Rib Fractures, Flail Chest & Stove In Chest

Rib Fractures, Flail Chest & Stove In Chest ppt

1. RIB FRACTURE,FLAIL CHEST & STOVE-IN CHEST Presented by- Imteyaz Anjum Luvneesh Dhar (BPT 4 th yr ) Submitted to- Dr. Aqsa Mujaddadi CPRS, JMI

2. RIB FRACTURE

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. 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

6. 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 .

7. Types of rib fracture

8. 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

9. 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

10. Diagnosis and treatment Investigation such as X ray MRI CT scan may be performed to confirm diagnosis.

11. TREATMENT CONSERVATIVE TREATMENT (thoracic belts) MEDICAL TREATMENT( analgesics,nsaid ) SURGICAL TREATMENT(ORIF) PHYSIOTHERAPY MANAGEMENT

12. PHYSIOTHERAPY MANAGEMENT It incudes Breathing exercises Active cycle of breathing exercise Incentive spirometry Thoracic mobility exercises

13. 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.

14. TYPES Anterior Lateral Posterior (Least Dangerous) Flail Sternum

15. 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.

16. SIGNS AND SYMPTOMS Pain at fractured sight with touch, respiration, sneezing or coughing. Shortness of breath. Paradoxical movement. Bruising/Swelling. Crepitus. Tachycardia. Hypotension.

17. 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.

18. DIAGNOSIS Palpation : crepitus and tenderness near fractured ribs. Chest X-Ray CT Chest MRI

19. 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 .

20. MANAGEMENT Conservative management Medical and surgical management Physiotherapy management

21. C ONSERVATIVE MANAGEMENT Rest Cryotherapy Rib taping is no longer the recommended treatment as it can impede inspiratory effort.

22. MEDICAL & SURGICAL MANAGEMENT Analgesics NSAID’s Intubation and ventilation Chest tube insertion Rib fracture fixation

23. PHYSIOTHERAPY MANAGEMENT GOALS : To aid better drainage of secretion To rebuild musculature To reposition chest wall

24. 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

25. 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.

26. 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

27. 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.