Cracked rib: symptoms and signs, what to do, how to treat

A rib bruise is damage to the soft tissues of the chest as a result of a strong blow. At the same time, the integrity of the skin and bones is preserved.

As for the severity of such an injury, the purpose of the ribs is precisely to protect the internal organs from damage. However, such a bruise is always particularly painful, and can sometimes be accompanied by the development of a serious illness.

Causes of rib fractures

In clinical practice, rib fractures are conventionally divided into two groups:

arising in healthy bones under the influence of a strong mechanical stimulus;
arising in functionally and structurally changed bones under the influence of minimal force.

Fractured ribs can be caused by:

Impacts with a blunt object to the chest. If the blow is not strong, only the upper layers of skin and muscles are damaged; if it is strong, the ribs are broken.
Road traffic accidents. Typically, a fracture is caused by a collision between the driver's chest and the steering wheel resulting from a collision/sharp braking. In this case, the bone often breaks in the area of the subclavian artery. If a pedestrian is injured due to a collision with a car, asymmetrical multiple fractures are diagnosed.
Injuries sustained during sports.
Falling from height. The severity of damage to the chest bones depends on the speed of the fall and the properties of the surface on which the person fell.
Squeezing the body between two objects. The resulting symmetrical pressure on the ribs provokes a bilateral fracture of the ribs, skull or pelvis. In this case, the skin and mucous membranes are rarely damaged.

As for pathological rib fractures that occur in functionally and structurally changed bones, the following diseases contribute to their occurrence:

metastases of malignant tumors in the bones;
rheumatoid arthritis;
primary tumors of bone marrow, bone tissue;
acquired/congenital absence of the sternum;
genetic abnormalities of the development of the chest skeleton;
osteoporosis.

Rib fractures are less common in children than in adults. This is explained by the greater elasticity of the chest in childhood.

Anatomical certificate

The rib cage consists of twelve thoracic vertebrae, to which twelve pairs of ribs are attached through joints. In front is the sternum, 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 true ribs are connected to the sternum by their own cartilaginous plates, while false ribs are not directly connected to the sternum; their cartilaginous parts are fused with the cartilage of the ribs that 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 a rib breaks, it is also often damaged, which can lead to bleeding and disruption of the nutrition of the intercostal muscles.

Symptoms of a rib fracture

Symptoms of rib fractures depend on the number of damaged bones, the presence of concomitant pathologies, and the degree of damage to internal organs. If one or two ribs are broken, the following symptoms occur:

Pain at the site of the injury. Pain syndrome is a consequence of irritation by bone fragments of nerve endings, parietal pleura, as well as rupture of muscle tissue. While talking or coughing, the discomfort intensifies.
Shallow and rapid breathing. Severe pain from fractured ribs makes it impossible to take a deep breath, so the patient breathes quickly and shallowly. If there is a contusion of the heart or lung, respiratory failure develops.
The patient assumes a specific position. To reduce pain, the patient leans towards the broken rib or squeezes the chest on both sides with his hands. This allows you to reduce the amplitude of respiratory movements and reduce pain during inhalation.
Symptom of “broken breath”. Trying to take a deep breath (even slowly), the patient begins to feel a sharp pain, due to which his breath seems to stop.

If it is necessary to distinguish a rib fracture from a bruise, attention is paid to subjective symptoms:

The chest is deformed. If several ribs are broken, there is a slight deflection in the chest area. The affected side seems to decrease in volume. This effect occurs due to shortening of the ribs when the resulting bone processes are displaced.
Swelling and edema (hematoma) appear in the area of the fracture. A pronounced inflammatory process develops.
The presence of a specific sound and tactile sensation that occurs when bone fragments are displaced relative to each other (crepitus).
The presence of open wounds in the chest area.
Formation of subcutaneous emphysema. Due to damage to the main bronchi and trachea, air enters the mediastinum and from there enters the skin of the neck.

If a rib fracture is suspected, the patient should immediately seek qualified medical help to avoid the development of life-threatening complications.

If you notice similar symptoms, consult a doctor immediately. It is easier to prevent a disease than to deal with the consequences.

Possible complications

Incomplete rib fractures usually have a favorable outcome. If you violate the prescribed regimen and do not change your lifestyle, the crack may grow and cause a complete fracture. This can cause damage to internal organs.

A rib crack in itself is not life-threatening. But with this injury, injury to internal organs is possible. If the upper ribs are damaged, the heart and lungs may be damaged; the lower ribs, the liver, spleen, and kidneys.

During this period, the likelihood of infection entering the respiratory tract increases. The patient's sputum production is impaired, and this can cause pneumonia.

Diagnosis of rib fracture

In order to understand whether a patient has a rib fracture or a bruise, traumatologists use the following methods:

Inspection, listening and percussion of the chest (allows you to determine whether there are accumulations of air and blood in the pleural cavity).
Chest X-ray. Typically, a plain radiograph in the anteroposterior projection helps make the correct diagnosis. The image clearly shows the location of the fractures and their number.
Ultrasound examination of the chest. Used to diagnose rib fractures in young children, as well as to detect the presence of blood in the pleura.
CT scan. It makes it possible to examine in detail each damaged rib, to identify changes in the structure of the heart, lungs, and blood vessels.

First aid

A crack may be confused with a bruise or fracture. In any case, the patient requires hospitalization and diagnostics. However, before the ambulance arrives, the victim should be given first aid. There is a whole set of measures that determine what to do if a rib is broken or cracked:

Apply ice to the injury site.
Provide the person with a flow of fresh air.
Give a painkiller (this could be “Analgin” or “Ibuprofen”).
Tightly tie the patient's chest around its entire perimeter. The bandage should only be applied while exhaling. The material can be a bandage or scarf.
Provide the person with peace, do not allow him to make sudden movements.

How to treat a rib fracture

First medical aid for fractured ribs consists of administering an anesthetic to the patient, for example, one milliliter of Promedol solution (2%). If transportation is necessary, the chest is tightly bandaged.

Upon arrival at the hospital, treatment of rib fractures is carried out according to the following scheme:

Injection of novocaine or other local anesthetic into the fracture area. This allows you to temporarily reduce the sensitivity of nerve fibers and reduce pain. If necessary, the novocaine blockade is repeated several times. If there are contraindications to the use of novocaine, doctors resort to narcotic painkillers.
Applying a circular bandage that does not apply pressure to the ribs. For young patients who can wear a plaster cast for a long time, a plaster corset is applied. It reduces the range of motion, stabilizes bone fragments, minimizes pain and stimulates abdominal breathing.
Immobilization of the resulting bone fragments with special devices. In the situation of bilateral rib fractures or the formation of massive rib panels, plates are installed. They are responsible for holding the bones in the correct position until they are completely fused. This treatment method requires long-term bed rest, so it is used only in extreme cases.

In general, treatment of rib fractures at home does not involve constant bed rest. The patient needs to move less, sit more, and perform light breathing exercises. It is important to avoid physical activity and sudden movements.

Medicines used to treat rib fractures

If a rib is fractured, the patient must strictly follow medical recommendations. Treatment is usually carried out using non-steroidal anti-inflammatory drugs, narcotic and non-narcotic painkillers:

Diclofenac;
Nimesila;
Naproxena;
Ibuprofen;
Morphine;
Promedol and some others.

If congestive pneumonia or any infectious complication develops, antibacterial drugs are used:

Ceftriaxone;
Amoxiclav, etc.

To increase the effectiveness of antibacterial treatment, the choice of agent is preceded by a microbiological examination of purulent discharge, sputum and other available pathological materials.

Surgical treatment of rib fractures

Surgical treatment of rib fractures is carried out extremely rarely - in the presence of serious complications that make independent recovery impossible. So, the indications for surgery are:

Pneumothorax. Excess air is removed from the pleural cavity. To do this, a tube connected to a vacuum pump is inserted there.
Open chest wound. Primary treatment of the wound edges is carried out, the surgeon removes non-viable tissue fragments. The bleeding vessels are ligated and antibiotics are administered.
Severe displacement of bone fragments. The fragments of broken ribs are compared and fixed.
Hemothorax. Blood is removed from the pleural cavity. To do this, a tube connected to special pumping equipment is inserted there. If bleeding in the pleural cavity does not stop on its own, an open operation is performed to ligate the bleeding vessel.
Internal bleeding, damage to large blood vessels and the heart. Surgical treatment is aimed at restoring the integrity of vital organs.

Also, surgery for fractured ribs can be performed if a severe contusion of the lung is diagnosed, there is a foreign object in the pleural cavity or in the wound canal, and severe damage to the abdominal organs has occurred.

Treatment time for rib fractures

How quickly a rib fracture heals depends on a number of factors:

the age of the patient (in older people, recovery takes longer);
general health;
the presence of displacements, fragments;
number of broken ribs;
correctness of the prescribed treatment.

Typically, healing of uncomplicated fractures takes from 3 to 5 weeks in adults, and from 2 to 3 weeks in children. After this period, the patients’ ability to work is completely restored. In the presence of serious complications, as well as in the case of surgical treatment of the disease, rehabilitation may take about two months.

Rules for transporting to hospital

The question of how to transport a victim with a rib fracture to the hospital is very relevant. Proper 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.

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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 you have to take the patient to the doctors on your own, you should remember several aspects.

Transportation should be as careful and smooth as possible. It is best if the person is in a semi-sitting position.

If the patient is unable to move independently, he is carried on a stretcher half-sitting.

If the patient is unconscious, in shock, or has serious injuries, transportation should take place in a supine position or on the injured side of the body. Many people mistakenly believe that it is necessary to lie down on the healthy side, but the lungs on this side will experience additional stress, which is completely unnecessary.

Preventing rib fractures

The occurrence of a rib fracture cannot always be prevented. Preventative measures are aimed at reducing the risk of fracture. These include:

avoiding excessive physical activity;
refusal to engage in extreme sports;
competent performance of physical exercises;
eating foods rich in calcium;
quitting smoking and drinking alcohol.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Rehabilitation

Victims are concerned about how long it takes for the crack to heal. This question is closely related to how the healing process occurs. The following stages are distinguished:

Exacerbation. This is the period immediately after injury. Lasts several days, accompanied by pain and sometimes inflammation.
Healing. This takes about 2 weeks. At this time, the structure of the bone tissue is restored. Minimal physical activity is allowed.
Recovery. This is already the rehabilitation stage. Lasts about 4 weeks. At this stage, the functioning of the chest is completely restored, and the rib bones are strengthened. During this period, you can engage in physical therapy, physiotherapy, and breathing exercises.

4. Treatment of inflammation of the rib bone

Conservative treatment for rib inflammation can be effective only in the earliest stages. In this case, antibiotics are prescribed and regular monitoring of the effectiveness of the therapy is necessary. If the inflammation continues to progress, surgical assistance cannot be avoided.

The extent of surgical intervention depends on the severity of the condition. If by opening the abscess, pus is released right up to the lesion itself, and the surgical wound allows small sequestration to come off, this may be enough for further positive dynamics and recovery, especially in the acute course.

If the sequestration and fistulous tract persist, rib resection may be required. During this operation, the part of the rib or several ribs affected by the inflammatory process, as well as the inflamed soft tissue around them, is removed. Surgical treatment is usually very effective. In approximately 4% of cases of such intervention there is a risk of damage to the pleura. However, modern precision operating instruments and apparatus virtually eliminate such human errors. In the postoperative period, antibiotics may be prescribed, and later rehabilitation measures are required aimed at restoring the functions of the sternum and associated limb movements.