Fracture of edges – the most widespread injury of a thorax. Fractures of edges make about 16% of total number of changes. At elderly people fractures of edges meet more often that is caused by age reduction of elasticity of bone structures of a thorax. Fractures of edges are followed by breast pain and lead to restriction of mobility of a thorax, for this reason breath to become more superficial that can cause violation of pulmonary ventilation. Multiple fractures of edges can be followed by damage of bodies of a thorax and pose hazard to life of the patient. The diagnosis of a fracture of edges is exposed on the basis of data of a X-ray analysis, if necessary ultrasonography of a pleural cavity and its puncture is carried out.
Fracture of edges
Fracture of edges – the most widespread injury of a thorax. Fractures of edges make about 16% of total number of changes. At elderly people fractures of edges meet more often that is caused by age reduction of elasticity of bone structures of a thorax.
Uncomplicated fractures of one-two edges well grow together and in itself do not pose a threat for life and health of the person. The main danger at this trauma is connected with breath violation, an internal injury and development of the accompanying complications. Uncomplicated fractures of edges meet in 40% of cases. Other 60% are followed by injury of lungs, a pleura and bodies of cardiovascular system. Multiple fractures of edges – the serious trauma constituting danger both because of possible development of plevropulmonalny shock, and because of sharply increasing probability of emergence of life-threatening complications.
The breast is the top part of a human trunk. The bone framework protecting heart and lungs is called a thorax. The thorax is formed by 12 pairs of edges. Between edges intercostal muscles, vessels and nerves are located. Behind all edges connect to a backbone. In the forward part ten pairs of top edges come to an end with cartilages. Elastic costal cartilages provide mobility of a thorax. Cartilages of seven top pairs of edges connect to a breast. Cartilages of the VIII-X edges connect with each other, and XI and XII edges lie freely, without being jointed in a forward part with other bone structures.
From within the thorax is covered by a soyedinitelnotkanny cover (an intra chest fastion) under a fastion at once the pleura consisting of two smooth leaves is located. Between leaves there is a thin layer of lubricant allowing an internal leaf of a pleura at breath freely to slide rather external. Tissue of a lung is formed by the smallest hollow bubbles – alveoluses in which, actually, and there is a gas exchange.
Falling, direct stroke to the area of edges or a sdavleniye of a thorax can become the reason of a fracture of edges. Most often edges break in the place of the greatest bend – on the side surfaces of a thorax. At a fracture of one edge of an otlomka are displaced very seldom. Multiple fractures of edges often are followed by the shift of otlomk (a change with shift). At the same time otlomk the sharp ends can injure a pleura, easy and intercostal vessels.
Injury of a pleura and lungs quite often is followed by development of complications – a gemotoraks and pheumothorax. At a gemotoraksa blood accumulates between external and internal leaves of a pleura. At pheumothorax in a thorax air accumulates. The lung is squeezed, decreases in volume, alveoluses are fallen down and cease to take part in breath. The fracture of edges with injury of a lung can be followed by penetration of air into hypodermic cellulose (hypodermic emphysema). At damage of intercostal vessels plentiful bleeding can develop in a pleural cavity or soft fabrics.
The patient complains of sharp breast pain. Pain amplifies at breath, the movements, a conversation, cough, decreases at rest in a sitting position. Breath is superficial, the thorax on the party of defeat lags behind at breath. At a palpation of the broken rib the site of sharp morbidity, sometimes – a bone krepitation (a peculiar crunch of bone otlomk) comes to light.
Forward and side fractures of edges are hard transferred by patients, are followed by breath violation. At damage of back departments of edges violation of pulmonary ventilation is, as a rule, less expressed. At multiple fractures of edges the condition of the patient worsens. Breath is superficial. Pulse is speeded up. Skin is pale, quite often cyanotic. The patient tries to sit not movably, avoids the slightest movements.
In the field of changes puffiness of soft fabrics, bruises is observed. At a palpation the poured sharp morbidity, a bone krepitation is defined. If the fracture of edges is followed by hypodermic emphysema, at a palpation of hypodermic cellulose the air krepitation which, unlike a bone krepitation, reminds a soft poskripyvaniye comes to light.
Developing of pheumothorax is demonstrated by deterioration in the general condition of the patient, the accruing short wind. Breath on the struck party is not listened. Injury of a lung can be followed by a blood spitting. Pheumothorax and – complications which, as a rule, develop after a trauma in the nearest future. In several days after a change one more dangerous complication – post-traumatic pneumonia can develop. Patients of advanced and senile age at whom pneumonia proceeds especially hard are more inclined to development of this complication.
Development of pneumonia is demonstrated by deterioration in the general condition of the patient, intoxication symptoms, difficulty of breath and temperature increase. It is necessary to consider that at the weakened elderly patients and patients with the severe combined injury post-traumatic pneumonia is not always followed by temperature increase. In some cases only deterioration in the general state is noted.
Developing of post-traumatic pneumonia is caused by decrease in level of ventilation of lungs on the party of a change. Breath at a fracture of edges is painful therefore the patient tries to breathe as much as possible superficially. The problem is aggravated with self-treatment. Many believe that for a good union of edges it is necessary to limit their mobility, having bandaged a thorax. As a result breath is limited even more, in lungs there are developments of stagnation, stagnant pneumonia develops.
Actually, at a fracture of edges in absolute majority of cases fixing is not required. An exception – some complicated and multiple fractures of edges at which help has to be given only in hospital conditions. In the absence of timely treatment of a complication of fractures of edges pose direct hazard to life of the patient. To prevent development of complications or to eliminate their consequences, at suspicion of a fracture of edges it is necessary to ask for the qualified medical care as soon as possible.
The diagnosis of a fracture of edges and the accompanying complications is established on the basis of a X-ray analysis. At suspicion on pneumo - and the rentgenoskopicheskiya of lungs, ultrasonography of a pleural cavity, a pleural puncture is in addition carried out.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Uncomplicated changes of one (in some cases – two) edges treat on an outpatient basis. The fracture of three and more edges is the indication for urgent hospitalization in office of traumatology. At an uncomplicated fracture of edges at the time of receipt the traumatologist produces local anesthesia of a change or vago-sympathetic blockade according to Vishnevsky. Then to the patient appoint analgetics, expectorant medicines, physiotherapeutic procedures and remedial gymnastics for improvement of ventilation of lungs.
Sometimes pheumothorax and develop not in the moment of arrival of the patient, and a bit later. At suspicion on development of these complications during treatment carry out additional roentgenoscopy. During treatment of the complicated fractures of edges, along with standard procedures (change anesthesia, analgetics, physical therapy and remedial gymnastics), additional medical events are held. The small amount of blood in a cavity between leaves of a pleura resolves independently. At the expressed gemotoraks the puncture of a pleural cavity is made. The doctor under local anesthesia enters a special needle into a pleural cavity and deletes the accumulated blood. Sometimes develops repeatedly therefore during treatment it is necessary to carry out several punctures.
At pheumothorax in certain cases it is enough to carry out a puncture for removal of air. Intense pheumothorax is the indication for urgent drainage of a pleural cavity. Under local anesthesia the doctor does a small section in the second intercostal interval on the sredneklyuchichny line. Enter a drainage tube into a section. Other end of a tube is lowered in bank with liquid. It is important that this bank was lower than the level of a thorax of the patient all the time. The air accumulating in a pleural cavity comes out through a tube, the lung finishes. The pleural drainage is usually kept within several days until air ceases to arrive on a drainage tube. Then do control roentgenoscopy and delete a drainage.
During treatment of post-traumatic pneumonia, along with the general medical actions (antibiotics, physiotherapy), it is very important to carry out remedial gymnastics for restoration of normal ventilation of lungs. Fixing of fractures of edges is required very seldom and is carried out, as a rule, at the massive injuries of a thorax which are followed by multiple unstable fractures of edges. The average term of treatment at uncomplicated fractures of edges makes about 1 month. Duration of treatment of the multiple and complicated fractures of edges is defined by weight of complications and the general condition of the patient.