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Fractures of the Ribs and Bone

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Fracture of the Ribs.—The ribs may be broken directly by a blow, which is apt to drive the fragments inwards to the injury of the lungs. Pressure on the body, as, for instance, that caused by a man being caught and crushed, say between two barrels or between a cart and a wall, is liable to produce fracture round at the back where the rib begins to curve forwards. In such a case there is great risk of fracture on both sides—a very serious accident. It is of importance to learn how the accident occurred in order to learn whether there is likely to be any wounding of the organs of the chest by the fragments. Frac tured ribs added to chronic bronchitis or heart disease are a very dangerous complication. Coughing may be an indirect cause of broken ribs in old people.

Signs.—The person has short, shallow breath ing. There is sharp, stabbing pain, increased by movement and rendering coughing or deep inspiration extremely distressing. The person is able to put his finger on the exact spot where the pain is. The pain does not move about from place to place, but is fixed. If the patient complains not of pain at a spot, but of pain all over the chest, the chances are against fracture. If the person indicates the seat of pain, with two fingers trace along the outline of the rib, pressing firmly. When the place of fracture is reached the fingers will detect movement and grating, and the pain will be greatly increased by the pressure. if the person be very stout, and especially if the fracture be near the spine, these signs may not be made out. Nevertheless, if, after injury, there is pain complained of at a particular spot, on breathing, it is to be treated as fracture.

Treatment consists in giving rest to the af fected part and preventing movement of the fragment. This is often done by bandaging the whole chest, but such treatment very often too seriously impedes respiration. A better way is to take strips of ad hesive plaster long enough to reach from the middle of the back to a little way beyond the breast-bone. Make the patient lean to the uninjured side, and then, beginning be hind, apply the plas ter, carrying the strips from the spinal column forwards and slightly upwards to the breast-bone. The strips should be so placed in reference to one another that one strip overlaps the strip immediately below. The strips are to be applied in this way till the whole of the injured side is covered by a sort of cuirass of plaster (see Fig. 42).

For the first twenty-four hours after the ac cident the person should be propped up in bed in the sitting posture to relieve the breathless ness and feeling of suffixation. If the distress and pain are very great opiates may be neces sary, and sometimes, in very exaggerated cases of this kind, bleeding is called for; but recourse should not be had to such remedies without the advice of a surgeon. In the case of an adult ten to twenty grains of chloral hydrate, to re lieve pain and induce sleep, is the utmost that ought to be given by inexperienced persons.

Fracture of the (Sternum). — The signs of this fracture are practically the same as those of fractured ribs, and the treat ment is also similar.