• Fracture of ribs symptoms

    There are two types of causes of fracture of the ribs, fracture of the ribs resulting from sudden impact on bone of significant mechanical strength in people with unchanged bone system - called mechanical, and as a result of pathological processes leading to a decrease in the strength of bone tissue.
    To the first type of cause of fracture of the ribs, referring to the following reasons:
    1. Fractures of the ribs in the fall.
    2. Fractures of ribs with a direct blow to the chest.
    3. Fractures of the ribs during compression of the thorax.
    To the second type of causes of fracture of the ribs, referring to the following reasons:
    1. Fractures of the ribs in osteoporosis( conditions in which calcium salts are washed out of bone tissue).
    2. Fractures of the ribs in chronic inflammation of the bone tissue of the rib.
    3. Fractures of ribs in tuberculosis of the ribs.
    4. Fractures of the ribs in the development of tumors in the thorax.
    5. Fractures of the ribs in blood diseases( myeloma).

    In itself, fractures of the ribs are not dangerous and heal quickly enough, the danger is associated with internal injuries.

    Mechanisms of

    The most common fractures are VII-X ribs in the lateral divisions( up to 75% of all rib fractures).This is due to the fact that it is here that the chest has the widest width.
    There are direct and indirect mechanisms of the appearance of fracture of the rib. With a direct mechanism of damage, one or more ribs in the site of the traumatic factor bend into the cavity of the chest and break, with the possible damage to the pleura and lung. The number of broken ribs in this case depends on both the impact force and the area of ​​the injuring surface. With a strong impact of the injuring surface of a large area, double fractures of the ribs are formed. Such fractures are called final, as a "window" is formed - a segment of the thorax separated from the general framework. With the indirect mechanism, there is a strong contraction of the chest, and fracture of the ribs arises on both sides of the acting force. Such kind of defeats are typical for clamping between two planes( clamping the torso between the rudder and the seat during the car incidents, gripping the chest between the car body and the wall, squeezing the chest with the car's wheel, heavy load, etc.).When compressed with great force, as a rule, multiple bilateral fractures are formed, complicated by damage to the internal organs - the so-called "crushed chest" or "crushed breast."Especially dangerous are the so-called flotating fractures of the ribs, leading to severe respiratory failure. Because of multiple double or bilateral fractures, a segment separated from the thorax is formed, which disrupts the normal breathing process. Clinically, this is expressed in the so-called flotation of the thorax - when the inhalation the separated segment falls, and exhales at the exhalation. With the final fractures, the so-called paradoxical breathing is observed. At the moment of inspiration, when the final segment is westing, the lung on the diseased side collapses, and the air from it rushes into a healthy lung. On exhalation the segment bulges out, the lung on the affected side expands and is filled with exhaust air from the healthy lung. With a sufficient value of the "window", not only the violation of the breathing function occurs, but also the pendulum movements( flotation) of the heart and the main vessels during respiration, which leads to a violation of cardiac activity. The most dangerous are the front bilateral and left-sided anterolateral lateral fractures. Mortality in this type of injury, even in modern medical facilities can reach 40%.With posterior fractures, the prognosis is more favorable due to the fixing role of the musculature of the back and the position of the victim mainly on the back.

    Classification of

    For etiology, fractures are divided into: traumatic and pathological fractures.
    Traumatic fractures appear due to the fact that a short but powerful force acts on the bone.
    Pathological fractures are the action of various diseases that affect the bone, destroying it. A turning point in this case happens by chance, you do not even notice it.
    Mechanical or traumatic fractures are divided into the following types of fractures:
    1. For the injury mechanism, fractures of the ribs are divided into:
    straight - the rib breaks where the traumatizing force is directly applied, damaging also the soft tissues of the chest.
    indirect - with the indentation of the broken rib inside, an angular displacement of the fragments takes place. If the external force acts on the rib closer to the spine, then it causes a fracture in the type of shift: the central fragment remains in place, and the peripheral one remains movable and the long one moves to the interior.
    tearing fractures of the ribs( with IX and below) are characterized by a large displacement of the fragment, torn from the rib.
    2. Classification of fractures in relation to skin lesions:
    1. Open fractures:
    - Primarily open
    - Secondarily open
    2. Closed fractures:
    - Incomplete
    - Complete
    Primarily open fractures - the skin is damaged by a traumatic force that breaks the bone. Secondary fractures - soft tissue and skin are perforated from the inside with a sharp end of the bone fragments.
    The wound, with a secondary fracture, is usually small( equal to the diameter of the end of the fragment that perforates the bone).In both the primary and secondary fractures, primary microbial contamination of the fracture zone occurs, followed by the development of suppuration and osteomyelitis.
    With incomplete fractures, the integrity of the entire bone is not broken( perforated, marginal fractures, cracks, torn bunches of bones).
    With a complete fracture, there is a violation of the integrity of the bone throughout its thickness, and fragments of damaged bone can be separated from each other.
    3. By the nature of damage, fracture of the ribs is divided into:
    - isolated fractures of the ribs without attachment of other skeletal injuries,
    - rib fractures that are combined with injuries of the chest and fractures of other parts of the skeleton,
    - non-severe fractures of the ribs, which are combined with injuriesother parts of the body.
    4. By fracture nature, fractures are distinguished: fractures
    - Transverse
    - Longitudinal
    - Screw-like
    - T-shaped
    - U-shaped
    - Perforated
    - Edge
    - Tooth-shaped
    - Splinter
    - Compression
    - Bursted
    At fractures always there are some bone fragments - fragments or splinters. Most often, the fracture is accompanied by the presence of two fragments, with a double fracture there are three fragments, with a triple or four fragments. Damage, in which two or more fracture lines are observed, is called a polyfocal fracture.
    At the same time, small fragments, called fragments, are often formed, such a fracture was called a comminuted one, and in the number of fragments fractures are called single-lobed and multi-lobed.
    In turn, depending on the size of the fragments, fractures are coarse-spiny, medium-osseous and finely fragmented.
    5. In terms of bone defect localization, fractures are distinguished:
    - Diaphyseal
    - Metaphyseal
    - Epiphyseal
    In relation to the joint, fractures divide into extraarticular and intraarticular, distinguishing diaphyseal and metaphyseal( extraarticular) fractures from epiphyseal( intraarticular) fractures on long tubular bones,.In the latter group, the epiphysioleosis is particularly distinguished from the epiphyses of the bones along the line of the neostegenous germ cell cartilage. To further refine the localization of fractures, the following terms are also used: subcapital, supracondylar, pre-alveolar fractures, etc.
    6. Types of displacement depending on the bias factor:
    - Primary( occurs at the time of fracture under the influence of traumatic force).
    - Secondary( occurs due to muscle contraction after fracture).
    7. Depending on the spatial orientation of the fragments, the following displacements are distinguished:
    - along the length of the
    - In width or lateral, when the fragments are displaced away from the longitudinal axis of the limb;
    - Axis or angular when the fragments become angled to each other
    - Along the periphery, when the distal fracture is rotated, i.e.rotates, around the longitudinal axis of the limb;
    Angular bone displacements in a segment with two long bones( forearm, shin) are also called axial displacement.
    8. Classification of fractures by clinical condition:
    - Stable
    - Unstable
    With stable fractures, a transverse fracture line is observed.
    In unstable fractures( oblique, helical), a secondary displacement occurs( due to the increasing posttraumatic muscle retraction).

    rib fractures are very frequent, resulting from a breach of the integrity of the bone or cartilage of one or more ribs. Fracture of one rib or fracture of a small number of edges, not accompanied by complications and other injuries, usually grow together independently and do not require significant interventions or immobilization.

    Accident rate

    Breast injuries are directly responsible for 25% of the 50-60 thousand fatal outcomes recorded annually as a result of road accidents and have a significant impact on the outcome in another 25-50% of accidents. Fractures of the ribs account for about 16% of the total number of fractures.
    Fracture of the ribs is the most common chest damage.
    In elderly people, fractures of the ribs occur more often, which is due to the age-related decrease in the elasticity of the bone structures of the chest.
    Uncomplicated fractures of one or two ribs grow well and do not in themselves pose a threat to human life and health.
    The main danger in this trauma is associated with impaired breathing, damage to internal organs and the development of concomitant complications.
    Uncomplicated fractures of the ribs occur in 40% of cases. The remaining 60% are accompanied by damage to the pleura, lungs and mediastinal organs.
    Multiple rib fractures are a serious trauma that is dangerous, both because of the possible development of pleuropulmonary shock, and because of the dramatically increasing likelihood of life-threatening complications.
    Not only the increase in the number of injuries is noted, but also the faster delivery by ambulance teams of critically ill patients who would have died before arriving at the hospital.
    Most patients with chest trauma can be saved by quickly providing adequate ventilation with endotracheal intubation and( or) drainage of the pleural cavity, as well as timely infusions of fluids. Only 5-15% of patients entering the SNP with a chest injury need thoracotomy.

    Anatomy of the

    Thorax is a bone framework that protects the heart and lungs. The thorax is formed by 12 pairs of ribs. Between the ribs are intercostal muscles, vessels and nerves. The thorax has two boundaries: the upper and lower.
    The upper border is the line that passes through the upper part of the sternum and clavicle to the scapula, and from the rear it represents the process of the seventh cervical vertebra.
    The lower border is a line running along the edge of the rib arch and the edges of the front ends of the free lower ribs, and behind it is the twelfth rib and the process of the twelfth thoracic vertebra.
    Behind all the ribs connect with the spine. In its anterior part, ten pairs of upper ribs terminate in cartilage.
    Elastic rib cartilages provide mobility of the chest. Cartilages of the seven upper pairs of ribs are connected to the breastbone. The cartilages of the VIII-X ribs are connected to each other, and the XI and XII ribs lie freely, not articulating in front with other bone structures.
    From the inside, the thorax is lined with a connective tissue membrane( an intrathoracic fascia) immediately below the fascia is a pleura consisting of two smooth leaves. Between the sheets there is a thin layer of lubricant, allowing the inner leaf of the pleura during breathing to slide freely relative to the outer one.
    The tissue of the lung is formed by minute hollow vesicles - the alveoli, in which, in fact, gas exchange takes place.

    Clinic pneumothorax depends on the type of it, the amount of air in the pleural cavity and the degree of collapse of the lung. With limited pneumothorax, the condition of the victim is satisfactory, he is calm, complains of pain in the chest. At the forefront are the symptoms of fracture of the ribs or penetrating wound of the chest wall. Auscultation is determined by weakened breathing on the side of the lesion.
    With an overview fluoroscopy( graph) of the chest reveals the accumulation of air in the pleural cavity.
    With medium and large pneumothorax, the clinic is brighter. The patient is restless, complains of pain in the chest, shortness of breath. The pain increases with exercise, breathing. The face is pale-cyanotic in color, covered with a cold sweat. Shortness of breath is noticeable even at rest. Breathing is rapid, superficial. Auscultatory - a sharp weakening of the breath on the side of damage. Percutally determined boxed sound. Pulse is frequent, weak filling. BP is somewhat reduced, but it can be normal. Radiographically determined: the area of ​​enlightenment in the form of a zone devoid of pulmonary pattern, collapse of the lung, displacement of the mediastinum to a healthy side. Fracture Symptom Diagnosis Complication
    With open pneumothorax, in addition to the above signs, there is a noise of air sucking through the wound of the chest wall, the release of air with blood.
    The most severe is the valve( strained) pneumothorax. His clinic is very bright, the condition of the victim is heavy, he is restless, feels pain, dyspnea.sometimes - choking. Is in a forced position, more often sitting. Skin covers of cyanotic color, moist. Swollen cervical veins are visible. Often there is a growing subcutaneous emphysema with air spreading to the neck and face. The thorax on the damage side is fixed, the intercostal spaces widened. There is a tachycardia up to 120 and above, a decrease in blood pressure to 90 or lower. Increases CVP.A pronounced tympanic sound is determined percussion. Auscultatory - a sharp weakening or complete absence of breath on the side of damage, displacement of the heart beat in a healthy way. X-ray is determined by the accumulation of air in the pleural cavity, subtotal or total collapse of the lung, the displacement of the mediastinum in a healthy direction.
    Important and at the same time, a simple method of diagnosis is pleural puncture in the 2nd intercostal space.
    4. Hemotorax
    Hemotorax is a collection of blood between the parietal and visceral pleura.
    Classification of hemothorax( PA Kupriyanov1946g):
    1 Small hemothorax - accumulation of blood in the pleural sinuses.(the amount of blood is 200-500 ml.)
    2. Medium hemothorax is the accumulation of blood up to the angle of the scapula( 7 intercostal space).The amount of blood from 500 to 1000ml.
    3. Large hemothorax-accumulation of blood above the vane angle( blood quantity more than 1 liter)
    There are hemothorax with stopped bleeding and hemothorax with continuing bleeding. The criterion is the Rusilua-Gregoire test: when bleeding continues, the blood taken from the pleural cavity coagulates.
    Depending on the time of their appearance, they distinguish between fresh hemothorax and chronic hemothorax.
    Collapsed hemothorax-clotting of blood flowing into the pleural cavity.
    Infected hemothorax - infection of blood in the pleural cavity.
    The cause of hemothorax: penetrating wounds of the chest wall, damage to the intercostal vessels, internal thoracic artery, lung vessels, mediastinum, heart damage.
    The hemothorax clinic combines the signs of acute blood loss, respiratory disorders, mediastinal displacement. The severity of the condition depends on the size of the hemothorax.
    Small hemothorax: symptoms are meager. Signs of acute hemorrhage, respiratory failure are absent. There is a slight pain and a weakening of the breathing in the lower parts of the lung. Radiography reveals blood in the sinus. When puncture in 7-8 intercostal space, we get blood.
    Mean hemothorax: chest pain, cough, shortness of breath. There is pallor of the skin. Percussion is determined by blunting on the side of the lesion. Auscultatory: weakening of breathing. BP reduced to 100, tachycardia - 90-1000 beats.in min.
    Radiographically, the fluid level to the blade angle is determined. When puncturing the pleural cavity in the 7 intercostal space, we get blood.
    Large hemothorax. The condition of the victim is severe. There are strong signs of acute blood loss: pallor of the skin, hypotension( BP 70 and below), tachycardia with a weak pulse filling( up to 110-120 per minute).There is pain in the chest, shortness of breath, cough. Percuturno - dulling of sound. Auscultatory - a sharp weakening of the breath, or its absence.
    Radiographically determined fluid level above the angle of the scapula and lung collapse.
    When an ultrasound is determined free fluid in the pleural cavity. Pleural puncture - we get blood.
    In most cases, all of these complications are accompanied by symptoms of respiratory failure.
    Symptoms of respiratory failure:
    - Paleness of skin
    - Cyanosis
    - Tachypnea
    - Asymmetric movements of the chest wall during breathing
    - Chest fracture of the chest
    - Persistent tachycardia.

    Emergency care for

    The main first aid measures for patients with fracture of the ribs are:
    - Immobilization( stabilization) of the ribbed framework
    - Adequate analgesia
    - Oxygen supply
    - Infusion( anti-shock) therapy
    - Urgent "gentle"!transportation and hospitalization in a trauma hospital.
    And now we will consider in more detail the tactics of emergency care for fracture of the ribs.
    Victims with open, combined and closed isolated chest trauma, accompanied by respiratory and circulatory disorders, are subject to emergency hospitalization in the hospital. Victims with chest bruises that are not accompanied by blood loss, clinically distinct organ damage, with isolated rib fractures, are not hospitalized.
    Victims with chest damage requiring hospitalization should be transported on stretchers in a semi-sitting position. During transportation it is necessary to constantly monitor the frequency and depth of breathing, the state of the pulse and the level of blood pressure.
    The scope and content of care for victims with chest trauma are determined by the severity and nature of the injury, and also depends on the time and place of its delivery. Victims with non-penetrating wounds of the chest first aid is limited to the application of an aseptic bandage.
    When dealing with a victim with a chest injury, fighting with pain is very important. It is necessary to administer analgesics that do not depress respiration( 2-4 ml of 50% solution of analgin, intravenously, 1 ml of 1-2% solution of promedol).Drugs that depress respiration( morphine, fentanyl) should not be given.
    For rib fractures, intercostal novocaine blockade is advisable, especially if long-term transport is to be carried out.
    With isolated fractures of one or two ribs not accompanied by internal injuries, local anesthesia of the fractures( in the hematoma) or conductive anesthesia of the intercostal nerves is performed. The latter is carried out by introducing a 1% solution of novocaine in an amount of 3-5 ml in sequence to the lower edge of the ribs along the scapular or near-vertebral lines.
    Blockade of fracture sites of ribs is made as follows. The skin above the fracture area is carefully treated according to a conventional technique, and the needle is inserted into this place until it touches the rib.5-10 ml of 1% solution of novocaine is consumed on the blockade of the fracture site of the rib. You can use a 0.5% solution of trimecaine, but in appropriately increased amounts.
    For multiple fractures of the ribs, an effective means of anesthetizing and preventing further pulmonary complications is paravertebral blockade, which is performed according to the following procedure.
    Position of the patient - on a healthy side. After treating the skin with a needle for intramuscular injection, intradermally inject 0.5% solution of novocaine or trimecaine. Point for the introduction of anesthetic is separated from the spinous process of the vertebral lateral by 1 cm. Prior to advancing the needle, Novocain solution, the needle is brought to a stop in the transverse process of the corresponding vertebra, after which 30-40 ml of 0.5% solution of novocaine or trimecaine is administered.
    In the pre-hospital stage, such a modification of the paravertebral blockade is justified, since it is technically simple and effective. Due to the novocain infiltrate, a reliable blockade of intercostal nerves is created in the region of their exit from the intervertebral foramen. If three or four ribs fracture, blockade should be done in the center of the affected area, and for multiple fractures of the ribs, the blockade is performed from two points: 2 intercostal spaces below the diagnosed lesion zone at the top and 2 intercostal spaces above the lower boundary of the damaged ribs.
    Has not lost its value in severe chest trauma and multiple fractures of the ribs with the phenomena of pleuropulmonary shock and vagosympathetic blockade according to AV Vishnevsky, which can also be performed at a prehospital stage.
    With multiple fractures of the ribs, accompanied by paradoxical breathing and the phenomena of severe respiratory failure, the patient is shown to be switched to IVL by feeding a mixture of nitrous oxide and oxygen in a ratio of 2: 1.With such ventilation, fragments of the ribs passively move on the "air cushion" of the lung, thereby creating conditions that exclude the need for various ways of fixing the unstable chest in the prehospital stage.
    It should be remembered that the imposition of all kinds of fixative bandages for rib fractures is unacceptable, since this restricts the respiratory movement of the chest and creates conditions for the development of pneumonia.
    The first medical aid for penetrating wounds to the chest is the application of an occlusive dressing to the wound. Thus, the pleural cavity is isolated from the atmosphere. The technique of applying an occlusive dressing should be observed very carefully. Sterile oilcloth, polyethylene, rubberized shell of the individual package should be applied directly to the wound. Apply a cotton-gauze dressing to the wound, and do not seal the sealing cloth over it. In this case, the dressing does not fulfill its function, since air penetrates through the cotton wool and gauze into the pleural cavity.
    In case of a large defect of the chest wall in front and lateral after the application of an occlusive dressing, it is necessary to bandage the arm to the chest wall on the affected side. This technique allows you to keep the bandage well when transporting the wounded. With extensive wounds of the chest for the application of an occlusive dressing, you can use sterile wipes, richly impregnated with indifferent ointments.
    If, after applying the occlusive dressing, the patient's condition worsens and dyspnea appears, cyanosis of the face, tachycardia, the respiratory noises on the side of the lesion disappear and the mediastinum moves to a healthy side, this indicates the development of a strained pneumothorax. Such an injured person needs to insert into the pleural cavity a needle with a wide lumen in the second intercostal space along the mid-inclusive line, putting a finger on it from a rubber glove with a notched apex and fixing it to the needle. This will eliminate the increased pressure in the pleural cavity. In parallel, you should start oxygen therapy and therapy, aimed at compensating the cardiovascular system.
    The main method of treatment of hemo- and pneumothorax is the removal of blood and air from the pleural cavity by puncturing and draining, which allows the lung to spread out. To remove air from the pleural cavity, the puncture is performed in the second intercostal space along the mid-inclusive line. This applies a needle for pleural puncture, equipped with a rubber extension or a two-way tap, through which the air is removed by a syringe. Removal of blood from the pleural cavity with extensive hemothorax is performed by pleural puncture or by drainage of the pleural cavity in the seventh to eighth intercostal space along the back axillary line.
    Technique for draining the pleural cavity. The skin in the region of the second intercostal space along the mid-inclusive line is treated with alcohol and alcohol solution of iodine, then the puncture area is carefully anesthetized with 0.5% solution of a local anesthetic. In the area of ​​introduction of the trocar with a scalpel, the skin is cut and the trocar is inserted into the pleural cavity through the cutaneous incision. Then, after removing the stylet, a rubber or plastic tube with a diameter of 8 mm is inserted through the trocar. It is fixed to the skin of the patient by a seam, and the free end of the drainage is immersed in a vessel with a solution of furacilin, which is suspended to stretchers below the level of the victim's body. Otherwise, the fluid can( according to the law of communicating vessels) flow into the pleural cavity. Drainage must be fixed to the vial.
    At the pre-hospital stage, during a long transportation of the patient, puncture of the pleural cavity with total hemothorax can be performed using a system for transfusion of solutions with a pre-cut filter.
    Infusion therapy in the prehospital stage is indicated for chest trauma accompanied by blood loss. Criteria for determining the magnitude of blood loss are marked external bleeding, lowering blood pressure to 100 mm Hg. Art.and below, the presence of medium and large hemothorax.

    Previous history of chest trauma. Pain in the place of impact, which increases during inspiration and exhalation or when coughing. Fractures of the ribs are characterized by the appearance of the symptom of "ragged inspiration", an attempt to slowly and deeply inhale is accompanied by a sudden pain and the breath stops. Often the postures of the victim during the broken ribs are forced, well, the movements themselves are chained. When visual examination of the chest is clearly visible, that its damaged part lags behind in the breath. As a rule, bruising and swelling are visually determined at the site of the injury. Complete fractures of the ribs, as a rule, are accompanied by a displacement of bone fragments with their subsequent ascent at the moment of exhalation and expansion at inspiration. With palpation, a sharp local tenderness is revealed, crepitation is possible. Strain in the form of a step at the point of maximum soreness also indicates a fracture of the rib. If the fracture of the ribs is accompanied by subcutaneous emphysema, palpation of the subcutaneous tissue reveals crepitation of the air, which, unlike bone crepitus, resembles a soft scratching.

    Complications of

    1. Subcutaneous emphysema
    2. Hemoptysis
    3. Pneumothorax
    4. Hemotorax.
    1. Subcutaneous emphysema is an accumulation of air in the subcutaneous tissue of the chest wall that spreads to other areas of the body. It is a symptom of damage to the lungs or airways.
    Subcutaneous emphysema, depending on the size, is divided into: limited, common, total.
    Clinic of subcutaneous emphysema
    Depends on the magnitude of emphysema. With limited emphysema, there is local soreness at the site of injury and a characteristic crunching occurs in the place of air accumulation in the cellulose. With a common emphysema, the clinic is brighter. Visually determined areas of swelling of the subcutaneous tissue, with palpation of which there is a subcutaneous crepitation, auscultatory reminiscent of the sound of a crunch of dry snow. Respiration on the side of damage is weakened. With severe neck emphysema, shortness of breath occurs, cyanosis of the facial skin.
    2. Hemoptysis, or hemoptysis - coughing up phlegm with blood from the larynx, bronchi or lungs.
    Blood in hemoptysis is scarlet and frothy.
    3. Pneumothorax is the accumulation of air between the parietal and visceral sheets of the pleura.
    Types of pneumothorax:
    1. For communication with the environment, the following are distinguished:
    - Closed pneumothorax. In this form, a small amount of gas enters the pleural cavity, which does not grow. There is no communication with the external environment. It is considered to be the easiest kind of pneumothorax, since air can potentially dissolve independently from the pleural cavity, while the lung is straightened.
    - Open pneumothorax. When the pneumothorax is open, the pleural cavity communicates with the external environment, therefore, a pressure equal to atmospheric pressure is created in it. In this case, the lung recedes, since the most important condition for spreading the lung is the negative pressure in the pleural cavity. The fallen lung is turned off from breathing, it does not take place gas exchange, the blood is not enriched with oxygen. May be accompanied with hemothorax.
    - Valve pneumothorax. This type of pneumothorax arises in the case of the formation of a valve structure that transmits air in a one-way direction, from the lung or from the environment into the pleural cavity, and prevents its exit back. With each respiratory movement, the pressure in the pleural cavity increases. This is the most dangerous form of pneumothorax, since irritation of the nerve endings of the pleura, leading to pleuropulmonary shock, and the displacement of the mediastinal organs, which violate their function, first of all squeezing the large vessels, join the deenergizing of the lung from the respiration.
    2. By the volume of air in the pleural cavity pneumothorax are divided into:
    1. Limited - the lung is compressed by 1/3 of the volume.
    2. Medium - light is squeezed by half the volume.
    3. Large - light pressed more than half the volume.
    4. Total - the collapse of the entire lung.
    3. In addition, pneumothorax can be:
    - Pristenochnym( in the pleural cavity contains a small amount of gas / air, the lung is not fully expanded, as a rule, it is closed pneumothorax).
    - Full( light fully collapsed).
    - Occasional( occurs when there are adhesions between the visceral and parietal pleura that limit the area of ​​pneumothorax, less dangerous, may be asymptomatic, but can also cause additional lung tissue ruptures at the site of adhesions).

    Clinic for pneumothorax

    1. Laboratory methods: a blood test with a formula and an overall urinalysis to exclude concomitant pathologies.
    2. Instrumental research:
    - Chest X-ray;
    - Magnetic resonance imaging( method of investigation of internal organs and tissues using the physical phenomenon of nuclear magnetic resonance);
    - Computer tomography( method of layer-by-layer examination of the internal structure of the object);
    - With possible complications from the cardiovascular system, electrocardiography is recommended.

    Treatment is limited to immobilizing the chest and prescribing painkillers. Immobilization is achieved by imposing a tight bandage bandage. Strips of sticky plaster or leukoplast are slightly longer than the semicircumference of the breast and 6-7 cm wide, on the side of the chest, transversely from the sternum to the spine, starting from X and reaching the VI-VII rib.
    The dressing is applied at the moment of maximum exhalation, going from bottom to top, with each next strip of patch half( tile) covering the previous one. Sometimes impose a circular bandage dressing. After 5-6 days, the bandage is changed. Leave the bandage on the patient for up to 2-3 weeks.
    The best painkiller is injection into the fracture site of 10-15 ml of 1-2% solution of novocaine. Anesthetic injection of novocaine can also be made in the appropriate intercostal space. Soreness often is eliminated for several days. With the phenomena of pleural shock, the patient's condition is facilitated by a vagosympathetic blockade.
    With open fractures of the ribs, the wound is subjected to primary surgical treatment. In wartime conditions, with a rifled rib fracture, the damaged ends are resected. The skin is usually not stitched.