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What is a rib fracture and rib bruise?
The ribs are the bones of the rib cage, there are 12 symmetrical pairs of ribs; they originate from the vertebrae and are connected to the sternum at the front.Rib fractures can occur when the chest is directly affected by force (chest trauma). A rib is particularly susceptible to injury due to its long, flexible shape; it can break in case of falls or bruises.
In elderly patients with osteoporosis, even a firm hug or crowd can lead to rib fractures
The danger of rib fractures is that the organs contained in the chest can suffer injuries, especially the lungs, heart, liver, spleen and the large arteries and veins running here.
A fracture of the first two ribs is extremely rare, but must be treated accordingly, because the other internal structures of the chest can be damaged and even lead to death.
The first two ribs are less pliable than the others; therefore, in the case of trauma to the upper rib cage, there will not be an undisplaced fracture, but a dislocated fracture in which the fragments are shifted inwards.
A patient may also appear in the emergency room of the hospital with multiple broken ribs; in this case, because of the risks associated with the trauma, a short inpatient stay of 24-48 hours for observation is recommended, because if the fracture is at the level of the ninth, tenth and eleventh ribs, the piece of bone can pierce the spleen or liver and cause heavy bleeding.
Injury to the pleura and lungs can result in pneumothorax (air in the pleural space) or hematothorax (blood in the pleural space) followed by hypovolemic shock.
The fracture of the middle and lower ribs can be displaced, undisplaced or consist in a fine crack; Debris fractures, burst fractures and piece fractures are practically non-existent. The trauma that caused the fracture can also cause distortion of the rib cartilage.
What causes a rib fracture?
The injury mechanism is a direct force or bruise. The causes of such fractures are car accidents and falls, but they can also occur during a firm hug or crowd.
What are the symptoms and signs of a rib fracture?
The main symptoms include pain at the injured site, swelling and an internal or external bruise. Painful stitches may occur when breathing, palpation and movements of the chest and back (stretching, bending and turning); also coughing and sneezing is very painful. In addition, shortness of breath can be noticeable. If several ribs are broken (rib series fracture), abnormal mobility of the injured ribs can occur, which is similar in terms of healthy ribs.
A “paradoxical breathing” occurs. The movement of the broken ribs during breathing can also lead to a fluctuation of the mediastinal artery/venous trunks in the midfur, which can cause a drop in blood circulation; in this way, a heart shock (cardiogenic shock) can occur.
How is a rib fracture diagnosed?
The diagnosis first of all includes questioning by the doctor, the patient describes the course of the injury and the type of trauma can already lead to a suspicion of rib fracture. The patient’s state of health is also important; an elderly lady with osteoporosis is much more likely to break her ribs than a young person.
In the emergency room, if rib fracture is suspected, an X-ray is taken, which is examined for interruptions in bone continuity.
If the X-ray does not show any abnormalities, the examination should be repeated (but at the earliest after 2 days), because the signs of injury may not have been recognizable on the first X-ray. A microfracture is visible only with the help of magnetic resonance imaging, because it also indicates bone edema.
What therapy is recommended for a rib fracture?
Immediately after the trauma, the affected area should be cooled with ice and the chest spared. After the rib fracture has been diagnosed, a supportive bandage can be applied, which is perceived by some patients as a relief. The bandage must not obstruct breathing, but should restrict the movements of the chest.
The only therapy that accelerates the healing and consolidation process is magnetic therapy; with their help, the times required for the formation of the bone callus can be halved.
Possible long-term effects include persistent pneumothorax. With very severe pain, the doctor may prescribe anti-inflammatory and analgesic drugs that temporarily relieve symptoms.
The sternum fracture What is it?
The sternum is the central bone at the front of the rib cage; it runs vertically and consists of three sections: the handle (Manubrium sterni), the main part (corpus sterni) and the sword process (processus xiphoideus).
Sternum fractures (sternal fractures) are relatively rare, accounting for less than 0.5% of all bone fractures in the human body. The sternum is protected by the structure of the rib cage, with direct trauma, the shock wave is transmitted directly to the ribs, which break much more easily.
The static state of the sternum suggests that it is an equivalent of the spine. Sternum fractures are mainly suffered by men because:
- they carry out heavier activities;
- they are more likely to suffer serious traffic accidents involving collisions with the steering wheel.
The age of patients who come to the emergency room is 25-30 years and older, because the bone growth of the sternum is the last bone to be completely completed at 25 years.
The under-25s have a much more flexible sternum that is practically impossible to break. If the sternum is squeezed inward during trauma, it can cause serious injuries. The most common cause of sternal fractures is direct violence; Fractures caused by indirect trauma, hyperflexion or hyperextension of the spine are rare. Most often, the sternum breaks between the handle and the body, at the level of the sternum angle (angulus sterni); the fissure usually proceeds horizontally, a longitudinal fracture is extremely rare.
Fractures that occur in a traffic accident are often accompanied by distractions of the costal cartilage; Injuries of internal organs mainly affect: trachea, pleura, pericardium and myocardium. Complications occur mainly in the lung area; if the sternum damages the lungs, respiratory insufficiency may develop.
What are the causes?
One of the main causes is the car accident; the seat belt creates intense and strong pressure against the chest, especially in the front area, where the sternum is located.
In other cases, the patient may crash into the steering wheel or, in the case of a motorcycle, the front part of the vehicle; in boxing or other physical sports, a punch or kick to the sternum can cause the fracture. Concomitant diseases can favor a sternum fracture because they weaken bone tissue; These include: aortic aneurysm, tuberculosis and cancers (neoplasms).
Which diagnostic methods are suitable?
Injuries to the sternum can be easily seen on an X-ray because it clearly shows the bone parts. With microfractures, X-rays are not very informative, in this case magnetic resonance imaging (MRI) is necessary, which shows the edema in black at the injured site. A computed tomography (CT) scan has a better resolution, but is rarely performed due to the high radiation levels and costs.
What are the signs and symptoms of a stern fracture?
A typical sign is the restraint of the patient, because by bending the upper body forward, the tension is taken from the ligaments and tendons of the sternum. In an upright position, they would put the bone under tension and thereby cause pain.
Within 4-5 days after the trauma, a bruise is noticeable and local edema can be detected. When palpating the injured area, a strong pressure pain may arise, the symptoms worsen when breathing, coughing, by movements of the upper body, especially when turning.
Breathing is difficult, superficial and the respiratory rate increases; the patient usually breathes with the abdomen. Severe fractures with displacement of the fragments can cause deformation of the bone; this happens mainly below the so-called handle; in addition, the movement of the chest is asymmetrical. The injured person has trouble finding a pain-free sleeping position at night.
How is a sternum fracture diagnosed?
Anyone who suffers severe trauma to the chest should immediately go to the emergency room, where an X-ray will be taken immediately. On the X-ray, an interruption of bone continuity can be clearly seen; if it does not show clear results on the day of the accident, it should be repeated after 2-3 days, because the signs of fracture may not be visible within the first 48 hours.
Which therapy is suitable for a sternum fracture?
Treatment is usually conservative, i.e. not surgical; however, if there is an unstable fracture with displaced bone fragments, there is an indication for surgical treatment by osteosynthesis, as well as respiratory insufficiency. If the patient is not operated, an elastic bandage can be applied to provide support and prevent excessive movements. For the pain, the doctor can prescribe painkillers (analgesics). A sternum fracture heals in about 40 days and the prognosis is usually good.
