Fracture (cont.)
Rib fracture
The ribs are especially vulnerable to injury and are prone to breaking due to
a direct blow. Rib x-rays are rarely taken as it doesn't matter if the rib is
broken or just bruised. A chest x-ray is usually taken to make certain there is
no collapse or bruising of the lung.
When we breathe, it is like a bellows. We inhale air into our lungs and the ribs
move out and the diaphragm moves down. When
a person has a rib injury, the pain
associated with it makes breathing difficult, and the person has a tendency to
not take deep breaths. If the lung underlying the injury does not expand, it is
at risk for infection. The person is then susceptible to
pneumonia (lung infection),which is characterized by
fever, cough, and
shortness of breath.
As opposed to other parts of the body that can rest when they are injured, it
is very important to take deep breaths to prevent pneumonia when rib fractures
are present. The treatment for bruised and broken ribs is the same: ice to the
chest wall, ibuprofen as an anti-inflammatory, deep breaths and pain medication.
Even if all goes well, there will be significant pain for four to six weeks.
With lower rib fractures, there may be concern about organs in the abdomen
that the ribs protect. The liver is located under the ribs on the right side of
the chest, and the spleen under
the ribs on the left side of the chest. Many times your doctor may be more worried about abdominal injury than
about the broken rib itself. Ultrasound or CT
scan may help diagnosis intra-abdominal
injuries.
Skull fracture
With the wide availability of CT scans, skull x-rays are rarely taken to
diagnose head injury. If a head injury exists, the physician will feel or
palpate the scalp and skull to determine if there may be a skull fracture. He
will also look into the ears to see if there is blood behind the ear drumm and he
will also complete a neurologic examination.
The skull is a flat, compact bone and it takes significant force to break it.
If a skull fracture exists, there is an increased likelihood of bleeding in
the brain, especially in children. There are guidelines that are available to
decide whether a CT scan is indicated (needed).
Minor head injury is defined as witnessed loss of consciousness, definite
amnesia, or witnessed disorientation in patients with a GCS (Glasgow Coma Score) score of 13-15.
With minor head injury, the following risk groups are considered when evaluating
need for CT brain scan:
High risk for potential neurosurgical operation
- Abnormal neurologic exam within two hours after injury
- Suspected open or depressed skull fracture
- Any sign of basal skull fracture (blood behind the ear drum, blackened
eyes, clear fluid running from the ears, or bruising behind the ear)
- Vomiting - two episodes
- 65 years of age or older
Medium risk (for brain injury on CT)
- Amnesia before impact - more than 30 minutes
- Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected
from motor vehicle, fall from height greater than 3 feet or five stairs)
Next: Fracture in children »
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