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Karuppal R, Kumaran CM, Marthya A, Raman RV, Somasundaran S. Isolated bilateral first rib fracture associated with congenital cervical block vertebra - A case report. J Orthop 2014; 10:149-51. [PMID: 24396232 DOI: 10.1016/j.jor.2013.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/21/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Raju Karuppal
- Dept of Orthopaedics, Govt. Medical College, Kozhikode 673008, Kerala, India
| | | | - Anwar Marthya
- Dept of Orthopaedics, KMCT Medical College, Kozhikode 673008, Kerala, India
| | - Rajendran V Raman
- Dept of Opththalmology, Govt. Medical College, Kozhikode 673008, Kerala, India
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Gupta A, Jamshidi M, Rubin JR. Traumatic first rib fracture: is angiography necessary? A review of 730 cases. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 1997; 5:48-53. [PMID: 9158123 DOI: 10.1016/s0967-2109(97)00060-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The two most common sites of first rib fracture were at the subclavian sulcus and in the neck of the first rib, posteriorly. Five distinct mechanisms for rib fracture were identified and included: (i) posteriorly directed trauma to the upper thorax or shoulder girdle; (ii) a direct blow to the sternum and anterior chest wall; (iii) a blow fracturing the clavicle; (iv) a strong sudden contraction of the scalenus anticus muscle; and (v) radiographic findings of a first rib fracture without history of trauma. Isolated first rib fracture regardless of mechanism of injury, results in a low incidence of major vascular injury (mean 3%), although with fracture displacement, the incidence is higher. First rib fracture associated with concomitant head, thoracic, abdominal, or long bone trauma was associated with vascular injury in 24% of cases. According to this review, specific indications for subclavian artery and aortic arch arteriography in patients with traumatic first rib fracture include widened mediastinum on chest radiography, upper-extremity pulse deficit, posteriorly displaced first rib fracture, subclavian groove fracture anteriorly, brachial plexus injury and expanding hematoma.
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Affiliation(s)
- A Gupta
- Western Reserve Care System, Department of Surgery, Youngstown, OH 44501, USA
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Abstract
Tracheoesophageal fistula is a very rare but potentially life-threatening complication of blunt chest trauma. Prior reviews have revealed that the victims were all young men involved in deceleration or crush injuries. Of those involved in motor vehicle accidents, most were thrown against the steering wheel. Herein, we review the world literature on this injury and include our own report of 1 of the few cases of traumatic tracheoesophageal fistula involving a female victim. In this case, the victim was an unrestrained driver thrown against an air bag.
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Affiliation(s)
- W J Reed
- Medical College of Wisconsin, Milwaukee, USA
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Woodring JH. The normal mediastinum in blunt traumatic rupture of the thoracic aorta and brachiocephalic arteries. J Emerg Med 1990; 8:467-76. [PMID: 2212568 DOI: 10.1016/0736-4679(90)90178-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In a review of 52 articles, published between 1953 and 1989, 656 patients with blunt traumatic rupture of the thoracic aorta or brachiocephalic arteries were identified. Of these, 608 (92.7%) had an abnormal mediastinum on initial chest radiographs obtained in the emergency department, thus allowing early detection of the vascular injury. Unfortunately, 48 (7.3%) of these patients had a normal mediastinum on their initial chest radiographs. This appears to occur when the traumatic pseudoaneurysm is not accompanied by associated mediastinal hemorrhage or hematoma formation, and the pseudoaneurysm is either small or is situated in such a way that it does not alter the mediastinal contour. The use of accessory clinical and radiographic signs to indicate the need for aortography has been shown to be of very low yield, but would have allowed the early detection of an additional 5.6% of the reported cases. Performing aortography solely on the basis of a history of major decelerating blunt trauma to the thorax remains the only way, in the acute emergency department setting, to detect the 1.7% of patients with aortic or brachiocephalic arterial rupture who have no mediastinal abnormality or accessory clinical or radiographic signs of vascular injury. There is evidence from the literature, however, to suggest that the evaluation of serial chest radiographs obtained at close intervals for the first month following trauma for the development of mediastinal abnormality or large hemothorax is an acceptable alternative to the routine performance of aortography in those blunt chest trauma victims with no clinical or radiographic suspicion of vascular injury.
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Affiliation(s)
- J H Woodring
- Department of Diagnostic Radiology, University of Kentucky Medical Center, Lexington 40536-0084
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Woodring JH, King JG. The potential effects of radiographic criteria to exclude aortography in patients with blunt chest trauma. J Thorac Cardiovasc Surg 1989. [DOI: 10.1016/s0022-5223(19)34586-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barrett GR, Shelton WR, Miles JW. First rib fractures in football players. A case report and literature review. Am J Sports Med 1988; 16:674-6. [PMID: 3071154 DOI: 10.1177/036354658801600622] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Fermanis GG, Deane SA, Fitzgerald PM. The significance of first and second rib fractures. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1985; 55:383-6. [PMID: 3870169 DOI: 10.1111/j.1445-2197.1985.tb00905.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There are differing opinions in the literature regarding the significance of first rib fractures. The plan at Westmead Centre is to standardize the initial assessment of patients with such fractures. A 3 year retrospective study of 170 trauma victims who sustained fractured ribs, was undertaken. Of the 15 patients with first rib fracture, all were involved in motor vehicle accidents. Over two-thirds of these patients sustained major chest injuries. Multisystem trauma involving cranial, abdominal or skeletal injury was common. One patient died as a result of head injury. Similar results were observed in 13 patients with second rib fractures. Brachial plexus injuries were noted in two patients with first rib fracture. Despite follow-up of high-risk patients at an interval which varied from 1 to 2 1/2 years after the original injury, major subclavian artery injury was not detected in patients with first rib fracture. From this experience and a literature review, we suggest that the general nature of trauma is similar in patients with first rib fracture to that in patients with second rib fracture. Patients with first rib fracture should be closely examined for neurovascular compromise. Guidelines for the use of angiography are discussed. If there is no evidence of neurovascular injury at presentation, and there is no other thoracic injury, recovery should be uneventful.
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Theriot BA, Gross BD, Sturrock BD. Isolated fracture of the first rib associated with facial trauma. J Oral Maxillofac Surg 1984; 42:610-3. [PMID: 6590812 DOI: 10.1016/0278-2391(84)90093-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Isolated fractures of the first rib are rare and often, though not always, indicative of severe trauma. The causes of first rib fracture are various, as are the sometimes serious complications of such a fracture. Since the oral and maxillofacial surgeon is involved many times in the primary care of the trauma patient, he must consider the possibility of first rib fracture and be alerted to the possible sequelae.
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Abstract
The diagnosis of rupture of the thoracic aorta or its major branches depends largely on the recognition of mediastinal hemorrhage from the initial chest radiograph and subsequent thoracic aortography. This review discusses the radiographic manifestations of mediastinal hemorrhage, including widening of the mediastinum; a ratio of mediastinal width to chest width greater than 0.25; abnormalities of aortic contour; opacification of the aortopulmonary window; depression of the left main bronchus; deviation of the trachea to the right; deviation of the nasogastric tube to the right; the apical cap sign; widening of the paraspinal lines; widening of the right paratracheal stripe; and left hemothorax. The relationship of these manifestations to major thoracic arterial injury is examined. Pitfalls in the radiographic evaluation of mediastinal abnormalities are considered, and indications for computed tomography of the thorax and thoracic aortography in the severely injured patient are reviewed.
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Abstract
Reported are two cases of stress-induced fracture of the first rib in young, healthy basketball players. Presumably the fractures resulted from violent contraction of the scalene musculature. This is the usual method of production of stress-induced first rib fracture, but basketball-related cases have not been reported previously. This entity probably is underdiagnosed, and is amenable to conservative outpatient management in most cases.
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Abstract
The benign condition of isolated first rib fracture is compared with the severity of intrathoracic injuries resulting from first rib fracture associated with multiple rib injuries. Seventy-five patients with 90 first rib fractures were divided into two groups. Group 1 (n = 13) included those with isolated first rib fractures and Group 2 (n = 62), those with first-rib fractures associated with multiple rib injuries. In Group 1 patients, intrathoracic injuries were mild with no major vascular injuries. Conversely, Group 2 patients sustained severe intrathoracic injury, 58% of them with aortic injury. Stress is placed on early diagnosis, assigning of priority to associated injuries, and early operative intervention.
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Charles KP, Davidson KG, Miller H, Caves PK. Traumatic rupture of the ascending aorta and aortic valve following blunt chest trauma. J Thorac Cardiovasc Surg 1977. [DOI: 10.1016/s0022-5223(19)39946-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Björk L, Hallén A, Westerholm CJ. Traumatic rupture of the thoracic aorta. Case report. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1971; 5:39-46. [PMID: 5115430 DOI: 10.3109/14017437109131950] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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REYNOLDS JACK, DAVIS JOHNTHOMAS. INJURIES OF THE CHEST WALL, PLEURA, PERICARDIUM, LUNGS, BRONCHI AND ESOPHAGUS. Radiol Clin North Am 1966. [DOI: 10.1016/s0033-8389(22)02899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Papamichael E, Fotiou G. Rupture of the thoracic trachea with avulsion of the apex of the right upper lobe. J Thorac Cardiovasc Surg 1965. [DOI: 10.1016/s0022-5223(19)33163-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Deaton WR, Coggeshall AB. ACQUIRED TRACHEOESOPHAGEAL FISTULA FOLLOWING COMPRESSION INJURY TO THE CHEST. J Thorac Cardiovasc Surg 1962. [DOI: 10.1016/s0022-5223(19)33000-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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GARAMELLA JJ, SCHMIDT WR, JENSEN NK, LYNCH MF. Traumatic aneurysms of the thoracic aorta. Report of four cases, including one of spontaneous rupture into the esophagus. N Engl J Med 1962; 266:1341-8. [PMID: 13896725 DOI: 10.1056/nejm196206282662601] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Rupture or laceration of the aorta is a more common result of nonpenetrating traumatic injury than is generally appreciated. Approximately 15 per cent of individuals with traumatic rupture survive temporarily. If the lesion is promptly diagnosed appropriate surgical treatment may be life-saving. Diagnosis may be difficult and at times the rupture may remain clinically silent for variable periods. The natural course from aortic rupture to false aneurysm formation with secondary rupture of the aneurysm may be brief or extend over many years. Surgical treatment of a false aneurysm that has remained stable for a prolonged period has been successful, but in some instances conservative management may be the treatment of choice.
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STEINBERG I. Chronic traumatic aneurysm of the thoracic aorta: report of five cases, with a plea for conservative treatment. N Engl J Med 1957; 257:913-8. [PMID: 13477411 DOI: 10.1056/nejm195711072571903] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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