Key points of diagnosis of rib fracture

Answer: (1) The main clinical symptom of patients with simple rib fracture is chest pain, which is aggravated when coughing or sneezing. Most rib fractures caused by direct external force have tenderness in the trauma area, and local bone rubbing sound can be felt; The rib fracture caused by indirect external force will cause pain at the fracture point when the chest is squeezed back and forth or sideways, which is called "squeezing pain".

(2) Radiological signs The diagnosis of rib fracture is mainly based on X-ray chest film. Anterior and oblique X-ray chest films can show the fracture line of ribs and indicate the fracture range, whether it is complicated with hemothorax and pneumothorax. When the rib below the seventh rib is fractured, special attention should be paid to whether there is any damage to abdominal organs, such as rupture of liver and spleen.

(3) Respiratory dysfunction is a prominent clinical manifestation of patients with multiple rib fractures. The main reasons are as follows: (1) After chest trauma, the secretions in trachea increase, patients dare not cough and take deep breaths because of pain, and the respiratory tract is easily blocked by secretions; ② Abnormal respiratory movement of chest wall causes respiratory restriction, decreased vital capacity, decreased lung compliance and tidal volume. The larger the floating chest wall area, the more obvious the ventilation dysfunction. ③ Multiple rib fractures are often complicated with pulmonary contusion, which causes pulmonary interstitial and alveolar hemorrhage and edema, and pneumothorax caused by lung laceration and stab wound, which affects ventilation and oxygen diffusion and exchange. These factors lead to the decline of ventilation and gas exchange function, which leads to obvious hypoxemia in patients.

In the clinical physical examination, it can be found that the respiratory movement of local chest wall and chest is contradictory, and the patient has difficulty breathing and cyanosis. Blood gas analysis can show that arterial oxygen partial pressure decreases and carbon dioxide partial pressure increases.