Rib osteomyelitis. Inflammation of the rib bone tissue

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The human spine is the basis of the musculoskeletal system. At the same time, it not only performs a supporting function and provides the ability to walk upright, but also represents a fairly flexible axis of the body, which is achieved due to the mobility of the vast majority of its individual parts. In this case, the anterior part of the spine participates in the formation of the walls of the thoracic and abdominal cavities. But one of its most important functions is to ensure the safety of the spinal cord that runs inside it.

Rib anatomy

The ribs in humans are represented by curved and narrow plates, which largely consist of long bone filled with spongy substance. Their shorter anterior part is represented by cartilaginous tissue. Each bone consists of an anterior end, a body and a posterior end, on which there is a small thickening - the head of the rib. Adjacent to it is the articular surface, through which the ribs are connected to the spine.

A number of authors in the structure of the rib distinguish the neck, the narrow part after the head, and the tubercle - a small thickening that comes into contact with the transverse processes of the thoracic vertebrae. This anatomical structure is absent in the 11th and 12th ribs, since they do not articulate with the spine.

On the front and back surfaces of the bones there are special notches for blood vessels and tuberosities - places for muscle attachment. According to the numbering, there are 12 pairs of ribs (for both women and men). The first 7 are considered true, since their anterior ends are connected to the sternum. The next three (8, 9 and 10) are false, since they are attached not to the sternum, but to the cartilaginous ends of the previous ribs. 11 and 12 are called wandering and are free, not attached to anything.

Causes

A rib fracture can occur as a result of various reasons, while a fracture of the 1st or 10th rib may not be different in any way and may occur simultaneously. Typically, the factors that cause these types of injuries are divided into two types - natural and pathological.

Natural causes include the following:

• road traffic accidents. Often, fractures of the 10th, 11th, 12th ribs occur precisely in emergency situations on the road. These injuries usually occur when the driver hits the steering wheel with his chest during a collision. Pedestrians may also be injured; they may collide with a car or fall on the asphalt, which will provoke a strong blow specifically to the area where the lower rib pairs are located;
• a strong blow to the chest. In this case, not only a fracture of the 10th rib, but also other rib pairs may occur. The impact can occur either with a fist or against various objects;
• falling from a certain height. If a fractured ribs in a young person can occur when falling from a high point, for example, from a tree, fence, roof, then in an elderly person, fractures of ribs 10, 11, 12 can occur even when falling from a chair. Bone fragility in older people is caused by severe thinning of cartilage and bone tissue;
• various sports injuries;
• squeezing, which is similar to the working process of a press. These injuries are of an industrial type. In this case, not only damage to the rib pairs can occur, but also to other parts of the musculoskeletal system - the coccyx, pelvis, spine, and sometimes even the skull.

Pathological types of fractures usually do not occur as a result of emergency situations. They can occur with a variety of health problems that can lead to brittle bone tissue.

Pathological causes include:

• rheumatoid arthritis;
• cancer metastases. The formation of metastases in the chest can occur due to the presence of malignant tumors in the breast, prostate gland, and kidneys. These pathological processes also include bone cancer;
• osteoporosis. This disease causes bone fragility. For this reason, not only a fracture of the 11th rib can occur, but also other rib pairs, as well as various parts of the skeleton (spine, pelvis, arms, legs). Injuries and fractures often occur with even minor impacts;
• sometimes the sternum may be absent. This pathology can be congenital or acquired;
• the presence of genetic abnormalities in the structure of the skeleton. In these conditions, severe bone fragility is observed.

Rib cage

In the anatomy of the chest, in addition to the ribs, there is a sternum, a flat bone that is shaped like a dagger, and the thoracic vertebrae. The sternum itself consists of the manubrium, body and xiphoid process. The latter structure may be bifurcated, have a hole, or be tilted to the side; many scientists consider it a vestige.

The structure of the chest is shown in the photo. Inside the sternum there is a significant amount of spongy substance, red bone marrow and blood vessels. Where a person’s 8th rib is located, the thoracic aperture (expanded part) begins.

There are three main types of chest:

1. Normosthenic. The chest has the shape of a truncated cone, the ribs are angled, and the angle between the xiphoid process and the costal arch is 90°.
2. Hypersthenic. The shape of the chest is cylindrical, the ribs run more horizontally, and the angle is greater than 90°.
3. Asthenic. It is characterized by the fact that the chest has the appearance of a flat, elongated cone with wide intercostal spaces.

The structure of human ribs

Each plate has a narrow shape, curved along the surface or along the edge. The back end of each human rib has a head. In pair IX it connects with the bodies of two adjacent thoracic vertebrae. In this regard, the second to tenth plates have a ridge that divides the head into 2 parts. I, XI, XII pairs articulate on the vertebral bodies with complete fossae. The posterior end of a human rib tapers behind the head. As a result, a neck is formed. It passes into the longest section of the plate - the body. Between it and the neck there is a tubercle. At the tenth ribs it is divided into two elevations. One of them lies below and medially, forming the articular surface, the other, respectively, above and laterally. The latter is joined by ligaments. The tubercles of the XI and XII ribs do not have articular surfaces. In some cases, the elevations themselves may be absent. The bodies of II-XII plates include the outer and inner surfaces and edges. The shape of the ribs is somewhat twisted along the longitudinal axis and curved anteriorly at the tubercle. This area is called an angle. At the lower edge, a groove runs along the inside of the body. It contains nerves and blood vessels.

At the anterior end there is a pit with a rough surface. It connects to the costal cartilage. Unlike the others, the first pair has a lateral and medial edge, a lower and upper surface. In the last indicated area is the tubercle of the scalenus anterior muscle. A groove runs behind the tubercle for a vein, and in front for a vein.

Functions

In addition to the fact that the chest is a strong frame for internal organs, it performs a number of important functions in the human body:

• protects the heart, lungs, large vessels, thymus gland and esophagus from injury and excessive shock;
• participates in the act of breathing, maintains its normal regular rhythm, does not allow the lungs to escape;
• provides full movement of the shoulder girdle and arms;
• This anatomical structure creates negative thoracic pressure, which ensures sufficient pumping function of the heart and promotes the outflow of venous blood from the lower parts of the body into the vena cava.

Thus, the ribs and the rib cage as a whole are an important skeletal structure in the human body that performs many useful functions.

Rib fracture concept

A fracture is usually understood as the loss of rib bones and cartilage of their original integrity. This condition occurs in older people, as well as in patients whose history previously included diseases in the chronic stage. This pattern is associated with the influence of the time factor. So, over a long period of time, the bones that form the frame of the chest are subject to wear and tear and become less elastic.

In the event that damage occurs without further complications, then only damage to the integrity of several ribs is present. This condition is not life-threatening. This is due to the ability of bones to fuse with each other.

A situation in which a broken rib impacts an internal organ with subsequent damage requires increased attention. In this case, the usual course of the respiratory process becomes difficult. As a result of exposure, the functioning of the lungs, heart vessels, and pleural cavity is disrupted. The formation of numerous lesions can cause death or irreversible consequences for health.

What diseases are associated with ribs?

Damage to the ribs and other bones of the chest is not a rare occurrence and can occur in various somatic and infectious diseases. The most common of them:

• split;
• chondritis, osteomyelitis;
• syphilis, tuberculosis;
• echinococcosis, actinomycosis, candidiasis;
• Tietz's disease;
• coarctation of the aorta, rickets;
• malignant tumors.

Structural anomalies

Split ribs are understood as a congenital structural anomaly, which rarely causes any complaints and is an x-ray finding. There are also additional and fused ribs, or their absence is possible.

Clinical signs appear in the presence of a cervical rib on one or both sides, which is attached to the transverse process of the 6th cervical vertebra. In this case, neurological symptoms most often appear: headache, dizziness, fainting, etc.

Much less common are congenital bone islands, which sometimes have to be distinguished from metastases and calcifications.

Osteomyelitis and chondritis of the ribs

Osteomyelitis is a purulent infectious inflammation of the bones, which mainly spreads hematogenously (through the bloodstream). It most often occurs in children after injuries and affects the first three pairs of ribs. The patient experiences severe chest pain and severe intoxication syndrome:

• high fever;
• chills;
• weakness, sweating;
• paleness of the skin.

Chondritis is understood as an acute purulent process in which the cartilaginous parts of the bones are involved. Pathology occurs rarely after surgical interventions. In the absence of treatment (detoxification therapy, use of systemic antibiotics), fistulas with purulent discharge may appear.

Tuberculosis and syphilis

Tuberculosis of the ribs is a specific inflammation of the bones, which is a consequence of dissemination (spread) from the lung tissue. When the ribs are affected, swelling, local pain and the formation of fistulas occur. As the tuberculosis process progresses, cysts and foci of destruction appear in the bones.

Syphilitic damage to these bones is extremely rare and is manifested by the appearance of swelling on the ribs, which periodically cause pain. Both pathologies are confirmed x-ray, using bacteriological tests for acid-fast bacteria and antibodies to Treponema pallidum.

Parasitic and fungal pathologies

When actinomycosis spreads to the structures of the chest, the edges of the ribs become deformed, and signs of periostitis appear - inflammation of the periosteum. This causes discomfort and pain in the upper torso.

Echinococcal (parasitic) cysts can occur in the area of ​​the ribs, causing their deformation and local compaction. They are detected by computed tomography and pose a threat of rupture with the release of parasites and their metabolic products into the chest cavity.

Tietz disease

It is also called thoracochondralgia. The pathology is characterized by the appearance of spindle-shaped compactions on the first 6 ribs in the area of ​​their cartilaginous ends. The main complaint of such patients is pain, which may be aggravated by coughing, deep breathing and shortness of breath.

Less common are isolated swellings without pain. The diagnosis is made clinically, treatment is carried out using hormonal drugs and painkillers.

Rickets and coarctation of the aorta

In the first case, there is a metabolic disease, which is based on vitamin D deficiency. In addition to pathological changes in the lower extremities, skull, sweating, specific changes in the peripheral blood (lack of calcium and phosphorus) in asthenic children, the doctor can palpate the costal rosary - compactions in the place of transition of the bone part into the cartilaginous part.

Coarctation of the aorta is a congenital abnormality of the largest vessel leaving the heart, which is characterized by narrowing of the descending aorta. The lower edge of the ribs becomes uneven due to the pressure of tortuous and overly dilated arteries.

Malignant neoplasms

Malignant lesions of the ribs also occur. It may be a primary disease or a consequence of a metastatic process. There are osteomas, osteosarcomas, and osteoblastomas. The diagnostic criterion for the terminal stage of osteosarcoma of any localization is the appearance of usurations (depressions) on the ribs.

The pathology is characterized by a variety of symptoms: pain, weakness, pathological fractures, fever.

What should I do?

If only one or two ribs are injured, then immobilization and hospitalization of the victim are not required. Treatment is carried out on an outpatient basis. Multiple fractures may require surgery.

Establishing a diagnosis

First of all, the doctor examines the patient and collects anamnesis. Carefully palpating the area of ​​damage, the specialist detects stepwise deformation and crepitus of bone fragments.

The tablet describes what is assessed during diagnosis for a fracture of the 9th 10th rib on the left and other similar injuries after the initial examination.

Table 4. Establishing a diagnosis.

The most accurate diagnostic method is x-ray examination. It allows you to locate the location of the injury and determine its extent.

First aid

It is necessary to carefully bandage the chest

Instructions for a fracture of the 7th rib on the left and other injuries are as follows:

1. Give the victim a pain reliever. 2-3 tablets of Ibuprofen or Analgin are enough. In more complex cases, it is recommended to give the person a Butorphanol or Ketanov tablet.
2. Apply an ice pack to the injury site. Cold helps reduce swelling and makes nerve receptors temporarily insensitive.
3. Reduce breathing amplitude. Using any dense material, you need to carefully bandage the chest in a circle at the exit height. In order to fix the affected area, it is recommended to use the victim’s upper limb. It is tightly wound to the body.
4. Call an ambulance or take the victim to the hospital yourself. During the trip, the patient must sit or recline. In case of a 1-sided lesion, it is placed on its side on the side of the injury. This helps improve the functioning of the 2 halves of the lungs.
5. If air penetrates into the pleural area, a polyethylene flap should be applied to the injured area and carefully fixed around the edges. The bandage should be as tight as possible.

Note! The patient should be admitted to the hospital within half an hour.

What should you not do?

In case of a fracture of the eighth rib on the left and other similar injuries, it is strictly prohibited:

• force a person to cough, take deep breaths;
• it is unprofessional to palpate the injured area by pressing hard on it;
• try to straighten bone fragments yourself;
• allow the victim to move, fall asleep, talk.

Diagnosis and treatment

Various imaging methods are used to study the human skeleton and ribs:

• radiography in several projections;
• computed tomography, scintigraphy;
• puncture biopsy.

Treatment depends on the cause and duration of the disease. Antibiotics, steroidal or non-steroidal anti-inflammatory drugs, and cytostatics can be used. In some cases, surgical treatment is resorted to (removal of tumors, cysts, correction of heart defects).

Injuries to the ribs and chest

The most common chest injuries are:

• bruises and concussions;
• fractures of the sternum and ribs;
• compression.

They can appear as a result of a fall, direct and indirect impacts, or jumps. With concussions and bruises, aching pain appears in the area of ​​​​swelling during breathing, and hematomas are common. Treatment consists of rest, taking painkillers and applying compresses and ointments, if necessary.

With fractures, there is a sudden sharp pain in the chest, which intensifies with deep breathing, coughing, and movement. The affected part of the chest is deformed and breathing may be somewhat delayed due to pain; crepitus is felt on palpation.

Fractures occur with the formation of bone fragments, which can injure blood vessels, lung tissue and the heart, thereby causing life-threatening complications.

Associated symptoms

Signs accompanying a fracture of the 5th rib on the left, a fracture of the 6th rib on the left, as well as a fracture of the 7th 8th rib on the left are presented in the table.

Table 1. How does a fracture manifest itself?

Damage severity

The label shows the severity of the injury.

Table 2. How serious is the fracture?

Possible complications

The incidence of the most dangerous complications is presented in the diagram.

Typically, doctors encounter a ruptured spleen

Other complications that develop due to fractures of the 7th and 8th ribs on the left, as well as other fractures on the left side, are presented in the table.

Table 3. Common complications.

Note! Complications of fractures are much more dangerous than the injury itself. They require longer treatment.

Which doctors should I contact to examine my ribs?

With primary complaints, patients should contact a pediatrician or therapist, who will refer for consultation to other specialists if necessary. It can be:

• neurologist;
• cardiologist;
• surgeon, traumatologist;
• rheumatologist, etc.

Treatment of rib fractures

For uncomplicated fractures, treatment consists of applying a special non-pressure bandage, using analgesics and regular examination. The presence of complex fractures with displacement, wandering fragments or complications forces one to resort to surgical treatment for open reposition of bones and relief of emergency conditions.