Fracture of the thoracic spine: symptoms, treatment

What is a thoracic spine fracture

Violation of the integrity of the vertebral structure can occur as a result of pathology, impact, or fall. Damage sometimes occurs as a result of a pinpoint blow of great force, a sharp and excessive extension or flexion of the spine. One or more vertebrae may be deformed.

Injuries to this section are equally common among women and men. Older people are prone to fractures due to osteoporosis. A feature of damage to the spinal column is the risk of complications, mainly when damage to muscle tissue, ligaments and cartilage is observed.

Associated syndromes

There are several main syndromes:

• Hemothorax. These are blood clots in the pleural cavity. Accompanied by the accumulation of air in the pleural area and leads to lung collapse.
• Pneumothorax. Occurs when air enters the pleural cavity during inhalation. Exhalation is impossible due to the formation of a valve due to a collapsing wound in the lung or chest wall. As a result, excess oxygen pressure occurs in the pleural area. The lung collapses and shifts to the opposite side.
• Emphysema. Occurs due to overgrowth of the pleural cavity. With a massive or sudden intake of air into the lungs, compression of large venous trunks can occur, resulting in a decrease in blood flow to the heart. As a result, this leads to severe cardiac disorders.

Important! A fracture can occur anywhere in the thoracic skeleton: in the area of ​​the manubrium, body or xiphoid process.

Causes of fractures

The main cause of a spinal fracture in the chest area is trauma. Vertebrae can be damaged by a fall, a strong blow, or excessive stress. The problem arises from unsuccessful dives and car accidents. Physically demanding work is also a risk factor.

The cause may be diseases that weaken bone tissue: bone tuberculosis, osteoporosis, tumor formations.

Elderly people often suffer from thoracic spine fractures. This is caused by a decrease in the strength of the skeleton and a weakened general condition of the body. Damage can occur due to awkward sudden movements, severe coughing and sneezing.

Chest concussion

A mild concussion may not be clinically apparent. The patient only feels a change in the depth and rhythm of breathing, lack of air. Severe chest concussions are accompanied by hemorrhage into the lungs and resemble a state of severe shock. The general condition of the patient is serious; cyanosis, cold and wet extremities, rapid, arrhythmic pulse, rapid, shallow and uneven breathing. Severe concussions sometimes result in the death of the patient. Such patients require intensive care, sometimes resuscitation, and then symptomatic therapy.

Classification and types of injury

According to their structure, fractures are divided into:

• compression - one vertebra is pressed into the underlying one, if the spinal cord is affected, recovery is significantly delayed;
• rotational – there is displacement, injury to the ligamentous apparatus, intervertebral discs, ribs;
• distraction – the vertebrae are stretched, there is rupture of muscle tissue and disc deformation.

According to the manifestation of complications, they are distinguished: uncomplicated - without damage to the spinal cord and complicated - sharp fragments affecting the cerebrospinal fluid and surrounding tissues. A complicated type of fracture of the vertebrae of the thoracic spine has consequences: limitation of movements up to disability, death.

Consequences

The consequences of injuries to the sternum include:

• improper fusion of processes,
• damage to the parietal pleura,
• pericardial damage and cardiac contusion,
• internal bleeding,
• hemothorax, pneumothorax, pyothorax,
• damage to the thoracic aorta and esophagus,
• lung damage leads to the development of pneumonia or pleurisy,
• mediastinitis.

Due to the fact that many vital structures are located in the chest cavity, violation of the integrity of the protective frame of the chest leads to serious consequences, and in advanced cases can lead to disability. If there is a suspicion of injury in this area, it is necessary to consult a traumatologist or surgeon to diagnose a sternal fracture and prevent consequences.

Symptoms of fractures

Symptoms depend on the characteristics of the damage and its severity; they can manifest themselves clearly or almost imperceptibly. Signs of a fracture can be seen immediately or after a couple of days.

Among the main signs of a chest fracture:

• pain at the site of injury, aggravated by standing, moving, touching;
• labored breathing;
• tension in the spinal muscles (trapezius, teres);
• abdominal discomfort;
• numbness of the skin surface;
• weakness of arms and legs;
• swelling.

In some cases, the deformation is noticeable visually.

Fracture of the 3rd thoracic vertebra

Trauma can lead to protrusion - protrusion of intervertebral discs. In this case, rupture of the fibrous rings does not occur. Such a fracture of the thoracic vertebrae has consequences in the form of the formation of hernias and leakage of spinal substance.

Fracture of the 9th thoracic vertebra

If the damage is not treated promptly, it can lead to congestive pneumonia. As a result of the fracture, dysfunction of the adrenal glands appears, allergies subsequently develop, and the immune system is weakened.

Fracture of the 12th thoracic vertebra

This is a low-traffic area, so damage is not as dangerous. It is necessary to avoid movements and bending forward. In women, a fracture can cause infertility.

Signs of injury

The main and main symptom is very intense pain directly at the fracture site. It gets worse with breathing or physical activity. Breathing is heard using a stethoscope in all parts of the lung.

Other signs of a fracture include:

• A slight decrease in blood pressure and the presence of slight tachycardia (fast heartbeat);
• Swelling and subcutaneous hemorrhage at the fracture site;
• When you press a finger on the damaged area, a sharp pain is felt;
• A characteristic crunching sound heard at the height of inspiration. Occurs during a fracture only at the beginning of exhalation. Or a crunch is heard upon palpation;
• If there is displacement during the fracture, a deformation of the chest is visible, the sternum is shortened;
• Breathing is rapid and intermittent, there is cyanosis of the nasolabial triangle and shortness of breath.
• If blood vessels or integrity of the lungs/bronchial tubes are damaged, hemoptysis occurs.

With combined trauma, there is traumatic shock and obvious respiratory dysfunction. The symptoms of a sternal fracture are fully consistent with the above manifestations.

Diagnostics

When the thoracic spine is fractured, the doctor first examines the patient, then resorts to palpation. The location of injury is determined by severe pain. Splinters can also be identified through proper palpation.

To clarify the full picture, an X-ray examination is necessary, and you also need to visit a neurologist. The photo shows the ridge and the extent of the damage. To clarify, images are taken in several projections. A neurologist evaluates reflexes and checks to see if the spinal cord is affected.

The treatment required is complex, so the diagnostic stage is important. An accurate determination of the extent of damage is necessary. The doctor additionally prescribes:

• ECG - to identify the effect of injury on heart function;
• blood test with ESR mark;
• radiculitis scan for older people;
• densitometry - determination of bone tissue density;
• CT;
• MRI.

Chest contusion

More common are ordinary chest bruises, which are sometimes accompanied by rib fractures. When the soft tissues of the chest are struck, local swelling and pain appear, and sometimes a subcutaneous fluctuating hematoma (with a tangential blow). Due to hemorrhages in the muscles, the patient breathes shallowly, and taking a deep breath increases the pain. To clarify the diagnosis, be sure to percussion and auscultation examine the condition of the lungs and take an x-ray of the injured half of the chest.

Treatment of patients consists of prescribing painkillers (analgesics, novocaine blockade), puncture of the hematoma, and after 3-4 days - thermal procedures, breathing exercises. Sometimes blood from a hematoma that has not resolved is removed through a skin incision. Antibiotics are not prescribed to prevent complications. Performance is restored in 2-3 weeks.

Treatment of thoracic spine fractures

Conservative and surgical methods are used in medicine. In case of a fracture of the thoracic spine without displacement or complications, conservative treatment is used. The techniques used are aimed at stopping pain. The doctor prescribes medications to relieve pain. If there is a risk of infection, a course of antibiotics is prescribed, as well as drugs that support the immune system.

For proper treatment, corsets and bandages are used, and it is recommended to sleep on an orthopedic mattress. Depending on the injury, spinal traction may be recommended. All patients, including those with lumbar deformities, must undergo a course of exercise therapy and physiotherapy.

In the early stages of treatment, it is important to maintain bed rest as prescribed by the doctor; this will ensure the correct position of the spinal column and rapid recovery.

Next, using a corset, the spine is fixed in the correct position and excess load is removed.

In case of a fracture of the thoracic vertebrae with consequences, at 2nd and 3rd degrees of severity, surgical treatment is required. Surgical intervention is necessary when the pain does not stop and the displacement of the 7th and 8th vertebrae cannot be eliminated.

When fragments form, laminectomy is used to relieve pressure on the spinal cord. Surgeons remove debris and stabilize the vertebrae and discs.

Fracture of the xiphoid process of the sternum

The xiphoid process is the lower part of the sternum. It has the shape of a blade or sword. Connected to the body of the sternum by movable fibrous cords. It is the attachment point for the large pectoral muscles.

The xiphoid process serves as a reference point during cardiopulmonary resuscitation. It is intense pressure on it that leads to rupture of the cartilage connection between it and the body of the sternum. As a result, a fracture of the xiphoid process and puncture of the diaphragm and liver occurs.

The xiphoid process is quite often injured during resuscitation measures.

I. Passport part. FULL NAME.:. Date of birth: August 23, 1929. Gender: male. Nationality Russian. Place of residence: city. Place of work: pensioner. Date and time of admission to the clinic: September 14, 2002, 12-00 hours. Referred to: city clinic No. 1, trauma center. Diagnosis: a) preliminary – fracture of the lower ribs on the left; b) clinical – fracture of the bodies of the VII-VIII ribs on the left. Concomitant diseases: type II diabetes mellitus, rhinophyma, chronic bronchitis.

II. Patient complaints upon admission to the clinic. Pain in the left half of the chest, below, on the side and behind. The pain intensifies with deep breathing, coughing and when lying on the left side. Difficulty breathing due to pain. Difficulty in active movements due to increasing pain.

III. History of the disease. Mechanism and circumstances of injury. I was injured on the evening of September 13th. While rushing down the stairs in the dark, I slipped on the peel of a watermelon slice. Fell on his left side. I immediately felt pain in the places of impact, more intensely in the chest. However, at first he did not pay attention to the pain, assuming that it was associated with a bruise. During the evening, the pain in the chest on the left did not subside. He took analgesics on his own. Upon self-examination, I noticed a bruise at the site of the impact, which I attributed the pain to. Getting out of bed the next morning, I realized that the pain was not decreasing, it was associated with breathing, and the cough was very painful. Then I decided to go to clinic No. 1. After examination, the doctor was sent to the city hospital, traumatology department, where he was admitted, collecting his things and bedding.

IV. Anamnesis of life. He started walking and talking on time. I went to school at the age of 7. Education – 9 classes. Then he began serving in the army, as a driver in the border troops. Completed training at the sergeant's school. He served until 1953, then quit and began working as a driver. He retired due to old age in 1989. Didn't work in retirement. Has 3 children, all of them live in the Russian Federation. Widower. At school age he underwent appendectomy. Since 1986, he has been suffering from non-insulin-dependent diabetes mellitus and has been taking Maninil-5. He has been smoking since the age of 16 and drinking alcohol since the same age. Marks chronic bronchitis 21-22 years old. In 1934-35 (approximately) he suffered from malaria. He runs the household himself with the help of a neighbor who lives one floor down. Housework is considered feasible. Financial support – old age pension and assistance from children. Heredity is not burdened. Allergy history – population A.

V. General somatic status. The patient's condition is satisfactory. Consciousness is clear. The position is active, sparing the left side.

The skin is pink and flabby. Visible mucous membranes are of normal color. Rhinophyma is noted. The subcutaneous fat layer is somewhat overdeveloped. The food is satisfactory. Lymph nodes are not palpable, palpation is painless.

Respiratory system. Breathing through the nose, noisy, abdominal type. The chest is emphysematous, normosthenic. During the act of breathing, the left half of the chest is less mobile than the right. On palpation it is rigid, painful, especially on the left, vocal tremor is increased. During percussion, the sound over all the lungs is somewhat dull, but in the upper parts it is closer to the pulmonary one. Topographic percussion: right lung - lower edge anteriorly along the 7th intercostal space, lateral along the 7th rib, posteriorly along the 6th intercostal space; left lung - the lower edge in front along the VII rib, on the side along the VII rib, behind along the VI intercostal space. Standing height of the apexes: in front 3.5 cm above the clavicle, in the back along the spinous process of C6. The width of Krenig's fields is 4 cm. Mobility of the lower edges: right lung - 4 intercostal spaces, left lung - 3 intercostal spaces. On auscultation: breathing is harsh, in the upper parts of the lungs it is weakened. Diffuse abundant dry wheezing. BH 20 per minute.

Cardiovascular system: upon examination, the apex beat is invisible. The pulsation of the carotid arteries is barely noticeable. The neck veins pulsate slightly, barely noticeable at rest. Palpation: apex impulse in the 5th intercostal space 1 cm inward from the left midclavicular line (MCL). Percussion: OST - right border 1.7 cm outward from the right edge of the sternum, left - 1 cm inward from the left SCL, upper - on the third rib; borders of the AST - right - along the left edge of the sternum, left 1.5 cm medially from the left SCL, upper on the IV intercostal space. The diameter of the heart is 11.5 cm, the width of the vascular bundle is 5 cm. Auscultation: the tones are somewhat muffled, rhythmic. Heart rate 80 per minute. The pulse is symmetrical, regular, full, of normal tension. The walls of the arteries are thickened. A/D 130/80 mmHg. right, 140/90 mmHg. left.

Gastrointestinal tract: examination - the oral mucosa is pink, the tongue is covered with a white coating at the root and along the edges, the tonsils are not changed, there are 20 teeth, many are covered with metal crowns. There are no hernias or tumor-like formations noted in the abdominal area. A postoperative scar is found along the right inguinal fold. On palpation, the abdomen is soft, painless, the edge of the liver is smooth, even, painless. On percussion over the intestines there is tympanitis. Liver: upper border – VI rib along the parasternal line, VI rib along the right SCL, VII rib along the anterior axillary line; lower border - 6 cm below the xiphoid process along the midline, 0.5 cm below the lower edge of the costal arch along the left parasternal line, 2.5 cm below the lower edge of the costal arch along the right parasternal line, 0.5 cm below the edge costal arch along the right SCL, on the upper edge of the XI rib along the right anterior axillary line. The gallbladder is palpated at the intersection of the right rectus abdominis muscle with the costal arch and is painless. Auscultation: intestinal peristalsis is active, rhythmic, uniform.

Genitourinary system: examination - there are no tumor-like formations, the genital organs are developed according to the male type, secondary sexual characteristics correspond to age. Both testicles are palpable. The kidneys are not palpable. Pasternatsky's symptom is negative on both sides.

Endocrine system: the thyroid gland is homogeneous, not enlarged. There is no hyperpigmentation, ocular symptoms are negative. There is moderate obesity due to non-insulin-dependent diabetes mellitus.

Nervous system. Consciousness is clear, criticism of the state is preserved, oriented in time and space. Memory saved. Intelligence corresponds to age and education. The mood is even and cheerful. Behavior during questioning and examination is adequate. Falls asleep (according to the patient) quickly, 8-10 minutes after going to bed. Sleeps peacefully, without waking up. Dreams are ordinary and varied. Waking up in the morning is not difficult. There are no hallucinations, delusions, obsessive thoughts or actions. Speech is smooth and he pronounces words correctly. The vocabulary of the Russian language is sufficient. Understanding of the spoken speech is complete. There is no aphasia. There is no apraxia, agraphia, alexia, amusia, or acalculia. FMN: photoreaction is sluggish, convergence and accommodation are weakened. Hypermetropia and presbyopia are noted. There are no disturbances in the reflex, sensitive, or motor areas. Meningeal signs are negative.

VI. Status localis. Excursion of the chest on the left during breathing is limited. On the left, from the VI to IX ribs between the middle axillary and scapular lines, there is a large bruise and swelling. Palpation of the lower ribs is painful. When palpating the VII-VIII ribs, pain and bone crepitus are noted. You can feel the fracture line of the rib bodies.

VII. Preliminary clinical diagnosis . Fracture of the lower ribs on the left.

VIII. Paraclinical studies. 1. General blood test. 09.16.02 Hb 121 g/l; R 4.32 * 1012/l; CPU= 0.8; L 8.2 * 109/l; ESR 18 mm/h; leukocyte formula: young – 0; stab - 2; segmented – 67; eosinophils – 1; lymphocytes – 25; monocytes – 3.

2. Biochemical blood test. 09.16.02 Direct bilirubin – 0; indirect – 8.6; total protein – 67.7 g/l; blood sugar – 8.0 mmol/l.

3. General urine analysis. 09/16/02 Color – light yellow; transparency is not complete; relative density – 1018; protein – 0; L 2-4 in p/z; R 3-4 in p/z; squamous epithelium is single.

4. No worm eggs were found in the feces. Gregersen's reaction is negative.

5. ECG. Heart rate is 82 per minute, the rhythm is regular, sinus. The position of the electrical axes of the heart is horizontal. Signs of moderate right ventricular hypertrophy.

6. X-ray.09/14/02 Plain X-ray of the chest in the anterior projection: fracture of the bodies of the VII-VIII ribs on the left. Chronic bronchitis, vicarious emphysema of the upper lobes of the lungs. Hypertrophy of the right heart.

IX. Clinical diagnosis. Based on:  complaints: pain in the left half of the chest, lower side and back, aggravated by deep breathing, coughing and when lying on the left side; difficulty breathing and active movements due to pain.  medical history: I received the injury while going down the stairs in the dark, slipping on the peel of a watermelon slice and falling on my left side. I immediately felt pain in the places of impact, more intensely in the chest. During the evening, the pain in the chest on the left did not subside; it was associated with breathing; the cough was very painful. Then I decided to go to clinic No. 1. After examination by a doctor, he was sent to the city hospital, traumatology department; - clinical picture: rhinophyma is noted. Breathing is noisy, abdominal type. The chest is emphysematous, movement of the left half is limited. On palpation it is rigid, painful, especially on the left, vocal tremor is increased. During percussion, the sound over all the lungs is somewhat dull, but in the upper parts it is closer to the pulmonary one. On auscultation: breathing is harsh, in the upper parts of the lungs it is weakened. Diffuse abundant dry wheezing. BH 20 per minute. Cardiovascular system: tones are somewhat muffled. Heart rate 80 per minute; - status localis: the left half of the chest is less mobile than the right; on the left, from the VI to IX ribs between the middle axillary and scapular lines there is a large bruise and swelling. Palpation of the lower ribs is painful. When palpating the VII-VIII ribs, bone crepitus is noted; the fracture line of the rib bodies can be felt;  paraclinical research methods: blood sugar – 8.0 mmol/l; Plain X-ray of the chest in the anterior projection: fracture of the bodies of the VII-VIII ribs on the left. Chronic bronchitis, vicarious emphysema of the upper lobes of the lungs. Hypertrophy of the right heart - a clinical diagnosis was made: closed fracture of the bodies of the VII-VIII ribs on the left. Concomitant diseases: type II diabetes mellitus, rhinophyma, chronic bronchitis.

X. Treatment. 1. Bed rest for 6 days; 2. blockade of the fracture site with novocaine 1% -10.0 once a day for 3 days; 3. ampicillin trihydrate 0.5 g 4 times a day for 5 days; 4. nicotinic acid 5% solution, 2.0 IM 1 time per day for 10 days; 5. vitamin B12 500γ, 1.0 IM 1 time per day for 10 days; 6. aloe extract liquid for injection, 1.0 IM 1 time per day for 10 days; 7. analgin 50% solution, 2.0 IM for severe pain; 8. Diphenhydramine 1% solution, 1.0 IM in one syringe with analgin for severe pain; 9. breathing exercises; 10. sollux on the left half of the chest.

Rationale for prescriptions: 1. bed rest to reduce the mobility of the patient’s axial skeleton and chest; 2. novocaine blockade of the fracture site relieves pain, reduces reflex tension of the intercostal muscles; 3. ampicillin trihydrate for the prevention of hematoma suppuration, in order to prevent congestive pneumonia; 4. nicotinic acid to dilate blood vessels and reduce post-traumatic swelling, improve nutrition of the ribs and damaged soft tissues; 5. vitamin B12 to improve metabolic processes; 6. liquid aloe extract for injection as an infiltrate-absorbing drug and biostimulant; 7. analgin solution to reduce pain, improve the patient’s condition, reduce anxiety; 8. diphenhydramine to reduce the patient’s anxiety due to pain, as a hypnotic; 9. breathing exercises to normalize lung function, prevent congestion in them associated with limited mobility of the chest; 10. Sollux to improve bone regenerative processes.

Recipes: 1. novocaine Rp.: Sol. Novocaini 1%-100.0 DtdN 3 S. for pain relief at sites of traumatic fractures (in the hands of a doctor!) # 2. nicotinic acid Rp.: Sol. Acidi nicotinici 5%-1.0 DtdN 20 in amp. S. 2 ml intramuscularly 1 time per day for 10 days. # 3. ampicillin trihydrate Rp.: Ampicillini trihyratis 0.25 DtdN 40 in tab. S. 2 tablets 4 times a day. #4. Vitamin B12 Rp.: Sol. cianocobalamini 500γ-1.0 DtdN 10 in amp. S. 1 ml intramuscularly 1 time per day for 10 days. #

5. aloe extract liquid for injection Rp.: Extr. Aloеs fluidum pro injectionibus – 1.0 DtdN 10 in amp. S. 1 ml intramuscularly 1 time per day for 10 days. # 6. analgin Rp.: Sol. Analgini 50% - 2.0 DtdN 10 in amp. S. 2 ml intramuscularly for severe pain. #7. Diphenhydramine Rp.: Sol. Dimedroli 1% - 1.0 DtdN 10 in amp. S. 1 ml intramuscularly with analgin in 1 syringe for severe pain. #

XI. Forecast and prevention. Prognosis: the patient’s age and concomitant diseases are complicating factors. However, the rib fracture was not accompanied by damage to the pleura or lung; treatment began 16 hours after the injury. Thus, the prognosis is favorable, restoration of working capacity will occur in 4-5 weeks. Prevention: preventing injuries, wearing appropriate glasses, moving more carefully.

XII. Diary. 09/24/02, 830 hours. A/D 130/80 mmHg, ps' 78. The patient's condition is satisfactory. Pain persists when coughing and palpating. Breathing is not difficult, there is no shortness of breath. The patient moves freely around the hospital.

09/26/02, 1800 hours. A/D 130/80 mmHg, ps' 76. The patient's condition is improving. Complaints of pain on palpation of the chest have practically disappeared. Pain persists when coughing and deep breathing. The patient spares himself. The food is ok. There are no minor complaints. At rest he does not feel pain, but cannot lie on his left side.

XIII. Epicrisis. The patient, born in 1929, was admitted to the clinic on September 14, 2002 and was under observation from September 24, 2002 to September 27, 2002. He was admitted with complaints of pain in the left half of the chest, below, on the side and behind, worsening with deep breathing, coughing and when lying on the left side. Difficulty breathing and active movements due to pain. From the medical history: he was injured on September 13, when he slipped while going down the stairs at home and fell. Took analgesics. The next day, he went to the emergency room of city clinic No. 1, from where he was sent to hospital treatment. From the life history: surgery for acute appendicitis, suffers from non-insulin-dependent diabetes mellitus, chronic bronchitis. Smokes, drinks alcohol. Objectively: signs of rhinophyma, chronic bronchitis, senile vicarious emphysema, moderate obesity due to diabetes mellitus. Status localis: left chest excursion during breathing is limited. On the left, from the VI to IX ribs between the middle axillary and scapular lines, there is a large bruise and swelling. Palpation of the lower ribs is painful. When palpating the VII-VIII ribs, pain and bone crepitus are noted. You can feel the fracture line of the rib bodies. A diagnosis was made: a closed fracture of the bodies of the VII-VIII ribs on the left. Concomitant diseases: type II diabetes mellitus, rhinophyma, chronic bronchitis. Treatment was prescribed and justified: 1. Bed rest for 6 days; 2. blockade of the fracture site with novocaine 1% -10.0 once a day for 3 days; 3. ampicillin trihydrate 0.5 g 4 times a day for 5 days; 4. nicotinic acid 5% solution, 2.0 IM 1 time per day for 10 days; 5. vitamin B12 500γ, 1.0 IM 1 time per day for 10 days; 6. aloe extract liquid for injection, 1.0 IM 1 time per day for 10 days; 7. analgin 50% solution, 2.0 IM for severe pain; 8. Diphenhydramine 1% solution, 1.0 IM in one syringe with analgin for severe pain; 9. breathing exercises; 10. sollux on the left half of the chest. By the end of the observation, the patient's condition improved: pain on palpation of the chest disappeared, the patient could move freely around the clinic, breathing became painless. It is recommended to complete the course of treatment and then try to prevent injuries.