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Trauma to the chest wall is very common in the event of blunt trauma. It can vary in severity from simply minor bruising to a single rib fracture to even severe crush injuries of both rib cages. The more severe the injury, the more critical it is. Severe chest wall trauma can lead to a compromised respiratory system. Chest Wall Trauma Basics Most chest injuries and chest wall traumas require no real therapy or treatment. The treatment for bruised or even broken ribs is to let them heal naturally, for example. However, broken or bruised ribs and other more severe chest wall trauma can indicate that there is a more severe underlying trauma. For example, many multiple rib fractures can mean that the patient has an underlying pulmonary contusion. This pulmonary contusion may not have been readily visible on the initial chest x-ray, but the fractures will show the doctor that he must take another x-ray. In addition, lower rib fractures can mean that there are diaphragmatic tears and even spleen or liver injuries. Upper chest wall trauma sometimes shows injuries to adjacent great vessels. This is usually true when the first rib is fractured as that particular rib is extremely difficult to break and requires a great deal of force. Chest wall trauma can be critical when certain parts of it are injured. For example, the rib cage and sternum provide stability and support for the thoracic spine. Any major damage to the rib cage and sternum could cause damage to the thoracic spine. Chest Wall Trauma Diagnosis Most severe cases of chest wall trauma will be diagnosed by the initial physical examination at a doctor’s office or hospital. Seat belt bruising, grazes, or other bruises are visible on an initial exam. Palpation may show the crepitus that is often times associated with broken ribs. If the patient is conscious, he or she may complain of pain on palpation of the chest wall or on the inspiration. Other, possibly more severe chest wall trauma, will be diagnosed via chest x-ray. An antero-posterior chest x-ray will show the most extreme and significant chest wall trauma. However, it will not show all rib fractures. A lateral or anterior rib fracture can be easily missed on an initial plain film x-ray. That said, knowing exactly where the fracture is, is not necessarily essential to treating the rib fracture, unless it is a pediatric chest trauma, as management and treatment in adults is determined by the clinical significance, not the placement.
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