Introduction
A rib fracture (so-called rib fracture) is a fracture of the rib in the bony or cartilaginous part. A serial rib fracture is when at least three or more adjacent ribs show a fracture. A fracture of a rib is when a rib is fractured twice, i.e. when a piece of rib is broken out. As a rule, fractures of rib fragments only occur after considerable external violence, as is the case in traffic accidents or bicycle falls at high speed.
The cause
Usually, a rib fracture is caused by a direct accident mechanism such as a fall on the chest. In the case of known osteoporosis, a rib fracture can also occur without an accident, since the bone density is greatly reduced and consequently the stability decreases. In the case of severe violence, such as in traffic accidents or riding accidents, several ribs may break at once.
If the violence is less severe, only one rib may be bruised, but the symptoms are similar. Under normal circumstances, coughing does not lead to a broken rib. However, certain chronic lung diseases such as bronchitis, allergic asthma, COPD and existing osteoporosis can lead to the disease.
In osteoporosis, bone density and bone stability are reduced, which leads to a so-called fatigue fracture of the ribs due to coughing. A fracture can also occur in pregnant women, as the space inside the abdominal cavity is reduced due to the constantly growing child and the ever-increasing size of the uterus. This increases the pressure – and tensile load on the ribs, which is why they can break by coughing. Therefore, it is important for the above mentioned risk patients to control an existing cough and to ensure normal breathing.
The symptoms
Typical symptoms of a rib fracture are localized pain that increases with respiratory movement. Especially deep breathing and coughing cause pain directly above the fracture area. Due to the pain, superficial gentle breathing or breathing inhibition can occur, which can have a problematic effect on the oxygen supply, especially in older patients.
Particularly in the case of a serial fracture of the ribs, breathing inhibition can occur. As a rule, fractures in the front wall of the thorax have a greater effect on breathing than fractures located at the back, since here the ribs are additionally stabilized by the back muscles. If several adjacent ribs are fractured, possibly several times (broken rib fragments), this can lead to so-called paradoxical breathing or inverse breathing.
In this case, the thorax retracts during inhalation – contrary to the natural movement – and bulges accordingly during exhalation. The greatest risk of rib fracture is the injury to the lung, heart or aorta through the broken rib. This can cause massive bleeding into the lung (hematothorax) or collapse of the lung (pneumothorax).
Severe pain is the central symptom after a broken rib. They get worse when breathing in and out and when coughing. Therefore, a significant reduction in pain is an important goal of the treatment, so that the patient can breathe and cough without any problems.
If this is not possible, a so-called “gentle breathing” occurs, in which the lungs are no longer sufficiently supplied with air or are no longer sufficiently “ventilated”. As a result, pneumonia and adhesions of lung tissue can occur, which significantly restrict breathing. In addition to pain therapy, respiratory gymnastics, breathing exercises and expectorant medication should be used.
As a rule, the pain improves within 2 weeks. Back pain can have many different causes. In rare cases, back pain is an indication of a broken rib. Nevertheless, injuries to the posterior part of the ribs facing the spine, resulting bruises or damage to nerves and vertebral bodies can lead to problems. Due to difficult breathing, most patients develop an unnatural relieving posture, which causes muscle tension in the back after a rib fracture.
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