Threshold of number of rib fractures in elderly blunt trauma: A simple or complex matter of numbers?

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

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Transdiaphragmatic Intercostal Herniation following Blunt Trauma

Case Reports in Radiology ◽

10.1155/2012/502765 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Debkumar Sarkar ◽

Melissa Warta ◽

Jason Solomon

Keyword(s):

Blunt Trauma ◽

Surgical Repair ◽

Rib Fractures ◽

Diaphragmatic Rupture ◽

Clinical Entity ◽

Rare Clinical Entity ◽

Intercostal Hernia

Intercostal herniation is very rarely and sporadically reported in the literature. Intercostal hernia can occur following blunt trauma and may be associated with rib fractures. We present a case of a patient who presented with rib fractures, diaphragmatic rupture, and intrathoracic herniation of abdominal contents with subsequent herniation of both lung and abdominal contents through an intercostal defect. The patient was successfully treated with primary surgical repair of the diaphragm and intercostal hernia. The presentation, pathophysiology, and management of this rare clinical entity are discussed.

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197 INCREASING NUMBER OF RIB FRACTURES PREDICTS MORTALITY IN MULTI-INJURY BLUNT TRAUMA VICTIMS.

Journal of Investigative Medicine ◽

10.2310/6650.2005.x0004.196 ◽

2006 ◽

Vol 54 (1) ◽

pp. S114.1-S114

Author(s):

B. Suckow ◽

J. Clayton ◽

A. Tillou ◽

H. G. Cryer

Keyword(s):

Blunt Trauma ◽

Rib Fractures ◽

Trauma Victims

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Rib Fractures and Mortality: Breaking the Causal Relationship

The American Surgeon ◽

10.1177/000313481908501127 ◽

2019 ◽

Vol 85 (11) ◽

pp. 1224-1227 ◽

Cited By ~ 1

Author(s):

Brittany Bankhead-Kendall ◽

Sepeadeh Radpour ◽

Kevin Luftman ◽

Erin Guerra ◽

Sadia Ali ◽

...

Keyword(s):

Blunt Trauma ◽

Injury Severity ◽

Rib Fractures ◽

Rib Fracture ◽

Direct Result ◽

P Value ◽

Trauma Patients ◽

Injury Score ◽

Urban Level ◽

Level I

Rib fractures have long been considered as a major contributor to mortality in the blunt trauma patient. We hypothesized that rib fractures can be an excellent predictor of mortality, but rarely contribute to cause death. We performed a retrospective study (2008–2015) of blunt trauma patients admitted to our urban, Level I trauma center with one or more rib fractures. Medical records were reviewed in detail. Rib fracture deaths were those from any respiratory sequelae or hemorrhage from rib fractures. There were 4413 blunt trauma patients who sustained one or more rib fractures and 295 (6.8%) died. Rib fracture patients who died had a mean Injury Severity Score = 38 and chest Abbreviated Injury Score = 3.4. Rib fractures were the cause of death in only 21 patients (0.5%). After excluding patients who were dead on arrival, patients dying as a result of their rib fractures were found to be older ( P < 0.0001) and had a higher admission respiratory rate ( P = 0.02). Multivariable logistic regression found that age ≥65 was the only variable independently associated with mortality directly related to rib fractures (odds ratio 4.1, 95% confidence interval = 1.3–13.3, P value < .0001). Mortality in patients with rib fractures is uncommon (7%), and mortality directly related to rib fractures is rare (0.5%). Older patients are four times more likely to die as a direct result of rib fractures and may require additional resources to avoid mortality.

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Surgical Stabilization of Rib Fractures in a 6-Year-Old Child After Blunt Trauma

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2017.07.034 ◽

2017 ◽

Vol 104 (6) ◽

pp. e439-e441

Author(s):

Zaid M. Abdelsattar ◽

Michael B. Ishitani ◽

Brian D. Kim

Keyword(s):

Blunt Trauma ◽

Rib Fractures

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THE CLINICAL MANAGEMENT OF BLUNT TRAUMA PATIENTS WITH UNILATERAL MULTIPLE RIB FRACTURES

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199112000-00038 ◽

1991 ◽

Vol 31 (12) ◽

pp. 1716

Author(s):

S Gabram ◽

R Schwartz ◽

L Jacobs ◽

D Lawrence ◽

W Kantor ◽

...

Keyword(s):

Blunt Trauma ◽

Clinical Management ◽

Rib Fractures ◽

Trauma Patients ◽

Multiple Rib Fractures

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Epidemiology of Sternal Fractures

The American Surgeon ◽

10.1177/000313480907500510 ◽

2009 ◽

Vol 75 (5) ◽

pp. 401-404 ◽

Cited By ~ 17

Author(s):

Gustavo Recinos ◽

Kenji Inaba ◽

Joseph Dubose ◽

Galinos Barmparas ◽

Pedro G. R. Teixeira ◽

...

Keyword(s):

Blunt Trauma ◽

Motor Vehicle ◽

Rib Fractures ◽

Common Mechanism ◽

Mechanism Of Injury ◽

Associated Injuries ◽

Sternal Fracture ◽

Significant Difference ◽

Aortic Injuries ◽

Sternal Fractures

The epidemiology of sternal fractures has been poorly described. The objective of this study was to examine the demographics, outcomes and injuries associated with sternal fractures. The trauma registry at a level I trauma center was retrospectively reviewed to identify all patients with sternal fractures over a 10 year period. Demographic data collected included age, gender, mechanism of injury and injury severity score. Patients were analyzed according to age ≤ 55 or > 55 years. During the 10-year study period, a total of 37,087 patients were admitted to the emergency department. Of these, 125 (0.33%) had a sternal fracture. The average age was 44 ± 17 years, with 76.0 per cent being male. The most common mechanism of injury was motor vehicle collision (68%) followed by auto vs. pedestrian (18%). Associated rib fractures occurred in 49.6% of the population, cardiac contusions in 8.0%, thoracic aortic injuries in 4.0 per cent and heart lacerations in 2.4 per cent of patients. Associated rib fractures were more likely to occur in patients over the age of 55 (66.7% vs 44.2%, P = 0.032) as well as a traumatic hemothorax (15.8% vs 40.0%, P = 0.005). However, no significant difference in mortality was observed between the two age groups (16.8% vs. 26.7%, OR: 0.56, 95% CI, 0.21 to 1.47; P = 0.234). Sternal fractures are a rare sequela of blunt trauma. Associated injuries are common, including rib fractures and soft tissue contusions. Associated cardiac and aortic injuries are rare but highly lethal and should be screened for on the initial chest CT scan. After appropriate exclusion of associated injuries, the majority of patients diagnosed with a sternal fracture following blunt trauma can be safely discharged to home.

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