What is it about ?
We are talking about rib and pelvic fractures in the same patient guide, because they often happen at the same time following a serious accident. They are generally treated conservatively. The adjective ‘conservative’ means that, if possible, surgery is avoided. The operation is only possible, and desired, in certain exceptional cases. The cause of the fracture is always a trauma (accident, blow, …).
In older people, the risk is greater because their bones are more fragile (osteoporosis). In this case, a heavy coughing fit can already cause a rib fracture. Fractures due to cancer metastases are rare.
How to recognize them?
Broken rib (s)
You feel pain on the pressure at the fracture site or in your back. The pain gets worse when you move, cough, sneeze, or breathe in deeply. Possible complications are hemorrhage and pneumothorax. A pneumothorax is caused by a rupture of the lining of the lung (pleura), causing blood or air to be present in the pleura. As a result, the lung contracts and you end up short of breath. The risk of complications increases as soon as you have more than 2 broken ribs.
Pelvic fractures
Pelvic fractures cause pain in the groin, pelvis, or hip areas. In most cases, you can no longer stand or walk and your movements are limited. The leg may be in an abnormal position: it is a little shorter on the side of the fracture and the foot slightly turned outwards.
There are different types of pelvic fractures:
- Avulsion fracture: In athletes, a strong contraction of the muscles can tear off a piece of bone at the point of insertion of the muscle on the bone. It causes sudden sharp pain. Hip flexion is difficult and the strength is greatly reduced.
- The pubic fracture mainly affects the elderly, after a fall;
- Multiple fracture of the pelvis is often the result of high-speed trauma (for example, a traffic accident or a fall from a certain height);
- Fracture of the acetabulum (a cup located on the pelvic bone (iliac bone) and used to accommodate the end of the thigh bone (femur)) is often seen in older people with weak bones. weakened by osteoporosis, after a traffic accident or a fall from a certain height.
After a fall or childbirth, the tailbone can fracture. This fracture is particularly painful and prevents you from sitting down normally.
How is the diagnosis made?
The doctor diagnoses a rib fracture by gently applying pressure to the ribs and / or breastbone. If he suspects the fracture of several ribs, he will pay special attention to possible complications. With pneumothorax or bleeding, the doctor hears less breath sounds on the affected side when he examines the chest. Sometimes more and more air collects in the chest. This situation can be fatal. The doctor recognizes this situation by a bluish coloration of the lips, an increased heart rate and a decrease in blood pressure. A chest x-ray is not necessary unless he suspects pneumothorax or bleeding, or thinks you may have more than one fractured rib.
In the event of a fractured pelvis, the doctor will ask you how the trauma unfolded. He will examine you and order an imaging test (X-ray or CT scan of the pelvis) to better see the fracture.
An x-ray is usually not needed to confirm a coccyx fracture. An x-ray is necessary in case of significant trauma (for example, a fall from a certain height on the coccyx) in order to exclude a fracture of the sacrum.
What can you do ?
The first few days a broken rib is very painful. Thereafter, the pain gradually decreases over a few weeks. You can take a pain reliever (eg paracetamol). It is very important to reduce pain in the elderly, otherwise they will not breathe deeply enough. This causes mucus (secretions from the lungs) to build up in the lungs and infection can occur.
Contact the doctor if you have difficulty breathing during the period after your fracture.
If you have a fractured tailbone, you can relieve the pain by sitting on a cushion shaped like a buoy.
What can your doctor do?
If you have multiple broken ribs, you will sometimes be hospitalized for observation. The doctor may locally anesthetize you on the fractured rib to ease the pain for a few hours. This treatment can be repeated if necessary. Putting a bandage around the chest provides support for the chest while breathing.
In the case of pneumothorax or hemorrhage in the pleura, a tube (drain) is placed in the pleura under local anesthesia to evacuate blood or air. An x-ray is taken once or twice a day to follow the progress.
Good pain treatment is important. In the case of an avulsion fracture, surgery is sometimes necessary to reattach the torn piece of bone with screws. Likewise, a pubic fracture requires good pain treatment, allowing you to quickly resume movement within the limits of pain.
In a severe pelvic fracture, you can lose up to 3 liters of blood. Emergency physicians will therefore place an infusion at the scene of the accident, in particular to administer physiological serum. You will then be transported to the hospital on a vacuum immobilizer mattress to limit bleeding and pain. Sometimes surgery is needed to repair the fracture.
Intervention is also necessary in the case of a fracture of the acetabulum with displacement of bone fragments or dislocation of the hip. 24 hours after the trauma, when the risk of bleeding has decreased, anticoagulant drugs are given to prevent clots from forming. Rehabilitation is done under the supervision of a physiotherapist.
The use of an appropriate seat is indicated in the event of a fracture of the coccyx. If complaints persist, the fractured fragment can be removed.
Want to know more?
- The thorax (ribs and sternum) (image) – Larousse
- The pleura (image) – formationambulancier.fr
- The sacrum and the coccyx (image) – Larousse
- The hip joint (femur and acetabulum) (image) – Larousse
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