Fracture of the sternum (chest)
A fractured chest is a serious injury that can lead to serious complications, such as damage to internal organs. If the fragments touch the lungs or heart, this poses an immediate threat to the patient's life. For this reason, a fracture of the ribs and sternum requires qualified medical care.
Such an injury involves, first of all, damage to the sternum, the flat bone located in the front of the chest. It is connected to the collarbones and ribs. In most cases, the proximal sternum is not injured in isolation - the ribs are also affected. Often, these fractures affect the area of the posterior and middle axillary lines.
The rib can break both when struck directly on it, and with strong pressure on the chest. With a direct impact, the rib sags into the body, then a splinter of bone can damage internal organs. When compressing the chest, multiple mother-in-law and closed fractures are possible over the entire area of compression. It is in this case that fractures of the largest number of ribs are diagnosed.
Content:
- Causes of the fracture of the chest
- Symptoms of a chest fracture
- Types of rib and sternum fractures
- Diagnosis and treatment of chest fracture
Causes of the fracture of the chest
The most common cause of a chest fracture is a road traffic accident. It is difficult to get a strong blow on this part of the body in another situation. Moreover, women are more prone to this type of injury than men. In car accidents, the driver suffers a fracture of his chest in a collision with the steering wheel. That is why airbags are so important. In some cases, they soften the impact and prevent severe damage. A fastened seat belt performs the same functions. You should not neglect the use of these funds while driving. Observance of basic safety rules will help to avoid serious injury in the event of an emergency.
Chest fractures are common in athletes. Gymnasts, weightlifters, wrestlers and hockey players need to be careful during training and competition. However, there is little risk of injury from a direct blow to the chest, such as a fall from a great height, because the chest is a strong frame protected by muscles and ligaments. It is possible to get a fracture in this way only in osteoporosis, when the bone tissue is weakened and thinned as a result of the disease.
It is very rare for children and adolescents to have a chest fracture. This is due to the fact that their cartilaginous part of the ribs is still very elastic, and perfectly serves as a shock absorber, softening the impact. The elasticity of the sternum of young people also smoothes the effect on the bone tissue.
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Symptoms of a chest fracture
The fracture of the chest is accompanied by a characteristic crunch. The patient can feel that the bones move freely inside. There is inflammation and swelling in the chest area. A shrapnel fracture of the chest can damage the lungs, which can cause breathing problems. The main symptom is severe pain. It is made worse by coughing, sneezing or laughing. The victim has shallow, accelerated breathing. A hematoma (bruise) forms in the area of damage, sometimes bleeding through the nose or mouth begins.
With a fracture, the pectoral muscles contract voluntarily, the deformation of the sternum becomes clearly visible externally. A person who receives this type of injury intuitively seeks to ease the pain and adopt a sitting position. This helps reduce discomfort.
If multiple fractures of the ribs are received, the pain will be mild. However, it will be quite noticeable on palpation. If the ribs and sternum are completely fractured, the pain syndrome will be much more pronounced. On palpation, sometimes it is even possible to determine the presence of fragments of the sternum and ribs even before the X-ray examination.
When it comes to fractures of the posterior ribs, the symptoms of respiratory distress are usually mild. Fractures of the lateral and front part of the chest are very painful, they are accompanied by serious disorders of ventilation of the lungs, as well as a significant violation of gas exchange in the body.
Possible complications of a chest fracture include pneumothorax and hemothorax. In the first case, air or gases accumulate in the pleural cavity. This phenomenon provokes a lack of oxygen, a drop in blood pressure and eventually sometimes causes cardiac arrest. Hemothorax is a similar phenomenon, but with it, not air is in the pleural cavity, but blood, which compresses the lungs, leading to impaired breathing and gas exchange.
Types of rib and sternum fractures
By the nature of the fracture line of the chest, the following types are distinguished:
- oblique;
- transverse;
- longitudinal.
In addition, the fracture of the chest can be open and closed, with or without displacement of fragments.
Diagnosis and treatment of chest fracture
First aid
In case of a fracture of the chest, it is important to provide the victim with first aid on time. It is often necessary to do this before the arrival of the doctors. Use ice to relieve pain and reduce swelling. Keep the cold in the place of damage for no more than 20 minutes, after which an hour break should follow. This will help prevent tissue frostbite.
Clothes that restrict movement and breathing on the victim must be unbuttoned, help him to take the most comfortable position and not allow him to move and talk. When the pain becomes unbearable, pain relievers are used, for example, Baralgin, Ibuprofen, Diclofenac, or Ketoral. With an open fracture, the site of injury is treated with an antiseptic solution, and the top is covered with a towel or clean cloth.
Diagnostics
A chest fracture can be diagnosed by taking an X-ray. Determine damage to soft tissues or internal organs using computed tomography.
Treatment
Dressings for chest fractures are not used because they restrict breathing, interfere with recovery, and contribute to the development of certain conditions such as pneumonia or pleurisy. Tight bandaging of the chest is necessary only for transportation of the patient.
For a fracture without displacement, a wide sticky patch is used to fix the area of injury. After 2 weeks, it is removed. In the presence of displacements, reduction is performed first, and then the fracture site is also fixed. Surgical intervention is used if there is a risk of damage to internal organs by fragments.
Medical treatment involves, first of all, pain relief. For this, retrosternal and intercostal novocaine blockades are used. During the procedure, the victim should be in a sitting position. To eliminate severe pain, a solution of Promedol is administered intravenously. If there are no contraindications, continuous epidural anesthesia is recommended. The patient is also given expectorant, decongestant and anti-inflammatory drugs, physiotherapy procedures are carried out.
To recreate the integrity of the "frame" of the sternum and normalize the breathing rhythm in case of multiple fractures (more than five ribs), a specific immobilization is used. Constant stretching is performed for the sternum and ribs, they are fixed with the support of special plastic splints, which are applied to the chest area. In cases of bilateral multiple fracture of the ribs with flotation of the anterior part of the sternum, long-term stretching for the ribs and sternum is used with special bullet forceps and strong threads.
Recovery
Fractures of the chest are healed within one month. Efficiency is restored in 4-5 weeks after complete fusion. If several ribs have been broken, it will be possible to return to work in 1.5-2 months.
After the fusion of the bones, the patient is prescribed breathing exercises, massage and physical exercises. For some time every day, you will have to tighten the chest with an elastic bandage. You need to increase physical activity gradually. Gymnastics is performed on the recommendation and with the permission of a doctor. It should include exercises for posture and flexibility. They avoid atrophy of the chest muscles.
A positive effect on the health and well-being of patients with fractures of the ribs and sternum is provided by classes in the pool: swimming, water aerobics, outdoor games. But even several months after complete rehabilitation, the area of injury should not be loaded, since there is a high risk of new cracks appearing.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
