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The ribs, sternum and spinal column are the framework of the chest. Inside it are the heart and lungs, and, in addition, a huge number of large vessels and nerve trunks. Therefore, a broken rib is a very serious injury. In some cases, it is a serious threat to life, and therefore first aid to a person whose ribs are broken is of great importance.
It should be noted that rib fractures are the most common among chest injuries. Among all fractures, this injury accounts for about 15% of cases. The IV-VII ribs are most often affected. This is due to the fact that where they are located, there is no so-called muscular corset, which effectively protects other ribs from external influences. In addition, they are significantly less flexible.
How severe a rib fracture is is determined by its type, as well as the presence of damage to surrounding tissues and organs. In approximately 60% of cases, such injuries are accompanied by lung lesions, the pleura, esophagus, liver, blood vessels and heart suffer. In this case, even death is possible. Fractures are also dangerous, as a result of which several ribs are damaged. In this case, as with multiple injuries of one rib, the likelihood of developing severe complications increases significantly.
Most often, rib injuries occur in people of the older age group and the elderly, since in children the chest is more elastic, and therefore less prone to such injuries. Knowing how to act and what first aid to provide to a person with a broken rib will help to significantly reduce the risk of complications and speed up his full recovery.
Anatomical reference
The thorax consists of twelve thoracic vertebrae, to which twelve pairs of ribs are attached with the help of joints. The sternum is located in front, to which the cartilaginous parts of the ribs adjoin.
All ribs are divided into three types: true (I-VII pair), false (VIII-X pair) and oscillating (XI-XII pair). The difference between them is that the true ribs are connected to the sternum by their own cartilaginous plates, and the false ribs are not directly connected to the sternum, their cartilaginous parts are fused with the cartilage of the ribs, which are located above. Finally, the cartilaginous part of the oscillating ribs is generally devoid of articulation with anything.
On the inner side of the ribs there is a groove in which the neurovascular bundle is located. If the rib breaks, then it is also often damaged, which is fraught with the development of bleeding and malnutrition of the intercostal muscles.
Causes of trauma
Depending on the condition of the ribs, experts distinguish between two types of their fracture. The first type is damage to healthy bones provoked by mechanical trauma. The second is pathological fractures, which are caused by changes in the bones, provoked by various diseases or minimal physical impact.
Fractures of the first type can be provoked by traffic accidents; a blow to the chest; falling from a height; injuries sustained during sporting events; gunshot wounds. In this case, the impact on the ribs can be indirect or direct. With indirect impact, the chest is compressed, as a result of which the ribs break on both sides of the place of pressure. As a rule, several ribs are affected at the same time. In the case of direct impact, the ribs break directly on the side subjected to this impact. In such a situation, debris can damage internal organs.
Fractures of the second type occur due to minimal mechanical impact on the ribs in patients suffering from osteoporosis, rheumatoid arthritis, osteomyelitis, genetic diseases and tumors of the ribs.
Classification of rib fractures and mechanism of injury
Rib fractures are classified according to several criteria. This is the presence or absence of skin damage, the degree of damage, localization, number of fractures, the presence of displacement of bone fragments.
So, according to the presence of damage to the skin, injuries are divided into closed (without damage to the skin, since bone fragments are located in the thickness of soft tissues) and open (with damage to the skin and soft tissues by bone fragments).
According to the degree of damage, complete fractures are distinguished, in which the bone is damaged throughout its entire thickness; subperiosteal fractures, in which bone tissue is damaged; cracks.
According to the place of localization, fractures are divided into unilateral (the integrity of one or more ribs is broken only on one side of the chest); bilateral (the ribs are damaged both on the right and on the left), as well as fenestrated (damage to the ribs occurs on one side of the chest, but in two or more places, resulting in a mobile bone fragment).
According to the number of fractures, injuries are divided into single and multiple.
According to the presence of displacement of bone fragments, fractures are with displacement and without displacement.
Most often, the fracture occurs in the zone of greatest bend, in other words, along the line of the armpit on the lateral surface of the chest. The most severe for the patient are fractures in the lateral and anterior parts of the costal arch, the symptoms are very pronounced, and first aid should be provided immediately. With fractures in the back of the costal arch, the symptoms are blurred, since the bone fragments in this area are less mobile during breathing.
Signs and symptoms of injury
How pronounced the symptoms are with a fracture of the ribs depends on the location of the injury, its severity, and also on whether the organs located nearby are affected or not.
Pain
Immediately after the injury, a dull pain appears in the area of the injured rib. It is caused by the fact that bone fragments irritate the nerve endings of the pleura and intercostal muscles. When a person inhales deeply or coughs, the pain syndrome intensifies. If the fracture is located on the front of the chest, the pain is more intense, and in case of damage to the costal bones on the back of the chest, the pain is less pronounced. Victims move very slowly, saving movement. When the patient lies or sits, the pain usually decreases.
Shallow breathing and the syndrome of interrupted inspiration
Due to the fact that with a deep breath the pain increases significantly, the patient tries to breathe so that the movement of the chest is minimal. It is noteworthy that from the side where the fracture is located, the chest seems to “lag behind” in breathing.
In addition, the so-called “syndrome of interrupted breath” is recorded in patients. A person tries to take a deep breath, but due to increased pain, he refuses this attempt. It is the presence of the “interrupted breath” syndrome that makes it possible to differentiate a fracture of the ribs from just a severe contusion of the chest.
Sometimes the inability to take a deep breath can provoke a panic attack in a person, attacks of uncontrollable fear, which must be stopped as soon as possible so that the patient’s condition does not worsen.
forced posture
To reduce the intensity of pain, the victim subconsciously tries to take a position that would help minimize the movement of the chest. As a rule, a person leans in the direction where the ribs are broken, or covers the chest with his hands, as if holding it.
Visual changes in the area of damage to the rib
At the site of the lesion, even with a closed fracture, edema appears, hematomas are noticeable, more or less pronounced.
Breast deformity
If several ribs are damaged at once, a visual change in the shape of the breast may occur. This symptom is especially pronounced in thin people – they have not only a deformity of the chest, but also a kind of “erasing” of the gaps between the ribs.
Crepitus
If a person has received multiple fractures without displacement, when probing the damaged area, a specific crunch appears, caused by the friction of the adjacent bones.
Cough
In some cases, the patient has coughing fits, which are quite painful. If bone fragments have damaged internal organs, then hemoptysis is possible.
Axial Load Syndrome
An important sign of a rib fracture is the so-called “axial load syndrome”. Check it by alternately squeezing the entire chest. Since it is a bone ring, when some of its sections are compressed, the load on others increases significantly. If a person’s ribs are broken, then during compression, the victim feels pain not at the site of compression, but directly at the site of the fracture.
Symptom Path
When trying to tilt in the opposite direction from the fracture, the patient experiences a sharp pain.
Other common symptoms include pale skin, tachycardia, and possible loss of consciousness.
It is noteworthy that with so-called simple fractures (injury to one rib without displacement), characteristic symptoms may be absent altogether or appear only after a considerable time after the injury. Therefore, for any injury to the chest, it is desirable to perform x-rays.
Possible Complications of a Rib Fracture
With serious fractures of the ribs, the risk of complications increases significantly, which pose a serious threat to the patient’s life. It should be borne in mind that some of these pathologies develop rapidly, and therefore the person providing first aid to the victim should be aware of the likelihood of their development.
So, the victim may develop pneumothorax – the accumulation of air between the layers of the pleura, as a result of which the respiratory function is impaired. The lung shrinks, being unable to perform its gas exchange functions. In the event that the pressure in the pleural region continues to increase, the mediastinal organs will shift in the opposite direction, as a result of which hemodynamics will be disturbed and cardiac arrest will occur. To save a person, a closed pneumothorax should be made open by performing a puncture in the anterior chest wall, as a result of which a hole appears for air to escape.
Probably also the development of hemothorax – accumulation of blood in the pleural sheets. This makes it difficult for the patient to breathe. If the accumulated blood is not immediately removed by puncture, respiratory failure begins.
If the nearby aortic ribs and vena cava are damaged, severe bleeding may develop. Due to excessive accumulation of blood in the pericardial sac, there is a possibility of developing the so-called cardiac tamponade. If the blood is not removed immediately, the likelihood of death is very high. When the fragments are displaced, bone fragments can touch large vessels, nerves, or vital organs.
Most often, conditions that threaten the patient’s life occur in the case of open fractures of the ribs. In this case, bone fragments are displaced into the mediastinum, as a result of which soft tissues and nearby organs can be damaged.
The most dangerous injuries of internal organs are:
- Lung damage. The victims develop subcutaneous emphysema, as a result of which breathing is sharply disturbed, air enters under the skin. When coughing, blood can be released from the respiratory tract.
- Damage to the aorta, in which, due to massive blood loss, the victim can die on the spot. Fortunately, such injuries are quite rare, only if the fracture of the lungs is combined with a fracture of the spine, or if, due to impact and compression of the chest, many fractures have formed on the left.
- Injuries to the heart, which lead to the immediate death of the patient and occur with a combination of fracture of the ribs and sternum. Heart contusions are also possible, which significantly reduce the patient’s life expectancy.
- Liver damage resulting in severe blood loss.
Most often from the internal organs due to fractures of the ribs, the lungs suffer. Their damage is fraught not only with pneumothorax and hemothorax, but also with respiratory failure, which is manifested by increased breathing, pallor of the skin, and increased heart rate. It is also possible to develop pleuropulmonary shock if a large amount of cold air enters the pleural cavity. Respiratory failure appears, severe cough, limbs become cold. If you do not help a person quickly, he will die.
Mention should also be made of another dangerous complication of a rib fracture, which can make itself felt a few days after the injury if first aid was provided poorly or with delay. This is pneumonia, which appears due to a sharp restriction of movement as a result of pain, the inability to breathe normally, too tight bandage and damage to lung tissue. The development of this complication often depends on the state of health of the patient and on his age – older people are more susceptible to this disease. They may show intoxication, increase body temperature, breathing becomes difficult, general weakness appears. If timely action is not taken, a fatal outcome is possible.
First aid rules
When providing first aid to a person with a broken rib, you need to know exactly what kind of measures should be taken in each case. At first glance, in general terms, they are all similar, however, depending on the nature of the fractures, they may differ. So, with single fractures and cracks, a minimum of actions aimed at alleviating the patient’s condition is sufficient, however, with more complex injuries, it is necessary to perform a clear sequence of actions as soon as possible. Therefore, further we will talk about the features of first aid, depending on the type of fracture of the ribs.
Uncomplicated closed fracture
An uncomplicated closed fracture is the simplest and at the same time the least dangerous type of injury. In this case, one or two ribs on one side are usually affected. Complications develop very rarely, and the victim, as a rule, is quite able to get to the medical facility on his own. However, even in this case, he needs first aid.
First of all, the patient should be given pain medication. It can be Ibuprofen, Analgin or Diclofenac. As a result, the pain symptom will decrease, and the person will be able to adequately assess his condition.
The next step is immobilization of the damaged area. If the injury is mild, then it is enough to stick several wide strips of adhesive tape on the injured area. This will help reduce the mobility of bone fragments.
The victim is helped to take a comfortable position in which the pain syndrome will be minimal. It is best to sit half-sitting or roll over on the damaged side so that the broken ribs are fixed.
Cold is applied to the injury site. It can be an ice pack or a heating pad with very cold water. As a result, sensitivity in the injured area will decrease and blood vessels will narrow. As a result, bleeding, if any, will slow down, swelling will go down and the development of a hematoma can be prevented.
After taking all these measures, the victim must be sent to the hospital. Please note that despite the comparative “lightness” of such an injury, a person should not be allowed to drive himself – his condition can suddenly and very quickly worsen.
Multiple closed fracture
Regrettably, often several ribs can be damaged at once due to trauma. Such multiple fractures are very serious, since broken ribs can damage internal organs. That is why assistance with closed multiple fractures should be provided immediately.
The victim is given an anesthetic to stop the pain syndrome, after which the chest is freed from excess clothing, facilitating the flow of air. The patient must be immobilized, having previously positioned him as comfortably as possible. The optimal position is half-sitting or lying on the affected side. In order to fix the ribs, a tight bandage should be applied, which, however, should not interfere with respiratory movements. To avoid displacement of fragments, the patient’s hand can be used as a splint.
In order to reduce the intensity of pain and relieve swelling, dry cold should be applied to the injured area. After that, it is necessary to call an ambulance and carefully monitor the patient’s condition until the doctors appear. In the event that pre-hospital care was provided correctly, this will facilitate further treatment and reduce the risk of soft tissue damage during patient transport to a medical facility.
Open fracture
An open fracture is an injury that carries a much greater number of risks. Delay in this case can cost the patient his life, and therefore first aid should be provided as quickly, smoothly and qualifiedly as possible.
First of all, the bleeding must be stopped. Please note that no foreign objects or bone fragments should be removed from the wound. It must be closed with a sterile bandage, previously treated with disinfectants and hemostatic agents.
After that, it is necessary to apply a fixing bandage. You can use a wide bandage or a piece of fabric of a suitable width for these purposes. The victim takes the deepest possible breath, after which the assisting person bandages him from a healthy area to the fracture site from left to right. The bandage should not sag, but it should not be too tight either. On a layer of bandages, it is desirable to apply a material that does not allow air to pass through, such as cellophane.
Next, the patient is given pain medication. You can also inject a non-narcotic pain reliever. Dry cold is applied to the wound to reduce bleeding and pain. The patient is helped to take the most comfortable position that would prevent the displacement of debris. After that, you should call an ambulance – the sooner the better, since bleeding or infection in the wound can have fatal consequences for the victim. Therefore, it should be transferred to the care of physicians as soon as possible and transported to the surgical department.
First aid for pneumothorax and shock
As noted above, with serious fractures, the development of pneumothorax is likely – accumulation of air in the pleural cavity. In this case, measures should be taken as soon as possible, because the slightest delay can cost the patient his life.
At the first signs of pneumothorax, the main task is to stop the penetration of air into the pleural cavity. A tight, airtight bandage will help with this. Most likely, you will have to use improvised means: a scarf, T-shirt or shirt. Of course, one cannot speak of complete sterility in this case, however, take into account that only the cleanest part of the used tissue should come into contact with the wound.
In order to make the bandage completely airtight, a plastic film can be applied on top.
In order for the victim to breathe easier, it is necessary to position him so that the upper body is elevated. In the event that a person has lost consciousness, he should be brought to his senses as soon as possible by bringing a product with a pungent odor to his nose. In the absence of ammonia, it can be nail polish remover, perfume, or even gasoline. Keeping the victim conscious is one of the main tasks.
Traumatic shock is another dangerous consequence of rib fractures. This condition is extremely undesirable, because it can lead to the death of the victim. Therefore, immediate action should be taken.
Traumatic shock has several stages. At the initial stage, the patient is very excited, complains of pain. There may be a panic attack, manifestations of aggression. The skin is pale, blood pressure is slightly increased, the pupils are dilated. There may be an increase in heart rate. The next step is to plunge the patient into apathy. The patient does not complain of pain, although it does not decrease. Heart rate increases, blood pressure decreases. The body temperature drops, the patient stops responding to sounds and light.
In such a case, the victim is laid on his back, with his head slightly lowered and his legs raised by about twenty centimeters. To protect the patient from hypothermia, he is covered with blankets. It is necessary to provide a person with complete peace, stop a panic attack and attacks of fear. It is mandatory to stop the bleeding and give painkillers.
Rules for transportation to the hospital
The question of how to transport a victim with a broken rib to the hospital is very relevant. The correct delivery of a person with broken ribs to a medical facility is possible only if a number of rules are observed. In addition, it will prevent the displacement of fragments and damage to soft tissues.
At the same time, transportation performed without following the algorithm can aggravate the patient’s condition. Therefore, if you cannot count on the arrival of an ambulance and the patient has to be taken to the doctors on his own, several aspects should be remembered.
Transportation should be as careful and smooth as possible. It is best if the person is in a semi-sitting position.
In the event that the patient is unable to move independently, he is transferred on a stretcher half-sitting.
If the patient has lost consciousness, is in a state of shock, or is seriously injured, transportation should take place in a supine position or on the injured side of the body. Many mistakenly believe that it is necessary to lie on the healthy side, however, the lung on this side will experience additional stress, which is completely useless.
What not to do when giving first aid
Often, guided by the best of intentions and seeking to provide the victim with first aid in full, volunteers only aggravate his condition. This may be due, in part, to the fact that people are simply not aware of how to proceed when helping a person with a fractured rib.
In particular, sometimes volunteer rescuers take actions that are under the strictest prohibition. Therefore, it should also be mentioned what should never be done with the help of a person with broken ribs.
So, you should not try to “set” and “return” broken ribs on your own. This is especially dangerous with open fractures. Yes, and with closed injuries, such actions are fraught with injuries to internal organs due to displacement of bone fragments.
You can not advise the patient to “cough to breathe easier.” Coughing can cause displacement of bone fragments, which can lead to fatal consequences. Even if the victim complains that he wants to cough, he should be gently distracted by trying to switch his attention to something else.
It is also extremely important to approach the application of a bandage.
It should not be too tight so as not to interfere with the victim’s breathing. In addition, when feeling the injury site, a minimum of effort should be made so as not to displace the bone fragments and not cause additional pain to the victim.
Finally, the patient should not be allowed to fall asleep before he is under the supervision of doctors.