3. INTRODUCTION
The ribs are bony framework of the thoracic cavity.
The ribs form the main structure of the thoracic cage protecting the
thoracic organs ,however there main function is to aid respiration
There are 12 pairs of ribs.
Each rib articulate posteriorly with two thoracic vertebrae by the
costovertebral joint.
An exception to this rule is the first rib that articulates with the first
thoracic vertebrae only.
4. Intro cont…
According to their attachment to sternum Ribs are classified into
1.true ribs (1-7)
2.false ribs (8,9,10)
3.floating ribs(11,12)
-true rib directly articulate with the sternum with their costal cartilage.
-false ribs indirectly articulate with the sternum
-floating ribs don’t articulate with sternum
5.
6. FUNCTIONS OF RIBS
The functions of the ribs are critical, as they protect
the contents of the thoracic cavity and mediastinum,
move superiorly, inferiorly, anteriorly and posteriorly
to facilitate breathing.
Their flexibility in their movement
increases/decreases the size of the thoracic cavity;
assisting the lungs in respiration. Control of these
movements via the diaphragm, external intercostals
and the inter-cartilagenous portion of the internal
intercostals
7. Rib fracture
The rib fracture is a crack or break in one of the
bones of the rib cage. A break in the thick tissue that
connects the ribs to the breastbone may also called
a fractured rib, even if the bone itself is not broken.
Rib fractures occur when a significant
enough force directed at the rib causes a
break.
They are often associated with other injuries
and the greater the number of rib fractures
the more likely are associated injuries.
9. Etiology
Blunt trauma including motor vehicle crashes , assaults , falls specially
down staircase
Non accidental trauma in pediatric cases
Compression to chest wall
Trauma to chest
Pathological fracture like osteoporosis,malignancies
Stress fracture- occurs most commonly in high level athletes
Coughing spells
10. Sign and symptoms
Severe pain at fracture site
Tenderness to touch
Abdominal pain if fracture rib are below the
diaphragm
Severe chest pain when coughing ,sneezing ,or
breathing deeply
14. FLAIL CHEST
Flail means to wave or move in an
uncontrolled way.
When three or more ribs located next to
each other are broken in at least two or
more places this results in free floating rib
segments and this condition is called a
flail chest.
16. CAUSES
Most Common - Vehicle Accidents (76%)
Second most common – Falls, especially in
elderly population (weak, frail bones) (14%)
Third most common – Blunt trauma in children,
especially those with genetic conditions.
Eg- Osteogenesis Imperfecta.
17. SIGNS AND SYMPTOMS
Pain at fractured sight with touch, respiration,
sneezing or coughing.
Shortness of breath.
Paradoxical movement.
Bruising/Swelling.
Crepitus.
Tachycardia.
Hypotension.
18. Paradoxical Movement
Paradox means contradiction.
The flail portion of the chest is :
Sucked in with inspiration, instead
of expanding outward.
Ballooned out with expiration
instead of collapsing inward.
21. COMPLICATIONS
Pneumonia
ARDS
Lung Abscess
Tear in the aorta- A sharp end from a break in one
of the first three ribs at the top of the rib cage
could pierce a major blood vessel, including the
aorta.
Tear in the lung – The jacked end of a broken
middle rib can punch a hole in the lung and cause
it to cave in.
Ripped spleen, liver or kidney – Ends of a broken
lower rib can cause serious harm to spleen, liver or
kidney.
26. PHYSIOTHERAPY MANAGEMENT
Use of an incentive spirometer should be
encouraged to prevent pulmonary atelectasis
Deep breathing exercises
Coughing exercises
Trunk exercises
Exercises to improve posture, flexibility and
strength, and to prevent localized lung collapse
27. STOVE-IN CHEST
The stove-in chest is a rare form of flail chest in which
there is the collapse of a segment of the chest wall,
associated with high immediate mortality.
It is usually due to severe blunt trauma to the chest wall
and is rarely encountered in imaging or emergency
medicine due to the high mortality at the scene.
28. As with flail chest, the stove-in chest is almost
always associated with other thoracic injuries
including:
Pulmonary contusion and/or laceration
Pneumothorax and subcutaneous emphysema
Haemothorax
29. Treatment and Prognosis
There is significant controversy in the optimum
management of trauma patients with flail chest,
ranging from conservative management to surgical
rib plate fixation.
The overall goals are adequate pain relief,
optimisation of gas exchange (pneumatic
stabilisation with positive airway pressure and/or
ventilation), and the prevention of secondary
sepsis.
