What Are the Different Ways to Treat a Bone Fracture?

There are a total of 12 pairs of ribs, which are divided equally on both sides of the chest, connected to the sternum and the back to the thoracic spine to form a complete thorax. When the chest is injured, whether it is closed or open, rib fractures are the most common, accounting for about 90% of thorax fractures. In children, the ribs are elastic and not easy to break, while in adults, especially the elderly, the ribs are weakened and easily broken.

Basic Information

English name

rib fractures

Visiting department

orthopedics

Multiple groups

Seniors

Common locations

rib cage

Common causes

Caused by external violence

Common symptoms

Local pain, restricted breathing, etc.

Contagious

no

Causes of rib fractures

1. Rib fractures are generally caused by external violence. When direct violence acts on the chest, rib fractures often occur at the site of the blow, the fracture ends are broken inward, and the internal organs of the chest cause damage.

2. When indirect violence acts on the chest, such as the compression of the chest, rib fractures occur outside the point of violence, and the fracture end is outward, which easily damages the soft tissue of the chest wall and produces chest hematoma.

3. Open fractures are more common in direct firearm or sharp injury.

4. When the ribs have pathological changes such as osteoporosis, osteomalacia, or based on primary and metastatic rib tumors, pathological rib fractures are also prone to occur.

Clinical manifestations of rib fractures

1. Local pain is the most obvious symptom of rib fractures, and it is aggravated with coughing, deep breathing, or body rotation. Sometimes patients can hear bone friction sounds or feel bone friction.

2. The pain and the stability of the thorax are damaged, which can restrict the breathing movement, reduce the breathing speed and reduce the alveolar ventilation. The patient is afraid to cough and sputum retention, which may cause obstruction of lower respiratory tract secretion, pulmonary consolidation or atelectasis. This is particularly important in patients with old or weak or existing lung disease.

3. When the patient has two or more fractures of each of the two adjacent ribs (also known as "flank chest"), when inhaling, the negative pressure in the thoracic cavity increases and the part of the chest wall softens inwardly; when exhaling, the thoracic pressure increases The injured chest wall floats and protrudes, which is opposite to the movement of other chest walls. It is called "abnormal breathing movement". The abnormal breathing movement can make the chest pressure on both sides unbalanced. The mediastinum moves to the left and right with the breathing, which is called "mediastinal swing." "It affects blood flow and causes circulatory disorders, which is one of the important factors that cause and exacerbate shock.

Rib fracture examination

X-ray chest radiographs can mostly show rib fractures, but for rib cartilage fractures, "green branch fractures", no fracture misalignment, or middle rib fractures on the chest radiograph because the ribs on both sides overlap each other, are not easy to find, should be CT, etc. Further examination and judgment based on clinical manifestations to avoid missed diagnosis.

Rib fracture diagnosis

The diagnosis of rib fractures is mainly based on the history of injuries, clinical manifestations, and chest radiographs. If you have a history of chest trauma, local pain and tenderness on the chest wall, and a positive thoracic compression test, you should consider the possibility of thoracic fractures. Combined with X-ray examination, you can confirm the diagnosis. Confirmed.

Rib fracture treatment

The treatment principles of rib fractures are analgesia, clearing of respiratory secretions, fixation of the thorax, restoration of chest wall function and prevention of complications.

1.Treatment of a single closed rib fracture

Because both ends of the fracture are supported by the upper and lower ribs and intercostal muscles, dislocations occur with little movement, and they can heal automatically. The fixation of the thorax is mainly to reduce the movement of the fracture end and reduce the pain. The methods are: multi-strap chest cloth fixation or elastic chest strap fixation. The principle of treatment of simple rib fractures is pain relief, fixation and prevention of lung infections. Epidural or intravenous analgesics are effective for long-term analgesia.

2. Flail chest treatment

Correct abnormal breathing movements, resist shock, prevent infections and deal with combined injuries. When the softening of the chest wall is small or located on the back, abnormal breathing movements may not be obvious or serious, and local bandaging can be used for pressure bandaging. However, when the floating range is more than 3 cm, severe respiratory and circulatory dysfunction can be caused. When it exceeds 5 cm or bilateral flail chest soft chest syndrome, it can cause death quickly and must be treated urgently.

3. Treatment of open fractures

Debridement treatment should be done early and thoroughly. Clear bone fragments and non-living tissues, bite the fracture ends to avoid stabbing surrounding tissues. If the intercostal vessel is damaged, the distal and proximal ends of the ruptured vessel should be sutured separately. Those with damaged pleura are treated as open pneumothorax. After the routine injection of tetanus antiviral serum and antibiotics to prevent infection.

Rib fractures mostly heal by themselves within 2 to 4 weeks, and the treatment of the fractured limbs is not as emphasized as in the treatment of limb fractures.