Dr. K.K. Pandey
Did you ever have involved in any fist fight or a riot where in you sustained a chest injury? After you had treatment for chest trauma, everything became alright, but ribs are still paining. It might be possible while driving a motorbike or scooter you had fallen down and broken your ribs. Your life was saved then but you still have pain in the chest while breathing. Sometime while driving a car, you might have sustained chest injury caused directly by a steering wheel of the car and after that you started having complaint of breathing difficulty along with chest pain. Sometime in past you got injured in a road traffic accident and sustained chest injury and rib fracture and got admitted in a hospital for a few days. Although you got discharged from the hospital, but after the discharge you developed problem of fever, chest pain and breathlessness. In all these circumstances, one should not sit idle and consult immediately a thoracic or a chest surgeon, otherwise one might face serious complications which may prove fatal.
Why a simple rib fracture may prove fatal?
In 70% cases of chest injury, fracture of ribs occurs and along with that muscles of chest too get damaged. In approximately 50% cases of rib fractures, the underlying lung is seriously damaged resulting into collection of blood and air inside the chest cavity. In medical terms, collection of air inside the chest is called ‘pneumothorax’ and collection of blood ‘hemothorax’. If both these medical conditions are not treated promptly and urgently, approximately 80% of them develop risk of an eventual death. Therefore, one should consult an experienced thoracic or a chest surgeon immediately after chest injury and start treatment under his care, otherwise no other alternative except death will remain.
‘Flail Chest–A dangerous state of rib fracture
Sometimes in road traffic accidents, many ribs are broken simultaneously at various places in the chest. This condition in medical terms is called ‘Flail Chest’ or swinging chest. During breathing this ‘flail chest’ segment does not move in accordance with the movements of the remaining original chest and makes its own independent existence. This independent flail chest segment never cooperates with the remaining chest during breathing mechanism, but at the top of it, this segment functions just the opposite. This is a very dangerous situation, because flail chest seriously impedes the breathing system and other functions of chest. The combined effect of these, lead to a rapid fall in oxygen level of blood. If a ‘flail chest’ is not treated effectively in time, death will become a certainty sooner or later. In such conditions, relatives and family members should take the victim to a modern hospital equipped with all the latest investigations and treatment facilities and where availability of an experienced thoracic or a chest surgeon also is there.
What will happen if rib fracture is not treated properly?
If rib fractures are not treated properly, sooner or later death will become inevitable. People generally do not take rib fractures seriously and go to small clinics and hospitals for treatment with the idea that it is a simple injury. Our medical fraternity too does not seem to be that much serious as desired regarding the treatment of rib fracture. What happens generally in India, people concentrate only on fracture of ribs and therefore they consult a bone specialist for treatment rib fracture.
People do not realize that a person who has sustained rib fracture must have injured his underlying lung also. With the result, people pay more attention to rib fracture than the underlying injured lung and thus damaged lung is totally neglected during treatment of chest injury. When they realize this mistake, it is too late and the victim of rib fracture develops a fatal condition of A.R.D.S. (Acute Respiratory Distress Syndrome). In this condition of ARDS, chances of survival are only 5%. In such a situation, the process of breathing and oxygenation is seriously impaired and amount of oxygen in the blood becomes dangerously low and carbon dioxide level in the blood touches very high. In such a scenario, various organs of the body like kidney, brain and liver stop working and chest x-ray becomes white and hazy instead of being black. Therefore people should take rib fracture sustained in a road traffic accident very seriously from the very beginning and thus avoid giving direct invitation to the dreaded ARDS or “white lung” which in fact is the messenger of death.
How does a rib fracture happen?
In today’s world, small arguments lead to physical fights. Exchange of hot words often culminates into fist fights which cause fracture of one or multiple ribs. Quite often two-wheeler-riders while driving carelessly, fall off on the road and break their ribs. Sometimes people fall from a height and break their ribs.
While driving a car without using a seatbelt, people receive a direct blow from the steering wheel, in the event of application of sudden brake. This results into a fracture of ribs of one side or both sides of the chest. In our democratic setup in India, there are daily occurrences of demonstrations, lathi charges, pelting of stones and bricks on the road. Quite frequently in these violent incidences demonstrators sustain injuries and their ribs are fractured.
How to prevent a rib fracture?
The best way to prevent a rib fracture is to keep your seat belt fastened while driving. According to one estimate, use of seat belt alone, reduces the percentage of deaths by 45% to 50% occurring due to road traffic accidents. This fact itself explains the great utility of seat belt in preventing deaths due to chest injury. If helmet acts as a protector for a motorcyclist, in the same way seat belt too acts as a life saver for a car driver. The instantaneous death occurring on the spot in a road traffic accident in majority of the cases is caused by chest injury and rib fracture. Therefore one must fasten seat belt while driving.
The author is a Senior Consultant in the Department of Cardiothoracic & Vascular Surgery at Indraprastha Apollo Hospital, New Delhi India.
Follow our WhatsApp channel
