Rib fractures are widely common in orthopedic clinical practice, especially in patients with chest trauma, where approximately 40% are accompanied by rib fractures. The occurrence of rib fractures not only increases the difficulty of clinical treatment, but also aggravates the physical and mental pain of patients and increases their economic burden. Therefore, in order to promote faster and better postoperative recovery for patients with rib fractures, it is crucial to implement scientific nursing cooperation.
1、 The etiology of rib fractures
There are a total of 12 ribs in the human body, and the 1st to 3rd ribs are protected by the scapula and clavicle. In addition, the ribs in this area are relatively short and thick, so the risk of fracture is relatively low; The risk of fracture in the 4th to 7th ribs is relatively high because the ribs in this area are relatively thin; The 8th to 10th ribs connect to the sternum and form a rib arch at the anterior end; The 11th and 12th ribs have greater elasticity, with a free anterior end and a relatively low risk of fracture. The 12 ribs distributed on both sides of the chest play a positive protective role in the important organs and tissues inside the chest. Once the chest is subjected to external violent impact, the ribs will bend inward and break. In addition to trauma, many factors such as tumor metastasis, osteoporosis, and intense exercise can also lead to rib fractures, manifested as chest pain and discomfort, especially when changing positions or breathing deeply, the pain will be significantly aggravated.
2、 Surgical treatment of rib fractures
Surgical treatment methods have a certain promoting effect on the recovery of rib fracture patients, and the material used to fix the fractured end of the rib during surgery directly affects the quality of patient prognosis. Nowadays, internal fixators, intramedullary fixation, Kirschner wires and other fixation devices are commonly used. Among them, implantable internal fixation materials can be used without removal if there is no pain or infection after application.
3、 Postoperative care for rib fractures
1. After the surgery, the patient should be sent back to the ward and kept lying on their back with their head tilted to the left or right. When the patient is fully conscious and their blood pressure and heart rate stabilize, they should be adjusted to a semi recumbent position while raising the head of the bed by 35 °. Changing positions every two hours and sleeping on an air mattress can reduce the risk of pressure ulcers.
2. Dynamically monitor physical signs, observe the patient's blood oxygen saturation, chest undulation, blood pressure, heart rate, lung breathing sounds, lip color, complexion, etc. every 15-20 minutes, be alert to respiratory distress, and immediately report to the doctor if the patient's heart rate is fast, breathing is shallow and fast, or irritable.
3. Respiratory care. Gently pat your back from bottom to top; Nursing staff apply pressure to the patient's chest with both hands to improve coughing effectiveness; After surgery, oxygen can be administered through a nasal cannula or by wearing a mask as needed. The patient should be assisted with effective coughing every two hours and encouraged to take deep breaths. If the patient is unable to cough up viscous phlegm independently, nebulization inhalation should be performed once a day in the morning, middle, and evening; If the patient has sputum retention, the sputum suction operation of fiberoptic bronchoscope can be considered to ensure sterility in the whole process to avoid unnecessary infection.
4. Pain management. Assist patients in maintaining a comfortable sleeping position to alleviate their pain; When coughing, patients are required to gently press the wound to avoid excessive tension; Teach patients pain relief techniques, such as music therapy, chatting, playing games, watching TV, taking deep breaths, etc., and use sedatives and painkillers if necessary.
5. Wound care. Proactively care for the patient, inquire about any redness, swelling, heat, or pain in the wound, carefully inspect the changes in the patient's wound dressing, and immediately replace it if bleeding or fluid leakage is found to ensure that the surgical area is dry and clean.
6. Drainage care. Ensure smooth drainage and properly place the drainage catheter. Do not compress or bend the catheter. Always squeeze the drainage catheter on time to avoid blockage of the lumen. If the lumen is blocked, replace it promptly and avoid repeated flushing with saline to prevent retrograde infection; During the process of moving patients, it is necessary to clamp the catheter to avoid causing pneumothorax. If the postoperative drainage volume exceeds 200ml per hour, immediately report to the doctor; The water column is not fluctuating, and caution should be taken when the conduit is under pressure; After the lung reopens, extubation can be considered.
7. Rehabilitation guidance. Exercise rehabilitation should be carried out as soon as possible 7 days after surgery or if the patient's condition allows, to prevent postoperative arm contracture and shoulder joint adhesion.
In summary, rib fractures have a significant impact on patients' daily lives, and good care is beneficial for patients to recover quickly and be discharged as soon as possible.