Bruise of edges – a trauma of soft fabrics (skin, hypodermic cellulose, muscles) in a thorax. Arises during the falling, blow or a sdavleniye. Unlike the majority of other injuries of a thorax, belongs to the category of slight injuries and does not pose potential hazard to life. Can be followed by rather intensive pain syndrome, hypostasis, formation of hematomas or hemorrhages. The diagnosis is exposed after an exception of other injuries of thorax. Treatment is conservative, the term of disability is up to 1 month.
Bruise of edges
Bruise of edges – the slightest injury of a thorax. At such damages only superficially located soft fabrics usually suffer, and bones and internals remain intact. The combination of a bruise of edges to other injuries is seldom observed: concussion, a bruise or a rupture of a lung, haemo - or pheumothorax. Such damages, even at preservation of integrity of edges, can pose hazard to life of the patient and demand performing urgent specialized treatment. Therefore careful differential diagnosis of injuries of thorax, an exception of heavy damages and a right choice of tactics of treatment are the most important tasks of the experts working in the field of traumatology and orthopedics.
Symptoms of a bruise of edges
The patient with a bruise of edges is disturbed by the pain amplifying at deep breath and the movements. In the field of a bruise the swelling appears. There are centers of hemorrhages of various size and a form. At the sliding blows hematomas quite often are formed. Soft fabrics at palpation are painful. To estimate pain level at an edge palpation in a zone of damage can be difficult as this part is in a zone of morbidity of soft fabrics. To exclude an edge fracture, it is possible, having pressed on an edge on some distance from area of a bruise – if the bone is whole, pressure will be painless.
One more symptom allowing to differentiate bruises of edges from changes – pressure upon a thorax. The traumatologist puts both palms on the side surfaces of a thorax and accurately squeezes it. If sharp strengthening of pain is absent – it with high probability allows to exclude a fracture of edges on the basis of clinical examination. It is necessary to consider that heavy damages (concussion of lungs, pheumothorax etc.) in some cases can arise even in the absence of changes. For assessment of a condition of respiratory system the auskultation is carried out. At uncomplicated bruises lungs are listened in all departments, breath on the sick party can be a little weakened. Perkutorno is normal of border of lungs.
The damages complicating a bruise of edges
Easy degree of concussion of a lung is followed by unsharply expressed clinical manifestations. The patient complains of feeling of shortage of air, at survey change of a rhythm and frequency of breath comes to light. At heavy concussion the condition of the patient worsens, develops sharp respiratory insufficiency. Breath becomes frequent, superficial and uneven. Skin gets a cyanotic shade. Foot and patient's palm cold, damp. The pulse which is speeded up arrhythmia is possible. Similar states pose hazard to life and demand performing intensive therapy.
The bruise of a lung is followed by hemorrhages in tissue of a lung or under a pleura. The pleura at the same time remains intact therefore pheumothorax and usually is absent. Gaps enough large vessels and bronchial tubes are in some cases possible. Patients with a slight injury of a lung have a short wind and a blood spitting. In the course survey local weakening of breath and obtusion of a perkutorny sound is found. At heavy bruises sharp respiratory insufficiency which is shown by weighting of the general state, breath violations, cyanosis, violations of a warm rhythm, a cold snap of extremities etc. develops. As well as at heavy concussions of lungs, intensive therapy is required.
at bruises of the edges which are not combined with changes arises seldom. Cases when the patient with a bruise has violations of coagulability of blood can become an exception, there is a tumor of a pleura or okoloplevralny areas of a lung. Small it is not shown and found only according to a X-ray analysis in any way. At a big gemotoraks decrease HELL, tachycardia, short wind, cyanosis, cough and breast pains is observed.
Pheumothorax at a bruise of edges is more often formed against the background of already existing pathology: pleural unions, chronic obstructive diseases of lungs, tumors of lungs etc. though development of this pathology is possible also at healthy lungs. The condition of the patient sharply worsens that is connected not only with falling off of a lung, but also with change of position of heart. Quickly accruing suffocation, swelling of cervical veins, cyanosis, decrease HELL, increase of pulse and other signs of the progressing sharp respiratory insufficiency is observed. For simplification of breath of the patient accepts the compelled sitting position, raising shoulders and leaning hands on edge of sitting. Palpatorno under skin of the top half of a body sites of a congestion of air at which palpation the soft gentle crunch is heard can be found. Breath on the sick party is absent, at percussion the timpanichesky or box sound is defined. Shift of borders of heart is possible.
Diagnosis of a bruise of edges
Primary differential diagnosis of a bruise of edges is carried out taking into account a condition of the patient and data of survey. For a final exception of heavy damages appoint a thorax X-ray analysis. At bruises of a lung the blackout centers which are not coinciding with borders of shares and segments come to light, emergence of tape-like strips of blackout on the course of some bronchial tubes is possible. At a gemotoraksa in the lower departments there is accurately visible, contrast homogeneous blackout with horizontally located upper bound.
At pheumothorax the pulmonary drawing in zones of falling off of a lung is absent, the shadow of a sredosteniye is displaced in the healthy party, sometimes under skin air layers are visible. In doubtful cases in addition to a X-ray analysis MRT of lungs allowing to reveal small sites of falling off of a lung, the small centers of hemorrhages etc. can be appointed. At violations of warm activity invite the cardiologist to consultation, at heavy respiratory violations – the pulmonologist or the chest surgeon. If pathological manifestations from edges and internals are absent, expose the diagnosis hurt edges.
First aid and treatment of a bruise of edges
The victim needs to give an analgetic, it is necessary to put cold to area of a trauma – it will help to reduce hypostasis, hemorrhages and hematomas. Even at satisfactory condition and lack of symptoms of severe injuries of a thorax of the patient it is necessary to bring to emergency station or a traumatologic hospital as at the initial stages heavy damages can proceed asymptomatically urgently. It is better to make delivery in a sitting or semi-sitting position – it will help the victim to facilitate breath.
To the patient with a bruise of edges recommend to limit physical activity. It is better to sleep in a semi-sitting position (with a big pillow or the raised head end of a bed). Bandaging of a thorax should be applied with care, only at severe pains and for short time as bandage not only reduces pain, but also limits thorax excursions. It involves deterioration in ventilation of lungs and increases probability of development of post-traumatic bronchitis and pneumonia, especially at people of advanced age and patients having diseases of respiratory system.
At intensive pains appoint analgetics. Patients are directed to UVCh, and then – to an electrophoresis. Advise to carry out breathing exercises for prevention of hypoventilation. At cough write out expectorant means with bronkholitichesky effect. Regularly carry out repeated surveys for timely identification of complications. At it is long not resolving hematomas of soft fabrics make opening and drainage. Recovery usually occurs till 1 month.