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词条 Rib fracture
释义

  1. Signs and symptoms

     Complications 

  2. Causes

  3. Diagnosis

  4. Treatment

     Nerve blocks  Surgery 

  5. See also

  6. References

  7. External links

{{Infobox medical condition (new)
| name = Rib fracture
| synonyms = Broken rib, cracked rib
| image = Fracturedribsmarked.jpg
| caption = An X ray showing multiple old fractured ribs of the person's left side as marked by the oval.
| pronounce =
| field = Emergency medicine
| symptoms = Chest pain that is worse with breathing in[1]
| complications = Pulmonary contusion, pneumothorax, pneumonia[1][3]
| onset =
| duration =
| types =
| causes = Chest trauma[3]
| risks =
| diagnosis = Based on symptoms, medical imaging[5]
| differential =
| prevention =
| treatment =
| medication = Paracetamol (acetaminophen), NSAIDs, opioids[3]
| prognosis = Pain improves over 6 weeks[5]
| frequency = Common[3]
| deaths =
}}

A rib fracture is a break in a rib bone.[1] This typically results in chest pain that is worse with breathing in.[1] Bruising may occur at the site of the break.[2] When several ribs are broken in several places a flail chest results.[3] Potential complications include a pneumothorax, pulmonary contusion, and pneumonia.[4][1]

Rib fractures usually occur from a direct blows to the chest such as during a motor vehicle collision or from a crush injury.[4][1] Coughing or metastatic cancer may also result in a broken rib.[1] The middle ribs are most commonly fractured.[5][1] Fractures of the first or second ribs are more likely to be associated with complications.[6] Diagnosis can be made based on symptoms and supported by medical imaging.[2]

Pain control is an important part of treatment.[7] This may include the use of paracetamol (acetaminophen), NSAIDs, or opioids.[4] A nerve block may be another option.[1] While fractured ribs have been wrapped, this may increase complications.[1] In those with a flail chest, surgery may improve outcomes.[8][9] They are a common injury following trauma.[10]

Signs and symptoms

This typically results in chest pain that is worse with breathing in.[1] Bruising may occur at the site of the break.[2]

Complications

When several ribs are broken in several places a flail chest results.[3] Potential complications include a pneumothorax, pulmonary contusion, and pneumonia.[4][1]

Causes

Rib fractures can occur with or without direct trauma during recreational activity. Cardiopulmonary resuscitation (CPR) has also been known to cause thoracic injury, including but not limited to rib and sternum fractures. They can also occur as a consequence of diseases such as cancer or rheumatoid arthritis. While for elderly individuals a fall can cause a rib fracture, in adults automobile accidents are a common event for such an injury.[11]

Diagnosis

Signs of a broken rib may include:[12]

  • Pain on inhalation
  • Swelling in chest area
  • Bruise in chest area
  • Increasing shortness of breath
  • Coughing up blood (rib may have damaged lung)

Plain X-rays often pick up displaced fractures but often miss undisplaced fractures.[13] CT scanning is generally able to pick up both types of fractures.[13]

Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic injuries such as pulmonary contusion.[3] Rib fractures are also a sign of more serious injury in elderly people.[14]

Treatment

There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection.[15] Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation.[16] Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera (e.g., lung contusion) or remotely (e.g., cervical spine injury). Spontaneous fractures in athletes generally require a cessation of the cause, e.g., time off rowing, while maintaining cardiovascular fitness.{{medical citation needed|date=August 2015}}

Nerve blocks

Nerve blocks that may be used to help with pain related to rib fractures include epidural anesthesia, paravertebral block, and serratus anterior plane block.[17][18]

Surgery

Treatment options for internal fixation/repair of rib fractures include:

  • Judet and/or sanchez plates/struts are a metal plate with strips that bend around the rib and then is further secured with sutures.[19]
  • Synthes matrixrib fixation system has two options: a precontoured metal plate that uses screws to secure the plate to the rib; and/or an intramedullary splint which is tunneled into the rib and secured with a set screw.[20]
  • Anterior locking plates are metal plates that have holes for screws throughout the plate. The plate is positioned over the rib and screwed into the bone at the desired position. The plates may be bent to match the contour of the section.[21]
  • U-plates can also be used as they clamp on to the superior aspect of the ribs using locking screws.[22]

See also

  • Pulmonary hygiene

References

1. ^1 2 3 4 5 6 7 8 9 10 11 {{cite book|title=Mosby's Medical Dictionary |format= E-Book|date=2013|publisher=Elsevier Health Sciences|isbn=978-0323112581|page=1567|url=https://books.google.ca/books?id=aW0zkZl0JgQC&pg=PA1567|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20171013013051/https://books.google.ca/books?id=aW0zkZl0JgQC&pg=PA1567|archivedate=2017-10-13|df=}}
2. ^1 2 3 4 {{cite book|last1=Adams|first1=James G.|title=Emergency Medicine E-Book: Clinical Essentials (Expert Consult – Online)|date=2012|publisher=Elsevier Health Sciences|isbn=978-1455733941|page=682|url=https://books.google.ca/books?id=rpoH-KYE93IC&pg=PA682|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20171013013053/https://books.google.ca/books?id=rpoH-KYE93IC&pg=PA682|archivedate=2017-10-13|df=}}
3. ^1 2 {{cite journal |last1=Wanek |first1=Sandra |last2=Mayberry |first2=John C |title=Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury |journal=Critical Care Clinics |volume=20 |issue=1 |pages=71–81 |year=2004 |pmid=14979330 |doi=10.1016/S0749-0704(03)00098-8 }}
4. ^1 2 3 4 5 6 7 {{cite journal|last1=May|first1=L|last2=Hillermann|first2=C|last3=Patil|first3=S|title=Rib fracture management|journal=BJA Education|date=January 2016|volume=16|issue=1|pages=26–32|doi=10.1093/bjaceaccp/mkv011}}
5. ^{{Cite book|title = PET-CT: Rare Findings and Diseases|last = Nanni|first = Christina|publisher = Springer|year = 2012|isbn = 978-3-642-24698-2|location = |page = 257}}
6. ^{{cite journal|last1=Murphy CE|first1=4th|last2=Raja|first2=AS|last3=Baumann|first3=BM|last4=Medak|first4=AJ|last5=Langdorf|first5=MI|last6=Nishijima|first6=DK|last7=Hendey|first7=GW|last8=Mower|first8=WR|last9=Rodriguez|first9=RM|title=Rib Fracture Diagnosis in the Panscan Era.|journal=Annals of Emergency Medicine|date=27 May 2017|doi=10.1016/j.annemergmed.2017.04.011|pmid=28559032|volume=70|issue=6|pages=904–909}}
7. ^{{cite journal|last1=Brown|first1=SD|last2=Walters|first2=MR|title=Patients with rib fractures: use of incentive spirometry volumes to guide care.|journal=Journal of Trauma Nursing : The Official Journal of the Society of Trauma Nurses|date=2012|volume=19|issue=2|pages=89–91; quiz 92–03|doi=10.1097/JTN.0b013e31825629ee|pmid=22673074}}
8. ^{{cite journal|last1=Schuurmans|first1=J|last2=Goslings|first2=JC|last3=Schepers|first3=T|title=Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review.|journal=European Journal of Trauma and Emergency Surgery|date=April 2017|volume=43|issue=2|pages=163–68|doi=10.1007/s00068-016-0721-2|pmid=27572897|pmc=5378742}}
9. ^{{cite journal|last1=Coughlin|first1=TA|last2=Ng|first2=JW|last3=Rollins|first3=KE|last4=Forward|first4=DP|last5=Ollivere|first5=BJ|title=Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials.|journal=The Bone & Joint Journal|date=August 2016|volume=98-B|issue=8|pages=1119–25|doi=10.1302/0301-620X.98B8.37282|pmid=27482027}}
10. ^{{cite journal|last1=Senekjian|first1=L|last2=Nirula|first2=R|title=Rib Fracture Fixation: Indications and Outcomes.|journal=Critical Care Clinics|date=January 2017|volume=33|issue=1|pages=153–65|doi=10.1016/j.ccc.2016.08.009|pmid=27894495}}
11. ^{{EMedicine|article|825981|Rib Fracture}}
12. ^{{Cite web|url = http://www.nhs.uk/conditions/rib-injuries/Pages/Introduction.aspx|title = Broken or bruised ribs|date = 2015|accessdate = 15 August 2015|website = NHS.UK|publisher = |last = |first = |deadurl = no|archiveurl = https://web.archive.org/web/20150820045022/http://www.nhs.uk/conditions/rib-injuries/Pages/Introduction.aspx|archivedate = 20 August 2015|df = }}
13. ^1 {{cite journal |last1=Dennis |first1=BM |last2=Bellister |first2=SA |last3=Guillamondegui |first3=OD |title=Thoracic Trauma. |journal=The Surgical Clinics of North America |date=October 2017 |volume=97 |issue=5 |pages=1047–1064 |doi=10.1016/j.suc.2017.06.009 |pmid=28958357}}
14. ^{{Cite journal|title = Fatality Risk and the Presence of Rib Fractures|journal = Annals of Advances in Automotive Medicine / Annual Scientific Conference|date = 2008-01-01|issn = 1943-2461|pmc = 3256783|pmid = 19026224|pages = 73–84|volume = 52|first = Richard|last = Kent|first2 = William|last2 = Woods|first3 = Ola|last3 = Bostrom}}
15. ^{{cite journal |last1=Morice |first1=A H |last2=McGarvey |first2=L |last3=Pavord |first3=I |title=Recommendations for the management of cough in adults |journal=Thorax |volume=61 |issue=Suppl 1 |pages=i1–24 |year=2006 |pmid=16936230 |pmc=2080754 |doi=10.1136/thx.2006.065144 }}
16. ^{{Cite book|title = Brunner & Suddarth's Textbook of Canadian Medical-surgical Nursing|url = https://books.google.com/?id=SB_-CRXvZPYC&pg=PA637&lpg=PA637&dq=flail+chest+sometimes+needs+assisted+ventilation#v=onepage&q=flail%2520chest%2520sometimes%2520needs%2520assisted%2520ventilation&f=false|publisher = Lippincott Williams & Wil|page = 637|date = 2009-01-01|isbn = 9780781799898|language = en|first = Pauline|last = Paul|first2 = Beverly|last2 = Williams|deadurl = no|archiveurl = https://web.archive.org/web/20160629114720/https://books.google.com/books?id=SB_-CRXvZPYC&pg=PA637&lpg=PA637&dq=flail+chest+sometimes+needs+assisted+ventilation&source=bl&ots=LRmcVdhbz3&sig=KtI8XKo2R3QEdGiRIVK1ElqdaVw&hl=en&sa=X&ved=0CEQQ6AEwBmoVChMI84fwyaqrxwIVStKACh0AKwyV#v=onepage&q=flail%2520chest%2520sometimes%2520needs%2520assisted%2520ventilation&f=false|archivedate = 2016-06-29|df = }}
17. ^{{cite journal |last1=Wardhan |first1=R |title=Assessment and management of rib fracture pain in geriatric population: an ode to old age. |journal=Current Opinion in Anesthesiology |date=October 2013 |volume=26 |issue=5 |pages=626–31 |doi=10.1097/01.aco.0000432516.93715.a7 |pmid=23995061}}
18. ^{{cite book |last1=Grant |first1=Stuart A. |last2=Auyong |first2=David B. |title=Ultrasound Guided Regional Anesthesia |date=2016 |publisher=Oxford University Press |isbn=9780190630478 |page=PT388 |url=https://books.google.ca/books?id=Rd8oDQAAQBAJ&pg=PT388 |language=en}}
19. ^{{cite journal |last1=Fitzpatrick |first1=D. C. |last2=Denard |first2=P. J. |last3=Phelan |first3=D. |last4=Long |first4=W. B. |last5=Madey |first5=S. M. |last6=Bottlang |first6=M. |title=Operative stabilization of flail chest injuries: review of literature and fixation options |journal=European Journal of Trauma and Emergency Surgery |volume=36 |issue=5 |pages=427–33 |year=2010 |pmid=21841954 |pmc=3150812 |doi=10.1007/s00068-010-0027-8 }}
20. ^{{cite book|last1=Mathison|first1=Douglas|title=Master Techniques in Surgery: Thoracic Surgery: Transplantation, Tracheal Resections, Mediastinal Tumors, Extended Thoracic Resections|date=2014|publisher=Walters-Kluwer Health|isbn=978-1-46988-903-0|url=https://books.google.com/?id=2u8NBQAAQBAJ&pg=PT338&dq=Synthes+MatrixRIB+Fixation+System#v=onepage&q=Synthes%20MatrixRIB%20Fixation%20System&f=false|accessdate=15 August 2015|deadurl=no|archiveurl=https://web.archive.org/web/20160512081713/https://books.google.com/books?id=2u8NBQAAQBAJ&pg=PT338&dq=Synthes+MatrixRIB+Fixation+System&hl=en&sa=X&ved=0CB4Q6AEwAGoVChMIgZ_dpZ2rxwIVypWACh3JUwpm#v=onepage&q=Synthes%20MatrixRIB%20Fixation%20System&f=false|archivedate=12 May 2016|df=}}{{Google books}}
21. ^{{Cite book|title = Skeletal Trauma: Basic Science, Management, and Reconstruction|url = https://books.google.com/?id=IDXgoS0vLFQC&pg=PA1418&dq=anterior+locking+plate#v=onepage&q=anterior%2520locking%2520plate&f=false|publisher = Elsevier Health Scien|page = 1418|date = 2009-01-01|isbn = 978-1416022206|language = en|first = Bruce D.|last = Browner|deadurl = no|archiveurl = https://web.archive.org/web/20160508172225/https://books.google.com/books?id=IDXgoS0vLFQC&pg=PA1418&dq=anterior+locking+plate&hl=en&sa=X&ved=0CD4Q6AEwBmoVChMIzNqshZyrxwIVy9SACh1ozgL0#v=onepage&q=anterior%2520locking%2520plate&f=false|archivedate = 2016-05-08|df = }}
22. ^{{cite journal |last1=de Jong |first1=M. B. |last2=Kokke |first2=M. C. |last3=Hietbrink |first3=F. |last4=Leenen |first4=L. P. H. |title=Surgical Management of Rib Fractures: Strategies and Literature Review |journal=Scandinavian Journal of Surgery |volume=103 |issue=2 |pages=120–25 |year=2014 |pmid=24782038 |doi=10.1177/1457496914531928 }}

External links

{{Medical resources
| DiseasesDB = 11553
| ICD10 = {{ICD10|S|22|3|s|20}}-{{ICD10|S|22|4|s|20}}
| ICD9 = {{ICD9|807.0}}, {{ICD9|807.1}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = emerg
| eMedicineTopic = 204
| eMedicine_mult = {{eMedicine2|radio|609}}
| MeshID = D012253
}}{{Fractures}}{{Chest trauma}}

4 : Chest trauma|Bone fractures|Injuries|RTT
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