The causes and mechanisms of fracture of ribs

Fracture of the ribs may occur in cartilage and in the bone part. If a fracture is not accompanied by complications, sometimes it takes its own, without medical assistance. But there are also single fractures that disrupt the function of the respiratory system, and multiple rib fractures can lead to severe respiratory distress.

Fracture of the ribs may occur in the fall, when struck on the chest, while squeezing the chest. Most observed fractures secondary ribs (IV to VII), as less protected (upper edges are covered with a thick layer of muscles and bones of the shoulder girdle and the bottom have a greater elasticity due to considerable length of cartilaginous part), on the back and axillary lines - in the areas of maximum bending ribs. In the direct mechanism of injury (eg, direct blow) one or more edges bend inwards - towards the chest cavity, often damaged respiratory system.

In the indirect mechanism of damage to the edges (for example, by squeezing the chest) chest flattened and broken ribs on both sides of the direct impact of force. With such a mechanism more likely to occur multiple rib fractures.

Fractures are single (isolated) and double (two or more ribs on one side of the chest), bilateral (on both sides of the chest), fenestrated (edge ​​breaks on both sides, and a fragment of the rib falls into the chest), such as cracks, subperiosteal (broken bone, and the periosteum remains intact - often a fracture occurs in young people). When there are sometimes severe respiratory distress, oxygen starvation and shock.

Signs of fracture rib

At the turn of the ribs is always a pain at the fracture site - alone blunt and sharp at the height of inspiration. The pain is worse when breathing deeply, coughing, straining when trying to probe the site of injury. But sometimes it still manages to feel the fracture site in the form of a ledge. Breathing with a broken rib is superficial because of the pain, and the injured side of the chest behind the sound. At the site of injury often can be found subcutaneous hemorrhage - hematoma. One of the hallmarks of rib fracture: while gently compressing the breast between your hands away from the damage occurs "reflection" pain in the rib fracture.

Rib fracture itself is not dangerous, it heals relatively quickly, the danger are related damage to internal organs. If one broken rib displacement of bone fragments usually do not happen. When multiple fractures of the ribs fragments can move in different directions and compress and injure adjacent tissue and organs and cause dangerous complications.

Confirms the diagnosis of rib fractures using radiographic studies.

Complications

Broken ribs may be complicated by damage to surrounding tissues and organs: lungs, heart, liver, kidneys, gastrointestinal tract, blood vessels and so on.

If damaged lung and pleura may hemothorax (blood in the chest cavity) or pneumothorax Pneumothorax - when help is needed immediately   (accumulation of air in the chest cavity), and subcutaneous emphysema (accumulation of air in the subcutaneous tissue).

When subcutaneous emphysema detectable specific creaking of fat under your fingers - crepitus Crepitus - a very serious symptom . If there is damage to the pleura (the bag, which lies light) or light, it may appear hemoptysis.

Deep breathing disorders arise when multiple fractures of the ribs. It is hard to occur, and end the double fractures, forming the movable portions of the ribs, for which there is proper ventilation of the lungs. More favorable double fractures occur on the back of the chest, as there is a sufficiently powerful muscle layer that allows you to record the chest with the patient on his back.

Sometimes rib fractures heart and major blood vessels are displaced in a healthy way that creates a circulatory disorder. The most severe fractures that affects the respiratory and cardiovascular system - a double fracture on both sides of the chest to form a complex rib-sternum (breastbone - a bone in the middle of the front surface of the chest to which the ribs are attached). The patient's condition may be exacerbated by highly sensitive nerve endings irritation of the pleura, in response to which also impairs the function of breathing and blood circulation.

Help

Isolated fractures of the ribs do not normally require hospital treatment, the treatment can be performed at home (fracture usually heals within a month). If in this case there is a pain, the pain relief is carried out (for example, by local administration of novocaine). Then appoint a special breathing exercises, sitting up in bed, physiotherapy - all of this is aimed at the prevention of pulmonary congestion.

Multiple and complicated fractures treated at the hospital where the patients underwent special treatment depending on its existing complications.

Galina Romanenko

The structure and characteristics of operation of the hip joint

The hip joint is formed by the acetabulum of the pelvic bone and the femoral head. This ball joint in which the movements of three types: flexor - extensor, reduction - Blade and rotational (rotation of the outer and inner).

The capsule of the hip joint cavity includes a front side of the femoral head, but leaves open a rear side half of the femoral neck. Ligament replacement unit represented by four extra-articular and two intra-articular ligaments. Extra-articular ligaments:

• iliac-femoral ligament - prevents tipping the pelvis back and restricts its lateral motion during walking;
• pubic-femoral ligament runs from the pubic bone to the femoral head, weaving into the capsule of the hip joint;
• sciatic-femoral ligament reinforces the posterior part of the joint capsule.

Inside the hip joint has two ligaments:

• bunch of the femoral head - it connects the femoral head to the middle of the acetabulum;
• transverse acetabular ligament - connects cutting edge of the acetabulum.

Blood supply and innervation of the hip performed widely branched network of nerves and blood vessels.

Types and causes of hip dislocation

Traumatic dislocation of the hip usually occur as a result of indirect injury. Depending on the position of the hip injury when the displacement of the femoral head occurs in different ways. There are:

• rear hip dislocation (most common, accounting for up to 80% of all dislocations Dislocation - Prevention and Treatment   hip) including iliac (up and backward) and ischial (downwards and backwards);
• front hip dislocation, including suprapubic (anterior and up), the obturator (forward and down);
• central - at the bottom of the acetabulum fractures.

The mechanism of posterior dislocation of the most often - indirect significant violence, when the thigh suddenly turns sharply inwards and provided. At the same time the head of the femur and tearing the capsule is restrained between its edges and muscles. The round ligament is torn completely normally. The femoral head is located on the outer and rear surface of the ilium; Low sciatic dislocation is the head backward and downward from the acetabulum.

How does hip dislocation

Hip dislocation manifest severe pain in the hip joint, the lack of active movements, forced position of the limb, depending on the dislocation. After the damage the victim can not stand on the leg. When the leg is bent posterior dislocation of the hip is reduced and turned into active movement in the hip joint is not possible. Attempts passively (by someone else) to deduce the finiteness of the forced position accompanied by severe pain, while there are characteristic sign of dislocation of the spring resistance and the shortening of the leg. Trochanter (located in front of the head) is felt high in the groin area is determined by the retraction, and the rear overhang is sometimes visible and palpable shift the femoral head.

For anterior dislocations (obturator and suprapubic) is characterized by a sharp retraction of the lower extremity, hip rotate outwards, the apparent lengthening of limbs. When the obturator dislocation of the head can be felt on the inner side of the hip, buttocks at the same time flattened, and the greater trochanter is not defined.

Diagnosis and treatment of dislocation of the hip

The diagnosis specify when radiography. The picture shows that the acetabulum is empty, and the head of the femur is shifted upwards or downwards.

Treatment of traumatic hip dislocation include manual closed reduction, sometimes in combination with other operations. Reduction is performed under general anesthesia with the introduction of special drugs to relieve tension in the muscles (muscle relaxants). After the reduction of dislocation produce immobilization (immobilization) limb using plaster cast or limb skeletal traction with a load of 3-4 kg. Walking with crutches is allowed after 3-4 weeks, and loading a limb - six months after the injury. Earlier load is dangerous because of the possible development of avascular necrosis of the femoral head - the destruction of the bone without the participation in the process of infection.

First aid at the hip dislocation

If you suspect a dislocation of the hip in any case it is impossible to reduce a. It should be possible to fix (to avoid unnecessary traumatic movements) leg in the position in which it found itself after an injury to the hip joint to make a cold, give the victim any pain medication and deliver it to the emergency room.

Galina Romanenko