Introduction
Rib fractures are not an easy area to treat in surgery. A rib usually breaks under direct or indirect force on the thorax. Depending on the force, direction and extent of the force applied, ribs can break in different ways, which in turn has an impact on symptoms, therapy and accompanying complaints. The degree of severity of a rib fracture can range from a simple fracture caused by light violence (e.g. excessive coughing in the case of weak bones, such as osteoporosis), which in some cases does not even impair the quality of life, to multiple fractures of one rib, to so-called rib serial fractures (fractures of more than three ribs), which can develop when massive force is applied to the thorax and can later lead to a hematothorax and/or pneumothorax. The biggest problem with rib fractures is an impairment of the breathing mechanics, since the ribs, as the bony corset of the thorax, must be synchronized with the breathing every time the patient breathes in and out.
Definition
A rib fracture (rib fracture) is a fracture of the cartilaginous or bony portion of a rib. A distinction is made between a simple rib fracture (a fracture in which the two fragments are not displaced from each other), a separation fracture (fracture at the transition from cartilaginous to bony rib tissue) and a fracture of a rib fragment in which one rib has multiple fractures. A serial rib fracture (serial rib fracture) refers to simultaneous fractures of at least 3 adjacent ribs.
The symptoms of rib fractures depend on the number and location of the fractured ribs. In the case of a simple, uncomplicated rib fracture, there is usually only pain over the affected area. The pain is dependent on breathing; it increases when breathing, deep breathing and above all when coughing, since the rib cage including the ribs expands during this process.
Characteristic for rib fractures are also a local pain under pressure and in some cases a noticeable crepitation (rubbing of the fracture surfaces). A nerve/vascular plexus runs under each rib. If this is injured by the fractured rib, local (localized) hematoma and intercostal neuralgia may occur.
Intercostal neuralgia describes a stabbing to pulling pain in the area of the intercostal ribs, which affect the sensitive area of the injured nerve in a belt-like manner and are in turn intensified by movement, breathing, pressing and coughing. Due to the respiration-dependent pain, older patients in particular minimize their breathing and flatten it. This leads to an undersupply of the lung and consequently to poorly ventilated lung areas in which germs can now collect and grow more easily.
The late consequence of a broken rib is pneumonia (inflammation of the lungs). In the case of more severe serial rib fractures, breathing can be considerably restricted. If the wall of the thorax becomes unstable due to the multiple fractures (so-called unstable thorax), paradoxical/inverse respiration with subsequent respiratory insufficiency can develop.
In this case, the chest wall behaves in the opposite way to its natural state, i.e. it contracts during inhalation and expands during exhalation, as the ribs can no longer serve as a counterbearing. The lung can no longer fill sufficiently with fresh oxygen, the patient must be intubated and ventilated as quickly as possible. Other accompanying symptoms can be lung contusion, hemato- or pneumothorax.
A lung contusion is a bruise of the lung that is accompanied by the rupture of small vessels in the lung and subsequent bleeding into the lung tissue. As a consequence of the lung contusion, individual areas of the lung are not ventilated as well. If larger vessels are injured and bleeding into the gap between the ribs and the pleura, the so-called pleural gap, a hematothorax develops.
The lungs are put under pressure, they can no longer develop properly and breathing is severely restricted. (The same symptoms occur in pneumothorax, except that in this case no blood but air enters the area between the lung skin (pleura) and peritoneum. This is caused by injury to the lung through the pointed end of a rib.
