Will rib fractures swell?

Written by Li Jie
Orthopedics
Updated on September 04, 2024
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Generally, swelling after a localized fracture is due to damage to the blood vessels in the area of the fracture. The bleeding that follows accumulates under the skin at the fracture site, causing obvious swelling. However, rib fractures are somewhat unique because after a rib fracture, the bleeding generally occurs internally, meaning the blood enters the chest cavity, leading to accumulation of blood and fluids within the chest. Generally, the blood does not accumulate under the skin. Therefore, rib fractures typically do not exhibit obvious swelling. There might be some local swelling, but it is usually not prominent. If not examined closely, it is generally not noticeable that there is significant swelling at the site of a rib fracture.

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Common sites of rib fractures

The most common sites for rib fractures are the fourth to tenth ribs, as they are more prone to fractures. The first to third ribs are relatively short and are protected by the scapula and clavicle. Additionally, the 11th and 12th ribs are quite mobile, making them less likely to fracture when subjected to external forces. Among the fourth to tenth ribs, the fourth to seventh ribs are the most susceptible to fractures, because their internal cartilage is relatively short, making these ribs the most likely to break when impacted.

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Complications of rib fractures

Rib fracture complications. Structurally, each rib is located above the intercostal arteries, veins, and nerves. Therefore, the most critical issue with rib fractures is that they can cause severe pain for the patient. Thus, the main complication of a rib fracture is pain. This pain persists 24 hours a day, especially when the patient takes deep breaths, coughs, or turns over while sleeping during the night, which can awaken them due to the severe pain. Additionally, because of this pain, the patient is unable to cough effectively. Therefore, a large amount of phlegm, especially in smokers, accumulates in the lungs, leading to complications such as lung infections and pneumonia. Besides pain, another complication of rib fractures is the potential puncture of intercostal arteries or veins, which can cause hemothorax. This condition can result in a significant accumulation of blood in the pleural cavity, and a severe hemothorax can be life-threatening, especially a progressing hemothorax. Therefore, for patients with fractures of three or more ribs, it is recommended, according to the 2017 US guidelines for the treatment of internal fractures and the 2018 consensus from Chinese experts on internal fracture treatment, to actively proceed with surgical interventions. Studies have found that active surgical intervention for fractures of more than three ribs can significantly reduce the patient's pain, shorten hospital stays, and improve quality of life. In summary, the main complications of rib fractures include pneumothorax, hemothorax, pain, and resultant lung infections and pneumonia. These complications are crucial in the treatment of rib fractures and need to be actively addressed.

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Orthopedics
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How to sleep with a rib fracture

Patients with rib fractures need to choose their resting positions based on their specific situations. If the fracture is on one side, the patient can rest in a lateral decubitus position on the healthy side to avoid stimulating and compressing the fractured area. The fractured side should not be used for side-lying as it can easily compress the fracture site, leading to displacement of the fracture ends, causing pain, and potentially affecting the healing and recovery of the fracture. In cases of fractures on both sides, it is recommended to adopt a supine position for sleeping, as side-lying can negatively impact the fractures and is not conducive to their recovery.

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Orthopedics
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What are the symptoms of a rib fracture?

When a rib fracture occurs, there is initially localized pain, particularly exacerbated during breathing, and increased pain during pressing on the ribcage. Early on, there may be no respiratory or pulmonary inflammation, but if there is no systematic treatment and no rest, this could lead to breathing difficulties and signs of inflammation in the chest cavity. Additionally, if multiple ribs are fractured at multiple sites, a condition known as flail chest may occur.

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What are the symptoms of a rib fracture?

Symptoms of rib fractures include, firstly, there is usually a clear history of trauma, either from direct impact or from falling and the ribs making contact with the ground, etc. Secondly, the main symptoms of a rib fracture include three points: The first is local deformity. If it is a single rib fracture, this deformity is generally not easy to detect. However, after multiple rib fractures, this deformity becomes readily apparent, and you can see that the chest cage is abnormal, with a caved-in appearance. Moreover, in cases like flail chest, breathing is also abnormal. Normally, when inhaling, the ribs should expand outward, but if flail chest occurs, the chest cage appears to expand inward during inhalation; therefore, such a condition often requires surgical treatment, otherwise the consequences are very serious. The second symptom is friction sound and bone rubbing sensation. Some people, after fracturing a rib, during deep breathing or activity, hear cracking sounds from within. This occurs because the continuity and integrity are disrupted by the fracture, and then during breathing or during movement, there is friction between the bones. The third point is abnormal movement, which occurs at locations without joints, resembling joint movements. Normally, a person has 12 ribs on each side. If the continuity and integrity of the ribs are not damaged, there should be no abnormal movement; that is, pressing on the ribs should not cause sensations similar to joint movements at places where there are no joints. Therefore, the symptoms of a rib fracture include three points: the first point being local deformity; the second, bone friction sounds and sensations; and the third, abnormal movement. If any of these three symptoms are present, it is generally indicative of a rib fracture.