Don’t neglect rib fracture

It has been seen in our country, the means and methods of transportation are faulty so much so an injured person is harmed far more than being safe during transport.
"While driving a car without using a seatbelt, people receive a direct blow from the steering wheel, in the event of sudden braking. This results in a fracture of ribs on one side or both sides of the chest."
"While driving a car without using a seatbelt, people receive a direct blow from the steering wheel, in the event of sudden braking. This results in a fracture of ribs on one side or both sides of the chest."Special arrangement

Have you ever been involved in any fist fight or a riot where you sustained a chest injury? After you had treatment for chest trauma, everything became alright, but ribs are still painful.

It might be possible that while driving a motorbike or scooter you had fallen down and broken your ribs. Your life was saved then but you still have pain in the chest while breathing.

Increased number of automobiles-One important reason of rib fracture

These days with rapid industrialization, more and more people are joining the rat race. People, due to the high price of house rentals in big cities, are moving to peripheral towns of metro cities for living and thus commuting daily from their place of residence to metro cities for earning their livelihood and on an average spend one to four hours daily commuting.

Because of this kind of hectic life, the number of automobiles plying on the roads has increased manifold. It appears all roads in the cities of India are flooded with auto rickshaws, two-wheelers, cars and buses.

This tremendous rise in the number of automobiles has brought forth one important fact that is the increase in cases of road traffic accidents.

Everyday, newspapers, radio and television channels report only major road traffic accident cases , but small road accident cases, people by and large remain unaware of.

Why road traffic accidents are dangerous?

The most important cause of instantaneous death on-the-spot, in the majority of cases of road traffic accidents, is always a chest injury. In 75 percent cases of death due to road traffic accidents, the chest injury plays either direct or an indirect role.

That is why, never ignore a chest injury and do not delay its treatment, otherwise death will become an eventual outcome very shortly.

It has been seen in our country, the means and methods of transportation are faulty so much so an injured person is harmed far more than being safe during transport.

This mismanagement in transportation causes serious complications that may sometimes lead to death also.

Why a simple rib fracture may prove fatal?

In 70 percent cases of chest injury, fracture of ribs occurs and along with that muscles of chest too get damaged. In approximately 50 percent cases of rib fractures, the underlying lung is seriously damaged resulting in collection of blood and air inside the chest cavity.

In medical terms, collection of air inside the chest is called ‘pneumothorax’ and collection of blood ‘hemothorax’. If both these medical conditions are not treated promptly and urgently, approximately 80 percent of them develop risk of an eventual death.

Therefore, one should consult an experienced thoracic or a chest surgeon immediately after chest injury and start treatment under his care, otherwise no other alternative except death will remain.

IS FLAIL CHEST A DANGEROUS STATE OF RIB FRACTURE ?

Sometimes in road traffic accidents, many ribs are broken simultaneously at various places in the chest. This condition in medical terms is called ‘Flail Chest’ or swinging chest. During breathing this ‘flail chest’ segment does not move in accordance with the movements of the remaining original chest and makes its own independent existence.

This independent flail chest segment never cooperates with the remaining chest during the breathing mechanism, but at the top of it, this segment functions just the opposite. This is a very dangerous situation, because a flail chest seriously impedes the breathing system and other functions of the chest.

The combined effect of these, lead to a rapid fall in oxygen level of blood. If a ‘flail chest’ is not treated effectively in time, death will become a certainty sooner or later.

In such conditions, relatives and family members should take the victim to a modern hospital equipped with all the latest investigations and treatment facilities and where availability of an experienced thoracic or a chest surgeon also is there.

What will happen if rib fracture is not treated properly?

If rib fractures are not treated properly, sooner or later death will become inevitable. People generally do not take rib fractures seriously and go to small clinics and hospitals for treatment with the idea that it is a simple injury.

Our medical fraternity too does not seem to be that much serious as desired regarding the treatment of rib fracture. What happens generally in India, people concentrate only on fracture of ribs and therefore they consult a bone specialist for treatment of rib fracture.

People do not realize that a person who has sustained rib fracture must have injured his underlying lung also. With the result, people pay more attention to rib fracture than the underlying injured lung and thus damaged lung is totally neglected during treatment of chest injury.

When they realize this mistake, it is too late and the victim of rib fracture develops a fatal condition of A.R.D.S. (Acute Respiratory Distress Syndrome). In this condition of ARDS, chances of survival are only five percent.

In such a situation, the process of breathing and oxygenation is seriously impaired and the amount of oxygen in the blood becomes dangerously low and carbon dioxide level in the blood touches very high. In such a scenario, various organs of the body like kidney, brain and liver stop working and chest x-ray becomes white and hazy instead of being black.

Therefore people should take rib fracture sustained in a road traffic accident very seriously from the very beginning and thus avoid giving direct invitation to the dreaded ARDS or “white lung” which in fact is the messenger of death.

How does a rib fracture happen?

In today’s world, small arguments lead to physical fights. Exchange of hot words often culminates into fist fights which cause fracture of one or multiple ribs.

Quite often two-wheeler-riders, while driving carelessly, fall off on the road and break their ribs. Sometimes people fall from a height and break their ribs.

While driving a car without using a seatbelt, people receive a direct blow from the steering wheel, in the event of sudden braking. This results in a fracture of ribs on one side or both sides of the chest.

How to recognize a rib fracture?

1. Onset of pain in any part of the chest after physical fights.

2. Onset of severe pain in chest on breathing after a fall from a scooter, motor cycle or from a height.

3. Complaint of breathing difficulty and severe pain in the chest after a road traffic accident.

4. Feeling of suffocation after a road accident.

What to do if you have a rib fracture?

In today’s world, a simple chest x-ray has turned out to be the cheapest, most important and useful investigative tool that helps in formulating the correct treatment strategy and thus the life of an injured person can be saved. One should never neglect any rib injury, however minor it looks like apparently and should consult a thoracic or chest surgeon immediately.

Never apply a tight clothing or plaster around the chest

In our country, patients with rib fracture usually go to a bone specialist. This ignorance causes harm in three ways. Firstly they lose the precious time that could have been utilized for a successful treatment.

Secondly proper evaluation of an injured lung becomes impossible, and thirdly in order to reduce the pain caused by rib fracture, a tight clothing or a belt, leucoplast or a dynaplast is wrongly applied around the chest. Sometimes plaster is applied over the chest.

People do not know by doing this (applying pressure over the chest) they are harming more than doing any good to patients. Due to an external compression, the injured lung cannot expand fully with the result either the lung gets constricted or it develops pneumonic infection, that leads to a serious disturbance in breathing mechanism, and ultimately a risk to life looms large.

How to prevent a rib fracture?

The best way to prevent a rib fracture is to keep your seat belt fastened while driving. According to one estimate, seat belts alone reduce the percentage of deaths by 45 percent to 50 percent occurring due to road traffic accidents.

If a helmet acts as a protector for a motorcyclist, in the same way a seat belt too acts as a life saver for a car driver. The instantaneous death occurring on the spot in a road traffic accident in majority of the cases is caused by chest injury and rib fracture.

The author is Senior Thoracic & Cardiovascular Surgeon Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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