Symptoms of rib fracture
The symptoms are generally severe chest pain, especially when breathing, speaking, and coughing. Thus, the rib fracture is symptomatically only slightly different from a rib contusion. The patient therefore often reacts with shallow (because less painful) breathing, up to dyspnoea, i.e. breathing difficulties.
This condition is particularly unpleasant for the patient, as he or she tries to take a breath in panic, but this process causes him or her severe pain every time. Further symptoms can be air accumulation under the skin in the rib fracture area, which is already a sign of a more serious injury: In this case, a broken rib was pressed inwards, against the lung skin and punctured it. Air escapes from the lung into the subcutaneous tissue, there is a risk of pneumothorax.
This is an absolute emergency indication. Furthermore, the fractured area is pressure-sensitive. Blood flows through the injured blood vessels into the subcutaneous tissue and a hematoma develops.
A classic example of a serial rib fracture, i.e. a fracture of several adjacent ribs, is the so-called “paradoxical breathing”: The thorax retracts while the patient breathes in, and bulges outwards during exhalation, i.e. in exactly the opposite direction to what one would expect in a healthy patient. This is because the diaphragm – the large muscle that lies underneath the two lobes of the lung – actively creates a kind of vacuum during inspiration (i.e. inhalation), so that air flows into the lungs from outside. Since the thorax is unstable, it is pulled in during inspiration and pressed outwards during exhalation.
Causes of rib fracture
The causes of rib fractures vary and occur mainly during sports with a lot of physical contact. To mention them all would go beyond the scope of this article, but boxing and cycling should be emphasized: In boxing, the notorious “liver hook” is aimed at the liver lying protected under the ribs. However, usually the liver is hit less, and more the ribs – if the punch is too strong, they break.
Although the thorax is extremely elastic, not all pairs of ribs are equally stable: While the upper seven pairs of ribs, the so-called “true ribs” (Latin: “costae verae”) are firmly anchored to the sternum, the pairs of ribs 8 to 12 end in cascades in the respective upper rib (the so-called “false ribs”, or Latin “costae spuriae”). This makes the structure more unstable and less elastic. Cyclists, and especially racing cyclists, have an increased risk of hitting the handlebars with their thorax in the event of a fall or sudden braking. Especially racing cyclists often have an asthenic physique, with little protective fat or muscle mass.
