Treatment of multiple rib fractures
Traumatology / / May 02, 2016
Damage skeleton of the chest is always accompanied by dysfunction of vital organs - heart and lungs.However, the severity of the disorder depends on the nature and the number of broken ribs, from injuries directly own internal organs and the severity of accompanying injuries.In non-severe chest trauma (fractures of ribs 2-4) functional disorders usually do not cause an immediate threat to life, but as a rule, make the patients suffer from severe pain due to the displacement of fragments of ribs of the respiratory excursions of the chest and at different body movements.As a result, victims are forced to migrate to shallow breathing, which does not provide sufficient alveolar gas exchange.Gradually increasing hypoxia reflex is deeper breaths, which dramatically increases the pain worsens again and ventilation.
Physically healthy people adequately carrying pain, usually do not require special care.Treating them is limited mostly single novocaine blockade of the fracture site.Those same elderly and particu
main principles of treatment of rib fractures, as well as any other damage to bones, are reduction and immobilization of bone fragments.Fractures of the ribs only on one line does not require special measures for repositioning, since by virtue of the anatomical features of the ends of their fragments typically retain contact with each other, and the fusion of the ribs even with a slight offset in length or cross section is no obstacle to the full restoration of function of the chest.Create the rest in the area of rib fractures is almost impossible, as the constant movement of the chest associated with vital functions - breathing.Therefore, the problem is reduced trauma to the creation of relative calm at the fracture site, in fact - to restrict the mobility of the chest.This can be achieved in various ways.NI Pirogov even in 1877-1878.during the war in Bulgaria successfully applied for fractures of the ribs plaster corset, strengthening them and upper and especially the lower ribs.This limited the wounded chest type breathing and diaphragmatic compensatory amplified.Naturally, plaster corset can easily transfer only physically strong people.Perhaps, in this regard, treatment of fractures of the ribs plaster corsets did not spread in trauma in peacetime.
More known way of limiting the mobility of the chest, preventing her sudden extensions because of cough, is the imposition of adhesive tape strips.It is necessary to follow the recommendation of L. Böhler: adhesive tape strip (not less than 10 cm wide) is applied around the chest at the bottom (even if the broken upper ribs) during exhalation victim;for fractures of the upper edges of the strip is further applied via a patch shoulder girdle to limit the mobility of the edges of bone fragments at hand movements.L. Belair especially emphasized aimlessness overlay adhesive on only one (damaged) half of the chest as the two halves of its functionally constitute one unit.A simple and affordable way to limit the respiratory excursions of the chest is the imposition of a circular (but not tight) cloth bandage or elastic bandage.The main function of bandages - the restriction of the thoracic type of breathing, as if the constant "reminder" victims breathe "belly" of the need.Bandaging the chest in fractures of ribs are well tolerated by patients and improves their lung ventilation, virtually harmless.If the dressing is reduced (or "slips"), then, as a rule, patients are asked to shift its "tighter".To facilitate the diaphragmatic breathing patients should be laid with the sublime position of the chest and take care of normal bowel function.
Dempferirovannoe extension of the sternum and the ribs on Mityunin
introduction of narcotic analgesics (mainly promedola) for "minor" injuries chest does not increase respiratory disorders (due to side-inhibitory effect on the respiratory center), as well as a good analgesic effect of allowingpatients normalize pulmonary ventilation by increasing the respiratory excursions chest.
In elderly patients the same, particularly with concomitant phenomena cardiopulmonary diseases, it is better to use non-narcotic analgesics (analgin, aminopyrine, reopirin).It is necessary to emphasize the importance of persistent classes breathing exercises with the victims in the first days after the injury.After 1.5-2 weeks fragments of ribs no longer be displaced due to the development of fibrous corn, pain stopped, the patients are active, willing to become involved in therapeutic exercises and do not require any more bandages, limiting chest rise.Full restoration of function usually occurs within 5-6 weeks.
In the treatment of patients with severe trauma ribs must participate thoracic surgeon, as well as other professionals (neurosurgeon, urologist, and so on. D.).In the acute phase of injury a big role in the rescue of victims plays an anesthesiologist, as emergency care to patients with severe multiple and combined fractures of the ribs begins with resuscitation, aimed at combating the ODN, massive blood loss, acute disturbance of vital body functions, and so on. Etc..
- multiple rib fractures (basics)
- main symptoms of multiple rib fractures
- first aid for injuries complicated burns
- Injuries in the home and at work
- struggle with pain in injuries
- Bilateral dislocations of hip
- tourniquet technique
- Transosseous osteosynthesis external fixation
- struggle with acute blood loss in trauma
Treatment of severe multiple fractures of the ribs is a complex set of simultaneous various measures aimed atthe elimination of pain, fixation of fragments of ribs, eliminating paradoxical displacement of the chest wall, the removal of intrathoracic injury.Ensure full anesthesia many rib fractures using mere novocaine blockade it is impossible, since, on the one hand, the introduction of a large amount of Novocain can cause severe intoxication, and on the other - not all fractures of ribs are available for the blockade, such as damage from posterior (asturning these patients is contraindicated).Conducting general analgesia drugs of opium groups in patients with severe breathing disorders is undesirable, though, in practice, we have to resort to it frequently as a result of the inefficiency of administration of other analgesics.Adequate analgesia can be achieved by subcutaneous administration of nitrous oxide.
Technique perform this simple procedure.Nitrous oxide is injected under the skin of the thighs or the anterior abdominal wall with a sterile system, consisting of a tee with a rubber tube that is connected to a needle for subcutaneous injection gas, rubber pad (pre-filled with nitrous oxide) or balloon and the syringe Janet.The analgesic effect is achieved after the administration of 2-3 liters of nitrous oxide as a result of patients calm, begin to breathe deeply, actively expectorate sputum, nap, which facilitates the transfer of the severity of post-traumatic period.The analgesic effect of nitrous oxide administration parapulmonalnogo lasts up to 2-3 days.Fixing
multiple rib fractures, especially in the formation of various types of "rib valve" can be achieved in various ways.Without the restoration of "framing" of the chest is not possible to normalize breathing, coughing and achieve effective airway clearance.Posterolateral "rib valves" usually do not require a special fixing because they "stabilized" the mass of the patient lying on his back."Short Ribs valve" small sizes on the front and the anterolateral surface of the chest can be fixed with sand bags.Effective treatment of skeletal traction of the sternum and ribs.Traction of the sternum is carried out for 10-35 days, a load of 2-5 kg by means of bullet forceps, gripping the body of the sternum, and the cord held by Brown reinforced the frame blocks.
osteosynthesis ribs needles or rods is of limited use because of the difficulty and trauma.Internal fixation ribs may be formed during thoracotomy undertaken in connection with damage to the heart, lungs or blood vessels.
Treatment of severe chest injuries by using mechanical ventilation pressurized shown in severe combined traumatic brain injuries, and after laparotomy, is always accompanied by paresis of the intestines and the violation of diaphragmatic breathing.
When multiple and associated fractures of the ribs the average hospital stay was 41 days.
Long-term treatment results indicate that all the victims with polifrakturami ribs return to their previous work;the combination of rib fractures with other injuries the ability to work is fully restored in 67.7% of patients with disabilities are 2.6%.Mortality is related primarily to the so-called "injuries incompatible with life" (a combination of severe damage to the rib cage, skull and brain, or limbs).