If ribs are broken, how can they be manipulated back into position and immobilised long enough to knit?
Don’t know for sure. I imagine if they were in danger of puncturing a lung or something I suppose they’d have to be moved. I broke mine a couple of years ago and they didn’t do anything. I asked whether they were going to strap them but the Doc said that that only stops the ribs on the good side from working properly. So in answer:- maybe they can, but the bastards didn’t for me.
I believe that ribs are really, really tough, in addition to being hard to set. Probably when they’re broken, it’s more of a fracture than a complete, dislocating break. That is, they’re still in the same spot, just not in perfect condition.
As a WAG, if you’ve been hit with enough force to break your ribs and rearrange them so they’re in danger of poking through something, then likely the things they might poke through are pretty badly damaged anyway.
So if you break a rib, you probably just need to be careful, because it’s not misaligned anyway.
Just a WAG, don’t hate me. And be sure to see a doctor if you do happen to get hit in the torso with a sledgehammer.
I’d think, with the nature of what the ribs are protecting, that unless you can physically take each side of the rib and move it back into place, it’s probably best to getcher ass to a doctor or such.
Yesterday, if not sooner.
Why, what’d you do?
–Tim
Nothing! I saw a re-run of Friends last night, where Monica’s rich boyfriend was trying to win the Ultimate Fighter championships or something. There was a scene where he was in some kind of full body cast (the one where his arms were sticking out) and I got to wondering if something like that could actually do anything useful.
I got my ribs smacked pretty hard sparring in Tae Kwon Do a few years ago and thought I might have cracked a couple. Took about five weeks to stop hurting. A lot of people told me that it wasn’t worth going to the doctor - they wouldn’t actually do anything unless the ribs were properly smashed and displaced. What I’m wondering is, does it require actual surgery to put them back where they belong in such a case?
I’m on Surgoshan’s side with this one, Matt. Sure, they’d probably have to do surgery to fix ribs smashed up that badly, but they’d probably be doing surgery anyhow to sew up your mangled lungs, spleen, etc.
jb
About 3 years ago, I got run over by a car, and broke quite a few (just about all? 
) my ribs. In fact, on the X-ray you could see a black band going diagonally down from shoulder to hip, where the fractures were, which I affectionatly thought of as the “tyre mark”.
Anyway, while I did have surgery on my pelvis, they didn’t strap my ribs at all; they said they didn’t do that any more, since it appeared to make no difference to the healing.
I think it does require surgery if ribs are seriously displaced, but if they’re that badly displaced, they’re going to cause internal damage anyway, so you’d need to be cut open whatever…
I once heard that removed ribs would grow back. Is that true?
Also, what’s the purpose of the xiphoid process? I know it can break off and damage organs below it in CPR, but I don’t know of any good things associated with having a prong of bone extending down below the sternum.
From my experience ribs, the majority of the time, stay in pretty much their anatomical arrangement even when broken. what does happen is the location of the break “grinds” on itself during breathing. To combat this we find a way to stop that side of the chest wall from expanding. (enter the wonderful game of how much to we stop the chest wall from expanding to prevent pain vs. patient being able to breath)
I’ve gone as far as asking the patient to push on it theirself, giving them a pillow or blanket (folded) to push on it with, or even using tape across that 1/2 of the chest (sterum to spine)
Warning: I am not a Doctor… but I am a carnivore!
Has anyone here eaten ribs? Those things are tied together by a muscle sheath, unlike the leg or arm bones where the muscle is only anchored at one end. I assume that it would take a near-fatal injury to move a rib away from its position in the ribcage.
They did nothing for my broken sternum. I still have a split where the two halves (bottom and top) don’t meet properly. Breathing sucked. So did try to lie down, getting up, and any sort of activity that involved that general area.
Oh, this reminds me. Important things to remember if you have many bruised/broken ribs:
-
Do not invite witty/funny friends to visit you in hospital. They are all bastards, and will not stop telling you jokes just because you are in serious pain.
-
Never sneeze.
Feel free to add your own…
I had the same problem after my appendectomy. I watched Jay Leno on the Tonight Show (before he took over as full-time host), and I was in constant pain giggling at whatever was in his monolog.
I cracked a couple of ribs falling down a ladderway on a ship. Chiefscott can relate to this, I stepped off the flight deck coaming, and instead of stepping onto the platform that leads to the catwalk, I stepped into the ladderway that goes from the catwalk to the gallery deck. A vertical fall of about ten feet landing with my ribs against the handrail. MF that hurt.
At medical the doc said he couldn’t give me any meds because of my flight deck duty. He couldn’t do much of anything so told me to take light duty. Light duty meant I couldn’t lift anything over 100lbs…by myself. <grumble> You’re a reak fuckin’ pal there doc. For well over a month it hurt like a sonofabitch to laugh or cough.
My broken ribs have never knitted.
Crocheted, macramed… yeah.
But never knitted.
I am an MD, and the above speculations about ribs not needing setting are mostly correct. They’re usually held in place pretty tightly by surrounding structures, even if they are broken, and will heal and remodel just fine. Formerly rib belts or strapping (duct) tape was used to provide comfort. But it turns out that when ribs are immobilized this way, people don’t breath deeply enough, and often get pneumonia. Since rib taping was just for comfort purposes, and pneumonia still kills people, the taping was dispensed with. I mostly give the patients with multiple fractures anti-inflammatories like ibuprofen, along with valium to decrease the muscle spasms going on between the ribs, and lots of opiate pain killers for the first week or so.
Sometimes however, the ribs are so broken they collapse a lung, tear an artery, puncture a spleen or liver or such, then the surgeons get involved to fix things with rivets and staples and the like. A bit more complicated!
Fun fact: Flail Chest! If enough ribs get smashed locally, they don’t work anymore to move the chest, and when you inhale (expanding the chest) this island of chest wall goes in instead of out, and when you exhale and collapse the chest, it goes out instead of in. Not a real good thing, as it tends to make breathing ineffective. Sometimes they get fixed surgically, sometimes the patient just gets tubed (attached to a ventilator) so a machine can breath for them for the weeks it takes for this to heal.
I second Dr. Q.
I was told that my opinion is not worth much, but’d dare to post it. Anyone here can take it or can ignore it.
qadgop
Given my limited experience to in the field of trauma, only 3 years, all prehospital, I have never seen a flail chest exhibit paradoxical movement. I have had several patients who had 2 or more ribs each broken in 2 or more places (per x-ray after ER delivery). That should meet the requirement for a flail segment. Upon questioning this to my paramedic instructor, the answer I received is that the contraction of the intercostal muscles prevents the movement.
At what point does the segment begin to move? The only thing I could come up with is at some point the muscle have to become tired. Would the paradoxical movement then begin?
In the movie the Right Stuff (if I’m remembering this correctly) doesn’t Chuck Yaeger break his ribs somehow and have to wear a brace? What would that help, if anything?