How to treat rib fractures

Rib fractures are quite serious. If you are not careful, your breathing may be affected. Many patients will feel severe pain in the fractured area during breathing, which will seriously affect their normal life and work. In this case, you must take some painkillers to improve the condition when necessary, and it is better to rest in bed more.

1. Local pain is the most obvious symptom of rib fracture, and it worsens with movements such as coughing, deep breathing or body turning. Sometimes patients can hear or feel the bone friction themselves.

2. Pain and destruction of chest stability can limit respiratory movement, shallow and rapid breathing, and reduced alveolar ventilation. Patients dare not cough and have sputum retention, which can cause obstruction of lower respiratory tract secretions, lung consolidation or atelectasis. This should be paid special attention to in the elderly and weak patients or those with existing lung diseases.

3. When flail chest exists, when inhaling, the negative pressure in the chest cavity increases, and the softened part of the chest wall sinks inward; when exhaling, the chest cavity pressure increases, and the damaged chest wall floats and bulges, which is opposite to the movement of other chest walls. This is called "paradoxical respiratory movement". Abnormal respiratory movement can make the chest cavity pressure on both sides unbalanced, and the mediastinum moves back and forth to the left and right with breathing, which is called "mediastinal swing", affecting blood return and causing circulatory dysfunction. It is one of the important factors leading to and aggravating shock.

The treatment principles for rib fractures are analgesia, clearing respiratory secretions, stabilizing the thorax, restoring chest wall function, and preventing and treating complications.

1. Treatment of single closed rib fracture

Because the two ends of the fracture are supported by the upper and lower ribs and intercostal muscles, there is little dislocation and movement, and they can usually heal automatically. The main purpose of fixing the thorax is to reduce the movement of the fracture ends and relieve pain. The methods include: fixation with wide adhesive strips, fixation with multi-strapped chest cloth or fixation with elastic chest strap. The treatment principles for simple rib fractures are pain relief, immobilization and prevention of lung infection. Analgesics can be taken orally or injected intramuscularly when necessary.

2. Treatment of flail chest

Correct abnormal respiratory movements, resist shock, prevent and treat infection, and deal with combined injuries. When the chest wall softening is small or located on the back, abnormal respiratory movements may not be obvious or severe, and local padding and pressure bandaging can be used. However, when the floating amplitude reaches more than 3 cm, it can cause serious respiratory and circulatory dysfunction. When it exceeds 5 cm or it is bilateral flail chest syndrome, it can quickly lead to death and must be treated urgently.

3. Treatment of open fractures

Thorough debridement should be performed as soon as possible. Remove bone fragments and dead tissue, and bite the broken ends of the bones flat to avoid injuring surrounding tissues. If the intercostal blood vessels are damaged, the distal and proximal ends of the ruptured blood vessels should be sutured separately. Patients with pleural damage should be treated as open pneumothorax. After surgery, tetanus antitoxin serum is routinely injected and antibiotics are given to prevent and treat infection.

Rib fractures can usually heal on their own within 2 to 4 weeks, and treatment does not emphasize the fusion of the broken ends as it does for limb fractures.