calcium) and proteins. Foods containing large amounts of calcium include: dairy products (the maximum concentration is found in cheese and cottage cheese), nuts, legumes and seeds (beans, green peas, almonds, sesame).

Foods that promote the absorption of calcium are vegetables, herbs, fruits, berries and dried fruits (asparagus, carrots, cabbage, gooseberries, apricots, blackberries, celery, seaweed). Among seafood, sea fish (salmon, sardines, cod) are useful.

As a source of vitamin D, which affects the absorption of calcium, eat fish oil, fish, eggs, vegetable oils and liver.

As an additional source of vitamins, use vitamin-mineral complexes as prescribed by a doctor.

Vitamin C is necessary for the formation of collagen; it is found in large quantities in citrus fruits, herbs, garlic ; it is also useful to consume gelatin and products containing it (jelly, jellied meat, marmalade) for the formation of collagen.

Physiotherapy

Breathing exercises for fractures and cracked ribs are a traditional practice in the treatment process. Breathing exercises begin 3-5 days after the injury.

Here is a sample list of breathing exercises:

• sitting with a straight, level back, take 6-7 deep breaths: inhale through your nose and exhale through your mouth,
• while sitting, pronounce the sound “he”, imitating coughing,
• while sitting, raise your shoulders as you inhale and lower them as you exhale,
• while standing, raise your arms to shoulder level while inhaling, while exhaling, lower your arms,
• while sitting, place your hands on your shoulders and do 10 circular rotations in both directions,
• walking in place or on a treadmill for 30-40 minutes,
• Place your hands behind your head and take a few breaths.

Advice. Perform all exercises without haste, following the correct technique; exercises should not cause you discomfort or cause pain. If pain occurs, stop the exercise and move on to the next one.

Other additional exercises from the list of exercise therapy for rib fractures can be prescribed to you by a physical therapy specialist, an orthopedist or a surgeon.

How to sleep with broken ribs

If you have a fracture, it is important to choose a comfortable sleeping position that will not cause pain or restrict your breathing. You can sleep on your side or back.

If you have a unilateral rib injury, doctors recommend sleeping on the side of the injury. This will keep the damaged ribs in a stationary position and make breathing easier with the healthy half.

You can also sleep in a reclining chair.

If you sleep comfortably on your back, place pillows under your arms to prevent you from rolling over while you sleep. Also place a pillow under your knees, this will relax your back muscles and spine.

Before going to bed, it is useful to do breathing exercises and take a few deep breaths. This relaxes and improves oxygen exchange.

Avoid active movements, coughing and stretching. This is painful and can harm injured ribs and internal organs. Use extra pillows to limit the mobility of the ribs during coughing; do not use pressure bandages on the ribs, they can lead to the development of pulmonary pathologies.

Sleep more, your body needs strength to recover. Night sleep should last at least 8 hours. If you feel tired or drowsy during the day, take a nap. For good sleep, go to bed at the same time, try not to eat at least 2 hours before bed, do not drink alcohol or caffeine before bed, and keep the room dark, quiet and cool.

Classification of fractures

Depending on the specific diagnosis of rib fracture, the ICD 10 code may vary in the last digits. However, the general designation of injuries in the sternum area is provided by code S22.

Let's look at the detailed designations of diagnoses:

• a rib fracture according to ICD 10 is designated by code S3;
• fractures of several ribs according to ICD 10 are coded S4;
• a wound to the sternum is recorded with code S2;
• thoracic vertebra injury - S0;
• multiple injuries to the vertebrae of the thoracic region - S1;
• when the sternum is retracted, the code S5 is set;
• damage to other parts of the chest - S8;
• a fracture of unknown location is recorded by recording S9.

For example, with a closed rib fracture, the ICD 10 code is S22.3 or S22.3.0. These values ​​will be equivalent.

This is the classification of subsection ICD 10 (fracture in the chest area and the corresponding vertebral area).

The general category of rib fractures is identified by ICD 10 code S22. For a more accurate diagnosis, the coding contains auxiliary numbers that indicate the specific type of injury.

Mechanism of occurrence

There is also a more detailed classification of compages thoracis injuries according to ICD 10. Costa fracture is only one of the categories in this group. But it is worth examining in more detail the mechanism for obtaining this type of injury.

The causes of fracture formation are divided into two types:

• Traumatic. A fracture results from an injury that places excessive pressure on the chest. This includes situations such as motor vehicle accidents, blunt force trauma, falls, sharp object injuries, gunshot wounds, and upper body compression.
• Pathological. A crack or fracture is a consequence of some disease or pathological process in the body. They are associated with a deterioration in the strength of bone tissue (osteoporosis), an inflammatory process in it (osteomyelitis), pressure on the bone and cartilage (tumor process in neighboring tissues), etc.

Thus, the cost of carelessness or a frivolous attitude towards one’s health can result in a violation of the integrity of the rib bones, which is fraught with a lot of negative consequences.

Main symptoms

Any costa fracture has approximately the same symptoms.

The first signs of this type of damage may be:

1. Pain. Severe pain occurs after injury; with palpation, breathing or movement, the unpleasant sensations intensify.
2. Breathing problems. Shortness of breath occurs, breathing becomes shallow due to pain. Broken parts of the bone can create the effect of retraction of compages thoracis or its abnormal movement during inhalation and exhalation (one-sided, opposite, etc.)
3. Swelling. Soft tissue swelling and hematoma develop.
4. Change in skin color. With superficial injuries, a large bruise forms and the skin may turn pale.
5. Cough. A severe cough appears, which the victim is forced to suppress. Phlegm accumulates in the lungs, which needs to be coughed up. When lung tissue is damaged, hemoptysis is present.
6. Crepitus. This can be either the crunching of bones or the “creaking” of air accumulated under the skin.

When soft tissues and blood vessels are damaged, an internal hematoma develops and bleeding occurs. This can lead to the accumulation of blood (hemothorax) or air in the pleural layers (pneumothorax). With severe injuries, there is a risk of developing congestive and post-traumatic pneumonia, especially in older people, or pleuropulmonary shock.

Fractures and their treatment

Doctors note that treatment is based on determining the severity of the injury and the presence of damage to internal organs and tissues

• If there is a slight fracture, the person is given a circular bandage made of elastic bandages. This process is called taping. He also numbs the damaged area with novocaine: a local anesthetic with 1 ml of 70% ethyl alcohol is injected.
• If the damage area is large, then narcotic drugs are used. The chest is fixed using a plaster corset or bandage.
• If there is bilateral damage and a large number of bone fragments, the patient may undergo surgery. It is aimed at installing special fixing plates that hold the bones in a stable state until complete fusion.
• The operation is also performed for open fractures. During it, the doctor treats the edges of the wound, removes damaged tissue and ligates severely damaged large vessels. After all the manipulations, the wound is sutured.
• If a patient develops pneumonia, he may be prescribed antibiotic and symptomatic drugs.
• If a patient develops pneumothorax, a puncture of the pleural cavity is performed. Pumping out air and restoring normal breathing is carried out using a vacuum pump.
• In the presence of extensive hemothorax, the patient also undergoes a puncture of the pleura and drainage of blood. If there is not enough accumulated blood, then the incision is not made and the blood resolves on its own.
• If a patient develops pneumothorax, hydrothorax, or respiratory failure, he is prescribed special medications.
• In order to remove the effects of oxygen starvation, the patient is prescribed oxygen inhalations.

Unlike a fracture, bruised ribs are treated by keeping the patient completely at rest and applying absorbable ointment to the damaged area. If a person has severe pain, he can take a pain reliever.

Anatomical structure of the thoracic region

In order to classify a rib fracture code according to the ICD, it is necessary to take a more in-depth look at the structure of the thoracic region. From the anatomy course, everyone remembers that a person has 12 pairs of ribs.

There are 3 types of them:

1. True . They are connected to the spine, as well as the sternum, using the sternocostal joints. These include pairs 1 to 7.
2. False . They are connected to the spine, and in the anterior part they are fused together with cartilaginous tissue and are adjacent to the articular part of the 7th pair of true ribs. These include 8, 9 and 10 pairs.
3. Hesitant . They come out of the spine and have a free cartilaginous edge, not connected to anything. These are the last 11 and 12 pairs.

The ribs are made up of bone and cartilage tissue. Damage may affect both areas. Much depends on the cause of the injury and the force of impact on the compages thoracis. Neighboring areas may also be affected: the sternum, spine and its processes.

Complications after a fracture

If the fracture is severe or undertreated, it causes complications. Complications from a displaced rib fracture may include pneumonia, pneumothorax, hemothorax, or emphysema.

Pneumonia develops when the patient remains immobile for a long time and has poor ventilation, a weakened body and the presence of a source of infection.

Hemothorax is a collection of blood in the lungs. It is accompanied by a drop in blood pressure and the development of arrhythmia. Minor hemothorax is diagnosed when an outpouring of no more than 500 ml of blood occurs. From 500 to 1000 ml, when the level of accumulated blood on the x-ray reaches the level of the angle of the scapula, the average hemothorax is determined. A large hemothorax is accompanied by an accumulation of blood of more than 1000 ml.

Hemothorax can also be infected or uninfected. If it is combined with pneumothorax, hemopneumothorax is recorded.

Pneumothorax is accompanied by the accumulation of air between the layers of the pleura. The pleural layers move apart under the influence of air pumped from the damaged lung tissue. If the pneumothorax is closed, then the air ends up in a confined space of the lung. If air only enters the lung and does not exit, a valve or tension pneumothorax is formed. Excess air pushes the mediastinum, heart, blood vessels and diaphragm to the opposite side, causing disturbances in breathing and circulation.

Pneumothorax is limited in size when the lung is compressed by a third of its volume, medium - by half its volume, and large or total when the lung is completely compressed.

Subcutaneous emphysema occurs when accumulations of air from the lung move to adjacent areas of the body: neck, abdominal wall. Mediastinal emphysema is a disease in which air enters the mediastinal tissue. The disease causes disturbances in blood circulation and heart function.

Can there be a fever with fractures? Yes, if the injury caused pneumonia. Although sometimes older people do not have a fever and only a deterioration in their general condition is observed.

If the victim is in poor health, the fracture may not heal for a long time. In this case, the problem arises - what to do if the bone does not heal after a fracture.

There are a number of recommendations to resolve the issue:

• you should strictly follow all the doctor’s instructions, do not remove the cast prematurely, do not put stress on the damaged part of the body,
• for a weakened body, vitamin and mineral complexes and a diet are prescribed.

Conditions on which the duration of recovery depends.

The recovery period is affected by several factors. The speed of healing, as well as long-term consequences, depend on their combination. The most important conditions include:

• Patient's age. Acceleration of recovery is observed in patients at a young age. For older people, it takes longer for the damage to heal. In most cases, the rate of cartilage formation and how long it takes for a rib fracture to heal depends on age.
• Size and type of bone. The highest recovery rate is observed for small bone fractures.
• Body weight. If you are overweight, recovery takes longer due to excess load on the damaged area.
• Accompanying illnesses. With metabolic disorders, for example, diabetes, rheumatoid arthritis, tissues grow worse.
• Bone structure. Longer recovery is observed when dense bone is damaged.
• View. Rapid recovery is observed with closed types of injuries. Violation of the integrity of the skin becomes the cause of infection, which can lead to suppuration.
• Damage to ligaments and tendons. Rupture of ligaments and tendons requires surgical intervention to restore their integrity. Multiple nature of damage. If several bones are destroyed at once, it may be necessary to apply an extensive immobilizing bandage. In this case, the period after how many days the rib fracture heals is extended.
• Time of medical care. When you seek help early, recovery occurs faster due to the fact that the risk of complications is reduced.

Recovery after injury

To combat the consequences of chest trauma, external and internal means are used:

1. Olive oil is mixed with 500 mg of mumiyo, the resulting mass is rubbed into the fracture area.
2. Raw potatoes are grated on a fine grater, and the pulp is applied to the injured area. Used as a painkiller and relieves swelling.
3. Remove the shells from boiled eggs, remove the films, and grind in a coffee grinder. Take 0.5 tsp orally. twice a day with meals.
4. A burning ointment is used to restore bone tissue. To prepare it, take 1 tablespoon of spruce resin, mix with 20 g of copper sulfate and mashed onion, add 50 g of sunflower oil. The mixture is heated before use.
5. A decoction of ivy budra is used in the form of compresses and lotions. The grass (1 tbsp) is poured with a glass of boiling water. Keep in a water bath for 10 minutes, filter, cool. Moisten a linen cloth and apply it to the fracture site. Remove the bandage after complete drying.
6. To prepare an immunostimulating mixture, take 1 glass of walnuts, honey, raisins, dried apricots, add squeezed crushed lemon. The mass is twisted and taken orally, 1 tbsp. l. after meal.

To help the bones heal as quickly as possible, the doctor prescribes physiotherapeutic procedures:

• magnetic therapy;
• UV irradiation;
• electrophoresis;
• hirudotherapy;
• UHF;
• interference currents.

In order for the rehabilitation period to go well, you should not lift heavy objects, make sudden movements, and avoid excessive physical exertion. Complex rib fractures can pose a threat to the life of the victim, so you need to be responsible for the treatment process and subsequent recovery from injuries.

First aid

1. First of all, call an ambulance.
2. Apply cold (ice pack or frozen food, cold water bottle) to the damaged area as quickly as possible. This will help relieve pain, reduce swelling and reduce the risk of hematoma.
3. You should take a strong pain reliever (Ibuprofen, etc.). You can use anti-inflammatory ointments and gels.
4. The victim is not recommended to move actively, since any movement can lead to complications.
5. To make breathing easier, you need to lie on the side that was bruised.
6. It is forbidden to apply a pressure bandage until examined by a doctor.

How to reduce the time it takes for a rib to heal after a fracture

In order to shorten the period of time it takes for a broken rib to heal, it is recommended to follow rules that affect various areas of the patient’s life. Their implementation is necessary from the moment of injury until the complete fusion of the fragments.

Medicines

In order to speed up the healing process with the help of medications, you must first carefully select the drug. Despite the great popularity and prevalence of calcium supplements, they must be taken in accordance with the doctor’s prescription, as well as the instructions, which indicate the required dosage and duration of use. Consumption of high dosages increases the risk of developing urolithiasis and heart rhythm disturbances.

The most effective are combination products that additionally contain vitamin D, phosphorus and magnesium. These drugs are well tolerated and absorbed from the digestive tract.

Osteogenon is currently widely used. It additionally contains collagen and collagen fibers. In this case, calcium is delivered directly to the bones, without being deposited in the kidneys in the form of salts, which prevents urolithiasis.

Physiotherapy

Physiotherapeutic procedures can be used immediately after a fracture. They allow:

• Reduce the severity of tissue swelling.
• Improve microcirculation by increasing the supply of oxygen, nutrients and calcium.
• Relieve pain syndrome that worsens the patient’s quality of life.
• Relax your muscles and relieve spasm and tension.
• Maintain muscle tone to prevent atrophy.

The rules for conducting physiotherapeutic procedures include:

• Compliance with staged procedures. Incorrect selection of techniques will slow down the regeneration process.
• Gradual change of methods. As the bone heals, the patient changes the duration and intensity of the procedures.
• Individual approach. Treatment tactics are selected depending on the individual characteristics of the patient.
• Monitoring the condition of the fracture by a specialist.

Among the most popular techniques used for fractures are:

• UHF therapy. Warming procedures can be prescribed several days after traumatic exposure. After a 15-minute procedure, blood vessels dilate and blood flow improves.
• Magnetotherapy. The procedure is aimed at improving the metabolism of phosphorus and calcium. Achieving a positive effect is observed 15 minutes after the procedures.
• Electrophoresis. The technique leads to a decrease in the severity of pain. Anesthetics are allowed to be used as medicines. The average duration of treatment is 10-15 procedures.

Nutrition

After a fracture occurs, the body will need nutrients. Among them are antioxidants. These components not only speed up the healing process, but also prevent the development of an inflammatory reaction. These include vitamins C, D, K and B6.

Minerals are used to heal fragments. Among them are calcium, copper, zinc and silicon. The main nutrients that should be present in the diet include proteins. This could include dairy products, beans, marine fish, and whole grains.

Antioxidants include nuts, dried fruits and legumes. In order to prevent calcium loss from bones, it is necessary to limit the consumption of red meats, carbonated drinks, sugar, as well as alcohol and caffeine.

The period of fracture recovery and how long the damaged area heals depends on adequate nutrition.

Physiotherapy

Therapeutic exercises can be prescribed in the early recovery period. After applying a tight bandage, the patient is recommended to perform breathing exercises. This requires taking deep breaths so that the deep parts of the lungs are affected.

As healing proceeds, gymnastics is added, aimed at preventing muscle atrophy and maintaining their tone.

In order to determine whether the ribs are healing after a fracture and whether the healing process is disrupted, it is necessary to regularly visit a doctor.

Types of rib injuries and their symptoms

Second degree rib injury is characterized by the presence of hematomas.
In the international classification of diseases, there are several degrees of rib bruises:

• The first degree of damage is characterized by unexpressed pain, but it can intensify with palpation and sudden movements; with a long stay at rest, the discomfort may disappear. Medical assistance is not required in this case, since the injury does not pose a threat to life and goes away on its own within 1-1.5 weeks. Minor injuries also include a rib injury without a bruise (hematoma).
• The second degree of injury is characterized by the appearance of a hematoma; the victim is bothered by pain, which becomes more noticeable when trying to move. In this case, it is necessary to undergo medical diagnostics to ensure that there are no cracks or fractures; the bruise itself is treated with anti-inflammatory and absorbable drugs.
• The third degree of damage is assigned to people after a fall from a height or after an accident. A third degree sports rib injury is also possible. The characteristics of the injuries are a combined clinical picture, which is caused by lung compression syndrome. The patient has difficulty breathing; when trying to take a breath, severe and sharp pain occurs, and painful shock is possible.

Symptoms of a rib fracture

Serious rib injuries require medical attention. If, when a rib is displaced without a fracture or with a violation of the integrity of the bone tissue, the treatment is incorrect or delayed, complications may develop, the most dangerous among them being death.

The degree of pain in the first minutes and even hours can vary. Sometimes the severity of the clinical picture is so strong that the patient is hospitalized in the inpatient department in a state of shock.

If after some time the pain subsides, this does not mean that everything is fine. We may be talking about an imaginary disguise of dangerous conditions. The clinical picture depends on the severity of the injuries received. Typically, bruised ribs can hurt for up to several weeks.

Breathing may be difficult due to severe pain, so in most cases it is not deep, frequent and superficial. If the injury involves soft tissue and the lung, hemoptysis or apnea may occur.

The stronger the bruise, the larger the hematoma will be. At first, its color is red, then as it heals it will darken, and after a few weeks it will turn yellow.

Swelling of soft tissues is an inevitable phenomenon. Soon after injury, a compaction forms, which reaches its largest size after a few hours. After about a day, the swelling goes away.

The appearance of dizziness due to injury is a dangerous symptom

Each case is individual, so additional symptoms may occur. Among the most dangerous are the following:

• pain in the heart area;
• dizziness;
• rapid breathing - 28-30 times per minute;
• confusion;
• high heart rate (more than 120-160 beats per minute);
• fainting.

Before the ambulance team arrives, you need to help the victim take a horizontal position, unfasten the buttons on his clothes and try to calm him down; movements should be limited.

Possible complications and consequences

With rib injuries, the heart and lungs often suffer, which is dangerous due to various complications.

Consequences of a rib fracture:

• with multiple, bilateral fractures, hemothorax develops, pneumothorax - accumulation of blood or air in the pleural cavity, the damaged lung ceases to function, and hypoxia develops;
• if the fracture is accompanied by damage to the aorta, liver or heart, there is a high probability of death;
• respiratory, heart failure of varying severity;
• with open injuries, infectious processes develop;
• complete or partial paralysis;
• subcutaneous emphysema.

With multiple and severe rib fractures, pneumothorax of the lung may develop.

Often, after the ribs fuse after serious fractures, the pain in the damaged area becomes chronic.

Rehabilitation

To speed up the recovery process, patients are prescribed physiotherapeutic procedures and therapeutic exercises.

Remember that the rehabilitation period increases due to the following factors:

• the patient’s age and the presence of serious illnesses;
• displacement of bone fragments;
• incorrectness of the prescribed treatment.

During rehabilitation, many patients think with horror about how a patient with a fracture of the thoracic ribs can sleep correctly so as not to harm themselves.

Doctors note that the position during sleep depends on the location of the damage:

• In case of injuries to the anterior part of the chest, the patient is recommended to sleep lying on his back, on a hard surface.
• If the back of the chest is injured, the patient should lie on the side that is not affected by the injury.

Rib fractures are a very common occurrence. If they occur, it is important to provide proper assistance to the patient and immediately transport the patient to the nearest hospital. Remember that self-medication in this case is not acceptable. It can only worsen the patient’s condition and lead to death.

Exercise stress

After a chest injury that is accompanied by chest pain, you should consult a doctor. Only a doctor can determine a fracture or bruise after examination and x-rays. The difficulty in timely diagnosing a rib injury is that many people, thinking that a rib fracture is accompanied by bleeding, do not rush to see a doctor without this sign, using incorrect self-treatment methods. Before treating a rib fracture, the diagnosis must be confirmed.

A broken part of a rib may not immediately put pressure on neighboring internal organs, and any sudden movement leads to increased pain and can cause serious complications. At home, after discharge from the hospital, it is necessary to protect the chest with a medical corset or bandage it tightly with an elastic bandage.

To heal a fracture faster, it is necessary to limit movements in the first weeks after the injury. It is recommended not to perform household activities temporarily. It is necessary to protect the chest from sudden movements that can lead to the displacement of fragile bones that have not yet had time to fuse.

Treatment of a rib fracture involves performing special breathing exercises, which are developed by the attending physician. It is necessary to perform inhalations and exhalations correctly in the first stages under the supervision of a doctor, so that a specialist can evaluate the correctness of execution.

You can move fully and return to sports only after the bandage has been removed and an x-ray has been taken, which will confirm complete fusion of the rib bones. Before determining the degree of fusion of the ribs on an x-ray, it is necessary to limit physical activity.

special instructions

After a rib fracture, coughing attacks may occur. Before coughing or sneezing, you need to protect your chest from mechanical stress. Before coughing, you need to apply a pillow or a folded blanket or towel to your ribs and press. If the cough starts suddenly, you need to press down on your chest with your hands.

Particular attention in the treatment of a rib fracture must be paid to the correct posture during sleep. Sleeping on your stomach and side is strictly prohibited!

If a person does not have the habit of falling asleep on his back, and this causes him a feeling of great discomfort and insomnia, before bed you can drink tea with a decoction of soothing medicinal herbs - chamomile, lemon balm, mint.

If a person with a broken rib is afraid that he will roll over on his side at night, it is recommended to place pillows or bolsters made of blankets under his sides. A rigid medical corset will prevent you from turning over on your side. You need to choose a pillow that is not very large and not fluffy. The head should not be much higher than the level of the rest of the body. It is better to keep your legs slightly bent at the knees; for this, bolsters or a pillow are placed under the knee joint.

Although rib fractures are common, they can cause serious complications if not treated promptly. It is strictly forbidden to use traditional medicine methods without the consent of your doctor. It is forbidden to remove the corset or bandages before the time prescribed by the doctor.

Stages of healing of a rib fracture

• Stage 1 – connective tissue callus. At the site of injury, blood accumulates, where cells that produce connective tissue (fibroblasts) migrate with the blood flow.
• Stage 2 – osteoid callus. Inorganic substances and mineral salts are deposited in the connective tissue callus and osteoid is formed.
• Stage 3 – hydroxyapatites are deposited in the osteoid, the strength of the callus increases. At first, this callus still remains loose, its size is larger than the diameter of the rib, then it decreases to normal size.