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Fractures of the Ribs.
Fracture of the ribs can usually be detected by the following signs :
The patient suffers extreme pain upon breathing, which he refers to one particular spot. He is unable to lie down upon the injured side without pain ; the difficulty in breathing is usually increased in the recumbent posture. If one of the fragments have penetrated the lung, the patient coughs up bloody mucus mixed with air ; sometimes air escapes from the lung into the cavity of the chest, and even into the connective tissue under the skin. In the latter case the skin is puffed up and crackles when pressed with the fingers.
By feeling along the course of the ribs we detect a painful spot ; pressure with two fingers placed an inch or two apart reveals a grating sensation at this point. By placing the ear over the skin at the seat of the suspected fracture we can hear a grating sound during the movements of the chest in breathing. If there be any difficulty in detecting the seat of fracture we can usually find the spot by placing one hand upon the back and the other upon the breastbone and pressing with considerable force ; the patient will experience a sharp pain at the seat of the fracture.
Fracture of the ribs is sometimes simulated by a severe bruise of the side ; in this case there is no grating sensation, but there is so much pain upon pressure that the patient cannot endure a careful examination. If the injury be only a bruise without fracture, the pain and tenderness will subside in a few days ; if there be a fracture, on the other hand, the pain during breathing persists.
A simple fracture of the ribs unites readily even without dressing. If, however, there be some injury to the lung, inflammation of the lung, or of the membrane covering it-the pleura - may involve the patient in a serious illness. If no such inflammation follow, a rapid recovery may be expected even though the skin be puffed up with air which has escaped under it. It is surprising to see the effects sometimes produced by this accident ; the entire side of the chest, indeed the whole body, may be enormously swollen ; the skin is simply full of air, and crackles whenever the fingers are pressed upon it. No danger is to be apprehended from this condition, however, unless the air has also escaped into and filled up the cavity of the chest between the lungs and the ribs ; in this case the lung may be compressed so that the patient cannot breathe, and dies of suffocation.
Treatment*-In most cases there is no perceptible deformity, unless several adjacent ribs have been broken. If there be an evident displacement of the fragments these are to be reduced by pressure with the fingers.
The object of treatment consists in measures which restrain the movements of the chest on the affected side, as a result of which the fragments are kept at rest and have an opportunity to heal. This object can be accomplished by applying broad bands of adhesive plaster around the injured side from the spine to the breastbone. These strips of plaster should be about two inches wide, each one overlapping the one beneath ; a sufficient number should be applied to cover five or six inches of the side of the chest. If adhesive straps cannot be obtained, the movements of the chest may be arrested by a bandage placed around the body drawn as tightly as the patient can bear it.
In some cases the application of such a bandage may at first increase the patient's discomfort. This, however, lasts but a short time, and in a few hours great relief is afforded. The dressing must be worn four or five weeks.
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