Pneumonia and Rib Fractures: Unveiling the Surprising Connection and Risks :Ribs fractures, are very underrated bone injuries, but they can cause a high amount of discomfort and can cause severe complications if not treated correctly. They are result of trauma to the chest which can differ from little cracks to broken ribs. If someone has a broken rib it can cause severe pain , but sometime this kind of fractures can also cause other secondary conditions too like pneumonia, which further worsens the condition of the patient.
Today we are going to talk about the ribs fracture and pneumonia as a complication of this fracture. Understanding this complicated conditions can help one to create a better protocol to treat and support the patient.
Ribs fracture can occur due to severe direct force or trauma, commonly it can happen in road traffic accidents, sports like MMA, boxing or any other sport also it can occur during a physical assault too.
If direct force is applied to someone’s chest it can cause ribs fracture, force’s nature can differ the fracture from simple crack to several broken ribs. This kind of fractures are very painful but they can also cause secondary conditions like pneumonia too. But the question is how an bone fracture can cause pneumonia like conditions, so answer is simple. When ribs fracture occurs, patient the one who’s having this fracture will do shallow breathing and will not do proper coughing or any activity related to lungs or chest, because of the pain he’s having. So this situation can cause fluid accumulation in one’s lungs which is an very good environment for bacteria to grow.
What is ribs fracture and pneumonia?
So both are very different conditions but also connected internally which can effects one’s health.
Ribs fracture
So basically ribs fracture are normal fracture which also occurs like other fracture, direct damage due to injury or trauma to the chest. Ribs creates a protective shielded cage around the heart and lungs to protect them. If there is excessive forces directly applied to chest It can cause ribs to break.
Causes
1. Trauma :
a. Road traffic accidents :
When two vehicles collides, one hits the steering wheel or dashboard resulting in severe force to the chest which can cause ribs fracture.
b. Falls:
When someone falls from high ground, significant forces is directly applied to the person’s chest causing trauma which is due to contact with the ground or any other object which leads to ribs fracture.
c. Sports injuries:
Sports like football, hockey, MMA, boxing or full contact fights can cause ribs fracture because of several reasons.
d. Physical assaults:
Kicks, punches or even a object’s hit on chest during the assaults can result into ribs fracture.
2. Crushing injuries :
a. Crush accidents
Just like road traffic accident if someone is trapped into structural collapse or accident occurring in industries can cause ribs fracture
b. Falling objects
If someone gets struck by a heavy weight fallen from the high ground it can cause ribs fracture.
3. Repetitive strain
a. Overuse injuries
Construction workers or weight lifters can have rib’s fracture because of the repetitive movements involved in their daily routine.
b. Intense coughing
If someone is having any pulmonary conditions like COPD, bronchitis or TB and also he is very malnourished or have very less bone density it can cause severe fracture due to very intense coughing.
4. Medical procedures
a. CPR
We all know that how much CPR is important procedure but sometimes it can cause a severe ribs fracture, because of the compressions being performed in process of resuscitations
5. Pathological conditions
a. Osteoporosis
Osteoporosis is one condition of bone in which bone gets weaken because of which even if there is very less force is applied it can cause ribs fracture
b. Bone metastases or cancer
Bone cancer or tumors of ribs can weaken the structure of bone which can cause ribs fracture.
Pneumonia
Now let’s talk about pneumonia, it is very common but highly serious lung infection. It shows the symptoms like fever, dyspnea and cough. It occurs due to inflamed air sacs which are also filled with pus.
1. Bacterial infection
a. S. pneumoniae :
Most common of all bacterial pneumonia. When infected person sneezes or coughs this can affect the other person.
b. Haemophilus influenzae:
Person with weak immune system or having any other lung condition can be affected by this bacteria.
c. M.pneumoniae
This bacteria causes atypical pneumonia, which very mild and more common
2. Viral infection
a. Influenza virus
Both influenza A and B can cause viral pneumonia
b. RS ( Respiratory syncytial )virus
Elders, infants and young children who have very weak immune system can be very likely affect with this virus infection
3. Fungal infection
a. Pneumocystis jirovecii :
Person with ongoing chemotherapy or weakened immune system have higher chances to get infected with this fungi.
b. aspergillus :
This particular fungi spreads spores if someone inhales them it can cause pneumonia. Person with lung conditions or weakened immune system can also infected with this fungi
4. Hospital acquired or ventilator associated pneumonia:
a. Bacterial infections:
Hospitalized patients have highly chances to get infected with this pneumonia due to bacteria present in medical infrastructure.
Pathophysiology of pneumonia occurring in in-patient who’s having rib’s fracture
1.impaired respiratory muscles :
- Patient having rib’s fracture has lots of pain with breathing which lim5.its the patient to do proper breathing and coughing. Which results in improper ventilation and cannot clear the secretions because of which pneumonia can occur.
2.altered lung physiology:
- In ribs fracture chest wall splits because of which there will be no proper lung expansion and impaired gas exchange which reduces lung compliances and work of breathing will be increased. This environment is very suitable for bacteria to grow.
3.predisposition to aspiration
- Patient who’s having ribs fracture cannot maintain upright position which increases the risk of gastric or oral aspiration. So when aspiration of pathogen occurs it can lead to pneumonia.
4.immobility and hospitalization
- Ribs fractured patient has to go for prolong bed rest which can cause impairment of mucociliary clearance which causes pneumonia.
5. Other factors
- Compromised immune function due to immune system suppression to infection either because of immunosuppressive drugs or any other medical conditions.
- Bacteria entered via aspiration, hematogenous spread or inhalation can cause inflammation, consolidation which can cause pneumonia development.
Also read : Pneumonia : Understanding Signs, Symptoms & management
Signs and symptoms of the in-patient with ribs fracture and pneumonia
In hospital environment, patient might be unconscious so to identify that patient is having pneumonia associated with ribs fracture is very important. If one observes the patient very carefully and looks for the physical signs he can provide a guide for diagnosis and management
1. Respiratory Assessment :
a. Rate and depth of breathing :
if patient have very fast and shallow breathing and also he’s chest is moving asymmetrically or having paradoxical breathing it can suggest that he’s having both rib’s fracture with pneumonia.
b. Use of accessory Muscles:
If patient is using intercostal or supraclavicular retraction muscles while breathing may indicate that patient is having pneumonia with rib’s fracture
2. Chest examination
a. Palpation :
Gentle palpation can also revel deformities related to ribs fracture and pneumonia.
b. chest expansion and percussion
examining the chest expansion while inspiration and it shows that there is asymmetry or restriction than it indicates ribs fracture or lung pathology
3. General assessment
a. Fever
If patient is having fever might suggests that there is underlying infection.
b. Altered mental status
Confusion or agitation in unconscious patient can suggest hypoxemia which an secondary to pneumonia or pain from ribs fracture.
c. Skin color or moisture
Pallor skin with diaphoresis and clamminess may suggest pneumonia with rib’s fracture.
4. Signs and symptoms
a. Respiratory distress
b. Chest wall tenderness
c. Chills
d. Cough
e. Sputum production
f. Consolidation in lungs found in x-ray
5. Investigations:
a. chest X- ray
b. CBC count
c. ABG analysis
d. CT scan
Management
1. Analgesics :
a. IV opioids such as morphine or fentanyl
b. NSAIDS like ibuprofen
2. Antibiotic therapy
a. IV broad-spectrum antibiotics like ceftriaxone with levofloxacin or azithromycin
3. Respiratory support
a. O2 therapy
Physiotherapy Management:
· To increase Lung volume :
a. Body positioning
b. Controlled mobilization:
- Tell patient to do rapid and small inhalation multiple times then do slow expiration
c. Breathing excercises:
- Pursed lip breathing
- Diaphragmatic breathing
- Respiratory PNF
- Intercostal streatch with vertebral pressure
· To reduce work of breathing
a. Positioning
- Side lying position
- Standing position
- Upright Sitting position
b. Relaxation techniques
- Forward leaning
- Sitting
· To clear secretions
- ACBT
- AD
- PD
- Humidification
- Mechanical help
- FlutterAcapella
- PEP
- Coughing
- Huffing
- Anterior chest compression
- Counter rotation assist
- Abdominal thrust assist
· To improve mobility
- Mobility exercises
- Thoracic expansion exercises
· to reduce tightness
- Gentle streatching