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A chest fracture is a severe injury that can lead to serious complications, such as damage to internal organs. If fragments touch the lungs or heart, this creates an immediate threat to the patient’s life. For this reason, a fracture of the ribs and sternum requires the provision of qualified medical care.
Such an injury involves, first of all, damage to the sternum – a flat bone located in front of the chest. It is connected to the clavicles and ribs. In most cases, the proximal sternum is not injured in isolation – the ribs are also affected. Often such fractures affect the region of the posterior and middle axillary lines.
The rib can break both when struck directly on it, and with strong pressure on the chest. With a direct impact, the rib bends inside the body, then a bone fragment can damage the internal organs. When compressing the chest, multiple cracks and closed fractures are possible over the entire compression area. It is in this case that fractures of the largest number of ribs are diagnosed.
Causes of a chest fracture
The most common cause of a thoracic fracture is a traffic accident. It is difficult to get a strong blow to this part of the body in another situation. Moreover, women are more prone to this type of injury than men. In car accidents, the driver gets a chest fracture during a collision when hitting the steering wheel. This is why airbags are so important. In some cases, they soften the blow and prevent severe damage. The same function is performed by a fastened seat belt. Do not neglect the use of these tools when driving. Compliance with elementary safety rules will help to avoid serious injury in the event of an emergency.
Thoracic fractures are common in athletes. Gymnasts, weightlifters, wrestlers and hockey players need to be careful in the process of training and competition. However, as a result of a direct blow to the chest, such as when falling from a great height, the risk of injury is low, since the chest is a strong frame, protected by muscles and ligaments. You can get a fracture in this way only with osteoporosis, when the bone tissue is weakened and thinned as a result of the disease.
Children and adolescents very rarely get a chest fracture. This is due to the fact that their cartilaginous part of the ribs is still very elastic, and perfectly functions as a shock absorber, softening the blow. The elasticity of the sternum of young people also smoothes the effect on bone tissue.
Symptoms of a chest fracture
A fracture of the chest is accompanied by a characteristic crunch. The patient may feel that the bones move freely inside. There is inflammation and swelling in the chest area. A splinter fracture of the chest can be accompanied by damage to the lungs, which causes breathing problems. The main symptom is severe pain. It is aggravated by coughing, sneezing or laughing. The victim has shallow, accelerated breathing. A hematoma (bruise) forms in the area of damage, sometimes bleeding through the nose or mouth begins.
With a fracture, the pectoral muscles arbitrarily contract, the deformation of the sternum becomes clearly visible externally. When a person receives this type of injury, he intuitively seeks to ease the pain and take a sitting position. This allows you to reduce discomfort.
If numerous damage to the ribs in the form of cracks is received, the pain will be mild. However, it will be quite noticeable on palpation. If the ribs and sternum are completely broken, the pain syndrome will be much more pronounced. On palpation, it is sometimes even possible to determine the presence of fragments of the sternum and ribs even before an X-ray examination.
When it comes to posterior rib fractures, the symptoms of respiratory disorders are usually mild. Fractures of the lateral and anterior part of the chest are very painful, they are accompanied by serious disorders of lung ventilation, as well as a significant violation of gas exchange in the body.
Possible complications of a thoracic fracture include pneumothorax and hemothorax. In the first case, air or gases accumulate in the pleural cavity. This phenomenon provokes a lack of oxygen, a decrease in blood pressure and, as a result, sometimes causes cardiac arrest. Hemothorax is a similar phenomenon, but with it, not air is found in the pleural cavity, but blood, which compresses the lungs, leading to impaired breathing and gas exchange.
Types of rib and sternum fractures
According to the nature of the line of the fracture of the chest, the following types of it are distinguished:
oblique;
transverse;
longitudinal.
In addition, a chest fracture can be open and closed, with or without displacement of fragments.
Diagnosis and treatment of a thoracic fracture
First aid
In case of a fracture of the chest, it is important to provide first aid to the victim in time. Often this must be done before the doctors arrive. You can relieve pain and reduce swelling with ice. Keep the cold at the site of injury should be no more than 20 minutes, after which an hour break should follow. This will prevent tissue frostbite.
Clothing that restricts movement and breathing on the victim must be unbuttoned, helped to take the most comfortable position and not allowed to move and talk. When the pain becomes unbearable, painkillers are used, such as Baralgin, Ibuprofen, Diclofenac or Ketoral. With an open fracture, the injury site is treated with an antiseptic solution, and covered with a towel or clean cloth from above.
Diagnostics
A chest fracture can be diagnosed by taking an x-ray. To determine damage to soft tissues or internal organs allows computed tomography.
Treatment
Dressings for chest fractures are not used, as they restrict breathing, interfere with recovery, and contribute to the development of certain diseases, such as pneumonia or pleurisy. Tight bandaging of the chest is necessary only for transporting the patient.
In case of a fracture without displacement, a wide adhesive plaster is used, with which the area of u2buXNUMXbthe injury is fixed. Removed after XNUMX weeks. In the presence of displacements, reposition is preliminarily performed, and then the fracture site is also fixed. Surgical intervention is resorted to if there is a risk of damage to internal organs by fragments.
Medical treatment involves, first of all, pain relief. For this, retrosternal and intercostal novocaine blockades are used. During the procedure, the victim must be in a sitting position. To eliminate severe pain, a solution of Promedol is administered intravenously. If there are no contraindications, prolonged epidural anesthesia is recommended. The patient is also given expectorant, decongestant and anti-inflammatory drugs, physiotherapy procedures are carried out.
To recreate the integrity of the “frame” of the sternum and normalize the rhythm of breathing in case of numerous fractures (more than five ribs), specific immobilization is used. The sternum and ribs are constantly stretched, they are fixed with the support of special plastic splints that are superimposed on the chest area. In cases of bilateral multiple fracture of the ribs with flotation of the anterior part of the sternum, long-term pulling of the ribs and sternum with special bullet forceps and strong threads is used.
Recovery
Fusion of fractures of the chest occurs within one month. Working capacity is restored in 4-5 weeks after complete fusion. If several ribs were broken, it will be possible to return to work in 1,5-2 months.
After the fusion of the bones, the patient is prescribed breathing exercises, massage and physical exercises. For some time every day you will have to tighten the chest with an elastic bandage. You need to gradually increase physical activity. Gymnastics is performed on the recommendation and with the permission of a doctor. It should include exercises for posture and flexibility. They help to avoid atrophy of the muscles of the chest.
A positive effect on the health and well-being of patients with fractures of the ribs and sternum is exerted by classes in the pool: swimming, water aerobics, and outdoor games. But even a few months after complete rehabilitation, the area of injury should not be loaded, as there is a high risk of new cracks.