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Yao L, Gong X, Li W. Bilateral first rib fractures with multi-organ complications: A case report and literature review. Heliyon 2024; 10:e31310. [PMID: 38841484 PMCID: PMC11152902 DOI: 10.1016/j.heliyon.2024.e31310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Background Bilateral first rib fractures are rare. This article presented the diagnosis and treatment of a case of bilateral first rib fractures with multi-organ complications and discussed the injury mechanism. Case presentation A 15-year-old girl fell off a motorcycle. She complained of right neck root pain and right upper limb weakness. The myodynamia of the right upper limb was grade 0, and the sensation disappeared below the level of the elbow joint. The computed tomography (CT) showed bilateral first rib fractures and transverse process fracture of the 6th cervical vertebra. Chest CT revealed a massive hemothorax in the right thoracic cavity, and head magnetic resonance imaging showed bilateral cerebellar infarction. Cervical computed tomography angiography (CTA) revealed a lumen occlusion at the origin of the right subclavian artery. The patient underwent an emergency thoracoscopy, and a re-examination of chest CT indicated that no obvious pleural effusion was found after the hemothorax was cleared. The patient underwent right subclavian arteriography and interventional endovascular thrombolysis, and the right subclavicular artery was patency postoperative. Bilateral first rib fractures and cerebellar infarction were treated conservatively. The brachial plexus injury did not show any signs of recovery after conservative treatment, and she was recommended to be transferred to a superior hospital for surgical treatment. Conclusions The injury mechanism of bilateral first rib fractures with multi-organ complications was closely related to the initial factor of the right neck root colliding with a bulge on the ground. We believe that the fractures occur as a result of a combination including a high energy trauma from direct impact and a low-energy mechanism from violent muscle contraction caused by neck hyperextension. This case report was helpful for clinicians to understand bilateral first rib fractures and their complications.
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Affiliation(s)
- Ling Yao
- Department of Intensive Care Unit, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei, China
| | - Xun Gong
- Department of Intensive Care Unit, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei, China
| | - Wanqiang Li
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei, China
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2
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Loescher J, Blomgren J, Weber K. First Rib Fracture Presenting as Chest Pain in a Collegiate Basketball Player: A Case Report. Curr Sports Med Rep 2024; 23:76-78. [PMID: 38437492 DOI: 10.1249/jsr.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Jeremy Loescher
- Department of Sports Medicine, Advocate Health Care, Chicago, IL
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3
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Li N, Wu Z, Jiang C, Sun L, Li B, Guo J, Liu F, Zhou Z, Qin H, Tan W, Tian L. An automatic fresh rib fracture detection and positioning system using deep learning. Br J Radiol 2023; 96:20221006. [PMID: 36972072 PMCID: PMC10230380 DOI: 10.1259/bjr.20221006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE To evaluate the performance and robustness of a deep learning-based automatic fresh rib fracture detection and positioning system (FRF-DPS). METHODS CT scans of 18,172 participants admitted to eight hospitals from June 2009 to March 2019 were retrospectively collected. Patients were divided into development set (14,241), multicenter internal test set (1612), and external test set (2319). In internal test set, sensitivity, false positives (FPs) and specificity were used to assess fresh rib fracture detection performance at the lesion- and examination-levels. In external test set, the performance of detecting fresh rib fractures by radiologist and FRF-DPS were evaluated at lesion, rib, and examination levels. Additionally, the accuracy of FRF-DPS in rib positioning was investigated by the ground-truth labeling. RESULTS In multicenter internal test set, FRF-DPS showed excellent performance at the lesion- (sensitivity: 0.933 [95%CI, 0.916-0.949], FPs: 0.50 [95%CI, 0.397-0.583]) and examination-level. In external test set, the sensitivity and FPs at the lesion-level of FRF-DPS (0.909 [95%CI, 0.883-0.926], p < 0.001; 0.379 [95%CI, 0.303-0.422], p = 0.001) were better than the radiologist (0.789 [95%CI, 0.766-0.807]; 0.496 [95%CI, 0.383-0.571]), so were the rib- and patient-levels. In subgroup analysis of CT parameters, FRF-DPS were robust (0.894-0.927). Finally, FRF-DPS(0.997 [95%CI, 0.992-1.000], p < 0.001) is more accurate than radiologist (0.981 [95%CI, 0.969-0.996]) in rib positioning and takes 20 times less time. CONCLUSION FRF-DPS achieved high detection rate of fresh rib fractures with low FP values, and precise positioning of ribs, thus can be used in clinical practice to improve the detection rate and work efficiency. ADVANCES IN KNOWLEDGE We developed the FRF-DPS system which can detect fresh rib fractures and rib position, and evaluated by a large amount of multicenter data.
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Affiliation(s)
- Ning Li
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
| | - Zhe Wu
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
| | - Chao Jiang
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
| | - Lulu Sun
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
| | - Bingyao Li
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
| | - Jun Guo
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
| | - Feng Liu
- Deepwise Artificial Intelligence (AI) Lab, Deepwise Inc., Beijing, China
| | - Zhen Zhou
- Deepwise Artificial Intelligence (AI) Lab, Deepwise Inc., Beijing, China
| | - Haibo Qin
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
| | - Weixiong Tan
- Deepwise Artificial Intelligence (AI) Lab, Deepwise Inc., Beijing, China
| | - Lufeng Tian
- Department of Radiology, Fushun Central Hospital of Liaoning Province, Fushun, Liaoning Province, China
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4
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Fukushima K, Kambe M, Aramaki Y, Ichikawa Y, Isshiki Y, Nakajima J, Sawada Y, Oshima K. Evaluation of injury threshold from the number of rib fracture for predicting pulmonary injuries in blunt chest trauma. Heliyon 2023; 9:e15278. [PMID: 37095910 PMCID: PMC10121455 DOI: 10.1016/j.heliyon.2023.e15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
Background Blunt chest trauma is a common presentation in emergency departments. The relationship between bone fractures and organ injuries has not been studied in detail. The purpose of this study was to examine the degree of external force represented by the number of rib fractures that causes lung injury in blunt chest trauma. Patients and methods This study was performed retrospectively using trauma patients who received medical examinations in a single university hospital emergency center between April 2015 and March 2020. We examined the association between the number of rib fractures and pulmonary damage using multivariable regression analysis and considered the relationship between rib fracture location and each type of lung injury. Results A total of 317 patients were included. The mean age was 63.1 years, 65.0% were male, and traffic accidents were the most common mechanism of injury (55.8%). The number of mean rib fractures was 4.0, and the mean Injury Severity Score was 11.3. The number of rib fractures was associated with an increased risk of pulmonary injuries: pulmonary contusion (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14-1.48, p < 0.05); hemothorax (OR 1.22, 95% CI 1.08-1.38, p < 0.05); pneumothorax (OR 1.15, 95% CI 1.02-1.30, p < 0.05); and hemopneumothorax (OR 1.14, 95% CI 1.01-1.28, p < 0.05). In addition, bilateral rib fractures were associated with fractures of the superior ribs more often and more severely, but were not associated with the occurrence of each type of lung injury. Conclusion The number of rib fractures was associated with an increased risk of pulmonary injuries. In addition, the type of pulmonary injury could be predicted from the number of rib fractures in blunt chest trauma.
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Affiliation(s)
- Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Kambe
- ER General Medical Center, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Alaniz L, Hoyos J, Muttalib O, Llerenas M, Tay E, Cordero JJ, Arora J, Melkonian J, Barrios C. My surgical practice: Implications of occult first rib fractures and how to approach their management. Am J Surg 2023; 225:588-590. [PMID: 36509586 DOI: 10.1016/j.amjsurg.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Leonardo Alaniz
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA; University of California, Irvine, School of Medicine, Irvine, CA, USA.
| | - Juan Hoyos
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA; University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Omaer Muttalib
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Miguel Llerenas
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Erika Tay
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Justin J Cordero
- University of California, Riverside, School of Medicine, Riverside, CA, USA
| | - Jagmeet Arora
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA; University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Jacklyn Melkonian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Cristobal Barrios
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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6
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Taib BG, Choong J, Madura T. Free functioning gracilis transfer for brachial plexus reconstruction using the internal mammary vessels as recipients: A case report. Microsurgery 2023; 43:74-77. [PMID: 36350060 DOI: 10.1002/micr.30983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/02/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
Abstract
Adult brachial plexus injuries are often associated with concomitant trauma to the axillary or subclavian vessels. In patients planned for free functioning gracilis transfer (FFGT) this poses a challenge to reconstructive surgeons where using the standard donor vessels can lead to endangering the circulation in the affected extremity or risk flap loss due to the poor perfusion pressures. This case report describes the use of a FFGT for upper limb reconstruction in a 22-year-old patient with a pan plexus injury and concomitant axillary artery injury following a high energy motorcycle accident. Ipsilateral internal mammary vessels were used as donor vessels after removing the 3rd and 4th costal cartilages. The gracilis muscle was harvested in its whole length, including a small transverse skin paddle, and transferred to the upper extremity. It was secured to the clavicle proximally, weaved into the Flexor Digitorum Profundus tendons distally and neurotised by the spinal accessory nerve. The procedure and postoperative course were uneventful and the follow up at 18 months showed MRC grade 4 in elbow flexion with only a slight contour deformity at the donor chest site. This is the first report demonstrating the use of internal mammary vessels for FFGT reconstruction in the upper extremity after removing two costal cartilages to achieve sufficient pedicle length.
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Affiliation(s)
- Bilal Gani Taib
- Brachial Plexus and Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Jia Choong
- Brachial Plexus and Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Tomas Madura
- Brachial Plexus and Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, Birmingham, UK
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Complications, and requirement of opioid use after rib fractures, an analysis of 1074 patients. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.887539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Diagnosis and management of adult BPI: Results of first 50 cases. J Clin Orthop Trauma 2021; 12:166-171. [PMID: 33716442 PMCID: PMC7920333 DOI: 10.1016/j.jcot.2020.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Commonest cause of brachial plexus injury in adults is traction injury sustained in motorcycle accidents. This article reports the results of first 50 cases done in a tertiary referral center with a brief review of literature. MATERIAL AND METHODS First 50 patients (46 male; 4 female, age from 12 to 45 years) with post traumatic brachial plexus palsy were included. There were 30 upper plexus and 20 pan plexus injuries, 27 had preganglionic and 23 postganglionic injury. Neurolysis was done in 19 patients and various combination of nerve transfer in 31. Mean follow-up period was 13.98 months. RESULTS - Over all shoulder abduction was good in 10 patients, fair in 32 and poor in 8. Elbow flexion was good in 19 patients, fair in 18 and poor in 13 patients. CONCLUSION The upper plexus and partial injuries have a good outcome in a majority of cases, while the results in global palsy are far from satisfactory.
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Gavelli F, Patrucco F, Daverio M, De Vita N, Bellan M, Rena O, Balbo PE, Avanzi GC, Castello LM. Sequelae of traumatic rib fractures: management in the Emergency Department. ACTA ACUST UNITED AC 2020. [DOI: 10.23736/s0026-4954.19.01863-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Basha MH, Singaravelu KP, Mohana G. Isolated open comminuted fracture of the first rib. J Postgrad Med 2019; 65:110-111. [PMID: 30924441 PMCID: PMC6515778 DOI: 10.4103/jpgm.jpgm_352_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the emergency department, open isolated rib fractures are rarely seen. There is scarce literature related to open isolated first rib comminuted fracture. We report a 33-year-old male who presented with an isolated open first rib comminuted fracture following a road traffic accident. He did not have any neurovascular or major organ injuries and was managed successfully with conservative treatment.
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Affiliation(s)
- M H Basha
- Department of Emergency Medicine, JIPMER, India
| | | | - G Mohana
- Department of Emergency Medicine, JIPMER, India
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11
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Kani KK, Mulcahy H, Porrino JA, Chew FS. Thoracic cage injuries. Eur J Radiol 2019; 110:225-232. [DOI: 10.1016/j.ejrad.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023]
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12
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Delayed subclavian artery rupture secondary to a traumatic first rib fracture. Trauma Case Rep 2018; 16:1-3. [PMID: 30186931 PMCID: PMC6123325 DOI: 10.1016/j.tcr.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/24/2022] Open
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13
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Jaiswal LS, Prasad JN, Maharjan R, Pandit N. Giant pseudoaneurysm of subclavian artery after blunt chest trauma. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:220-222. [PMID: 30175294 PMCID: PMC6116782 DOI: 10.1016/j.jvscit.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/22/2018] [Indexed: 11/04/2022]
Abstract
Subclavian artery (SCA) pseudoaneurysm after blunt chest trauma is rare and its delayed presentation months after the SCA injury is even rarer. Herein we discuss a case of SCA pseudoaneurysm in a 74-year-old man who presented to us 5 months after blunt chest trauma. He had been managed conservatively for the fracture of first rib and clavicle until presentation to our hospital. He had uncontrolled hypertension and a rapidly increasing large painful swelling (10 by 8 cm) in left clavicular region along with purplish discoloration of the overlying skin. The diagnosis was confirmed after computed tomography angiography and the patient was successfully treated with surgical evacuation of clots, primary repair of the rent in the SCA, and plating of clavicular fracture.
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Affiliation(s)
| | - Jagat Narayan Prasad
- Department of Anaesthesiology and Critical Care, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajiv Maharjan
- Department of Orthopaedics, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narendra Pandit
- Department of Surgery, B P Koirala Institute of Health Sciences, Dharan, Nepal
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Abstract
OBJECTIVES First rib fractures (first RFX) have been correlated with increased morbidity and mortality. Whether this is due to the fracture of the rib itself or due to an increased number of associated injuries remains debatable. DESIGN Retrospective cohort study. SETTING Level 1 trauma center. PATIENTS One thousand eighty-nine patients with rib fractures divided into 3 groups: group A (n = 44) with isolated first RFX, group B (n = 116) with first RFX combined with other rib fractures, and group C (n = 929) with rib fractures without first RFX. INTERVENTION None. OUTCOME MEASUREMENTS Age, sex, Injury Severity Score, mortality, number of ribs fractured (RFX), incidences of flail chest, multiple coinjuries, hospital and intensive care unit lengths of stay, and duration of mechanical ventilation. RESULTS Group A, when compared with group B, had significantly lower Injury Severity Score, RFX, rates of flail chest, pulmonary coinjuries, and shorter hospital length of stay and intensive care unit length of stay. Group A compared with group C had significantly lower age, RFX, rates of flail chest, and hemopneumothorax. In group B, all outcome measurements were significantly higher than those in group C. Incidence of subclavian artery, brachial plexus, and first thoracic vertebra injuries was significantly higher in group A. Frequency of traumatic brain and orthopaedic coinjuries was comparable in both groups with first RFX. CONCLUSIONS Isolated first RFX alone are associated with higher incidence of injuries to subclavian structures and the first thoracic vertebrae. When they are combined with fractures of other ribs, the overall severity of trauma expands significantly. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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15
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Nummela MT, Bensch FV, Pyhältö TT, Koskinen SK. Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma. Radiology 2017; 286:696-704. [PMID: 29095676 DOI: 10.1148/radiol.2017162429] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ2 and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. © RSNA, 2017.
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Affiliation(s)
- Mari T Nummela
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
| | - Frank V Bensch
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
| | - Tuomo T Pyhältö
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
| | - Seppo K Koskinen
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
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17
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Talbot BS, Gange CP, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. Radiographics 2017; 37:628-651. [DOI: 10.1148/rg.2017160100] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Brett S. Talbot
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Christopher P. Gange
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Apeksha Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Nina Klionsky
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Susan K. Hobbs
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Abhishek Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
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18
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Yonezawa N, Nakayama Y, Takei T, Toh M, Asano M, Imamura T, Ito T. Fatal delayed rupture of the subclavian artery in a patient with first-rib fracture caused by blunt trauma. Clin Case Rep 2017; 5:260-263. [PMID: 28265386 PMCID: PMC5331207 DOI: 10.1002/ccr3.823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/29/2016] [Accepted: 12/20/2016] [Indexed: 01/04/2023] Open
Abstract
This case highlights the probable association of significantly displaced posterior first‐rib fracture and jagged edges of the fracture line following blunt chest trauma with delayed ipsilateral subclavian artery rupture. Early angiography and first‐rib repair should promptly be considered under such circumstances.
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Affiliation(s)
- Naoki Yonezawa
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Yusuke Nakayama
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Tetsuhiro Takei
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Masafumi Toh
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Mitsutoshi Asano
- Department of Cardiology Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Tomonori Imamura
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan; Present address: Department of Emergency and Critical Care Medicine Shinyurigaoka General Hospital Kawasaki Kanagawa Japan
| | - Toshitaka Ito
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan; Present address: Department of Emergency and Critical Care Medicine Shinyurigaoka General Hospital Kawasaki Kanagawa Japan
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19
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Sammy IA, Chatha H, Lecky F, Bouamra O, Fragoso-Iñiguez M, Sattout A, Hickey M, Edwards JE. Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database. Emerg Med J 2017; 34:205-211. [PMID: 28119351 PMCID: PMC5502246 DOI: 10.1136/emermed-2016-206077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/07/2016] [Accepted: 12/17/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. METHODS Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. RESULTS There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). CONCLUSION First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries.
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Affiliation(s)
- Ian Ayenga Sammy
- School of Health and Related Research, The University of Sheffield, Sheffield, UK .,Department of Clinical Surgical Sciences, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
| | - Hridesh Chatha
- Emergency Department, Aintree University Hospitals, Liverpool, UK
| | - Fiona Lecky
- The Trauma Audit and Research Network, University of Manchester, Salford, UK
| | - Omar Bouamra
- The Trauma Audit and Research Network, University of Manchester, Salford, UK
| | | | - Abdo Sattout
- Emergency Department, Aintree University Hospitals, Liverpool, UK
| | - Michael Hickey
- Emergency Department, Aintree University Hospitals, Liverpool, UK
| | - John E Edwards
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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20
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Bordoni B, Marelli F, Morabito B, Sacconi B. Osteopathic treatment in a patient with left-ventricular assist device with left brachialgia: a case report. Int Med Case Rep J 2017; 10:19-23. [PMID: 28144166 PMCID: PMC5245912 DOI: 10.2147/imcrj.s120558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study deals with an osteopathic approach used for a patient with left-ventricular assist device (L-VAD) affected by left brachialgia. Clinical examination revealed the presence of thoracic outlet syndrome and pectoralis minor syndrome, with compression of the left proximal ulnar nerve, related to the surgical sternotomy performed. The osteopathic techniques used can be classified as indirect and direct, addressed to the pectoralis minor and the first left rib, respectively. To our knowledge, this is the first text in literature with an osteopathic treatment in a patient with L-VAD.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, Milan; CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore; CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima
| | - Fabiola Marelli
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore; CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima
| | - Bruno Morabito
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore; CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima; Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome
| | - Beatrice Sacconi
- Center for Life Nano Science, CLNS@Sapienza, Istituto Italiano di Tecnologia, Rome, Italy
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21
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Abstract
Last century saw a marked increase in vascular injuries and their treatment has been improved from the experience gained in the major conflicts in the latter half of the last century. This trend of increasing numbers of vascular injuries has been perpetuated by a rise in civilian violence. This article reviews the mechanisms, diagnosis and treatment of vascular injury and outlines some of the advances in endovascular techniques for treating vascular trauma.
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Affiliation(s)
- DP Strong
- Selly Oak Hospital, University Hospitals Birmingham NHS Trust, UK,
| | - AT Edwards
- Selly Oak Hospital, University Hospitals Birmingham NHS Trust, UK
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22
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Abstract
The majority of thoracic injuries encountered in the UK are secondary to blunt trauma following motor vehicle accidents. Rib fractures account for more than half of these injuries. Sternal fractures, although less common, have an increased incidence following the implementation of seat belt legislation. Both rib and sternal fractures may compromise ventilation by a variety of mechanisms. Pain leads to a reduction in lung expansion and sputum retention. Fractured ribs may cause penetrating injury resulting in a haemopneumothorax. There may also be asso ciated pulmonary contusion and flail chest, which further compromises ventilation. Sternal and rib fractures are managed by a number of specialties including accident and emergency staff, cardiothoracic and trauma surgeons, as well as anaesthetists and intensivists. The management of rib and sternal fractures principally consists of the identification and treatment of associated injuries, appropriate respiratory care and symptomatic relief. This article reviews the literature on the investigations and management of the patient with rib and sternal fractures.
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Affiliation(s)
- NJ Howell
- Department of Cardiothoracic Surgery, University Hospital NHS Trust, Birmingham, UK
| | - AM Ranasinghe
- Department of Cardiothoracic Surgery, University Hospital NHS Trust, Birmingham, UK
| | - TR Graham
- Department of Cardiothoracic Surgery, University Hospital NHS Trust, Birmingham, UK
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23
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Nonunion of the first sternocostal synchondrosis accompanied by sternoclavicular joint synovitis. Case Rep Orthop 2014; 2014:798329. [PMID: 25254128 PMCID: PMC4164510 DOI: 10.1155/2014/798329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/22/2014] [Indexed: 11/21/2022] Open
Abstract
Injury to the sternocostal synchondrosis of the first rib is quite rare. We report one such case in a 50-year-old man with nonunion of the first sternocostal synchondrosis accompanied by synovitis of the sternoclavicular joint. He first underwent arthroscopic surgery of the left sternoclavicular joint. Postoperatively, the patient's symptoms decreased by half, but another pain and crepitus at the inferior lateral portion of the sternoclavicular joint developed. Since MRI and functional CT reexaminations revealed nonunion of the first sternocostal synchondrosis, resection arthroplasty of the first sternocostal joint was performed. This resulted in immediate resolution of the symptoms. At 2-year follow-up, his symptoms disappeared entirely with no limited range of motion of the shoulder.
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24
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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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25
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26
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Chimenti PC, Elfar JC, Giordano BD. Dominant-Sided First-Rib Stress Fracture in a Collegiate Baseball Pitcher: A Case Report. JBJS Case Connect 2013; 3:e108. [PMID: 29252263 DOI: 10.2106/jbjs.cc.m.00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter C Chimenti
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. . .
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27
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Hayashi D, Roemer FW, Kohler R, Guermazi A, Gebers C, De Villiers R. Thoracic injuries in professional rugby players: mechanisms of injury and imaging characteristics. Br J Sports Med 2013; 48:1097-101. [PMID: 23962879 DOI: 10.1136/bjsports-2013-092681] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Professional rugby players are prone to traumatic thoracic injuries due to the use of minimal protective gear to cover the torso. In the 2007 Rugby World Cup, thoracic injuries occurred at a rate of 8.3 cases/1000 player-hours. CT and MRI play an important role in the diagnosis of these injuries. Vital internal organs, such as the heart, lungs, trachea, liver and large blood vessels lie within close proximity to the bony structures and what seems to be a simple rib fracture or clavicular dislocation can have potentially life-threatening complications that are not detected by conventional radiography. Cross-sectional imaging helps to determine the choice of treatment. Ultrasound offers a quick and dynamic imaging examination and allows high-resolution assessment of superficial tissues that complements conventional imaging. In this review article, we (1) presented data on incidence of thoracic injuries in professional rugby players; (2) described the anatomy of the joints comprising the thoracic cage and major muscles attached to the rib cage; (3) discussed indications and relevance for MRI and presented an optimised MRI protocol for assessment of suspected thoracic injury; and (4) illustrated various types of thoracic injuries seen in professional rugby players, including sternal contusion, retrosternal haematoma, manubriosternal disruption, sternoclavicular dislocation, rib fractures and injuries of the pectoralis major muscle.
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Affiliation(s)
- Daichi Hayashi
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut, USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA Department of Radiology, University of Erlangen, Erlangen, Germany
| | - Ryan Kohler
- Australian Sports Commission, Bruce, Australia
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Chris Gebers
- Drs Van Wageningen and Partners, Somerset West, South Africa
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28
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Wang HW, Xiang Q, Li CQ, Zhou Y. Traumatic vertebral fractures with concomitant fractures of the first rib. Orthop Surg 2013; 5:100-4. [PMID: 23658044 DOI: 10.1111/os.12039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/05/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the characteristics of patients with traumatic vertebral fractures and concomitant fractures of the first rib and their management. METHODS From January 2001 to December 2010, 17/3142 patients (0.5%) with traumatic vertebral fractures who presented to our hospitals had concomitant fractures of the first rib. RESULTS The study included 14 men (82.4%) and 3 women (17.6%) patients of age 32-57 years (mean, 46.6 years). The mechanisms of trauma were falls from heights in seven, motor vehicle accidents in five and direct collisions with blunt objects in five. Thirteen patients (76.5%) presented initially with pulmonary complications after sustaining trauma. Three patients sustained one rib fracture, two three rib fractures, three four rib fractures and 10 > five rib fractures. The injuries were right-sided in three cases, left-sided in three and bilateral in eleven. Four patients (23.5%) presented with craniocerebral injuries. According to the American Spinal Injury Association (ASIA) classification, 10 patients (58.8% of the total study group) had motor and sensory deficits (ASIA A-D). There were no vascular injuries or deaths. CONCLUSION Traumatic vertebral fractures with concomitant fractures of the first rib are associated with multisystem injuries, but not always with morbidity and mortality. A multidisciplinary approach, early diagnosis, appropriate treatment and observation in the intensive care unit may prevent morbidity and/or mortality.
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Affiliation(s)
- Hong-wei Wang
- Department of Orthopaedics, Xinqiao Hospital, Chongqing, China
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29
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30
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Tjoumakaris FP, Matzon JL, Williams GR. Clavicle fracture with thoracic penetration and hemopneumothorax but without neurovascular compromise. Orthopedics 2011; 34:e692-5. [PMID: 21956070 DOI: 10.3928/01477447-20110826-31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Clavicle fractures are rarely associated with more severe neurologic or vascular injuries. When these associated injuries are encountered, prompt recognition and treatment are paramount to optimize outcome. The majority of fractures that result in neurovascular compromise are from high-energy trauma; however, a high index of suspicion should be present in all cases as low-energy trauma can also result in more catastrophic injury. This article describes a case of a low-energy clavicle fracture in a 28-year-old woman that resulted in intrathoracic penetration of the fracture fragment with hemopneumothorax. The patient underwent successful chest tube placement and open reduction and internal fixation of the fracture. A multidisciplinary team was used during surgery, including cardiothoracic, trauma, and orthopedic surgery. Two years postoperatively, the patient was back to normal activities with no neurologic, pulmonary, or vascular sequelae. This case highlights the importance of a comprehensive physical examination and inspection of all radiographs so that associated injuries are not missed.
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Affiliation(s)
- Fotios P Tjoumakaris
- Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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31
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Breen KJ, Conneely JB, Winter DC. Isolated first rib fracture with minimal trauma. Ir J Med Sci 2011; 180:887-8. [DOI: 10.1007/s11845-011-0700-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 02/17/2011] [Indexed: 11/28/2022]
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Abstract
PURPOSE The purpose of the study was to determine if first rib fractures are associated with an increased incidence of thoracic vascular injury in pediatric patients. METHODS The medical records of all children diagnosed with a first rib fracture or a central vascular injury after blunt trauma treated at a state-designated level 1 pediatric trauma center from 2000 to 2009 were reviewed. RESULTS Thirty-three children (0.27% of patients; mean age, 10.9 ± 0.9 years) were identified with either a first rib fracture or thoracic vascular injury owing to blunt trauma. Thirty-two children had a first rib fracture, and only 1 child (3%) had significant thoracic vascular injury. Mediastinal abnormalities (indistinct aortic knob) were identified in 3 children, 2 with first rib fracture on initial chest radiograph. Despite a normal cardiovascular examination result, 25 (74%) children with a normal mediastinum on screening chest radiograph underwent computed tomography. No child with a normal mediastinum on initial chest radiograph was found to have associated intrathoracic injuries requiring further intervention. In children with first rib fractures and a normal mediastinum by screening chest x-ray, the negative predictive value for thoracic vascular injury was 100%. CONCLUSIONS Children with first rib fractures without mediastinal abnormality on chest radiograph require no further workup for thoracic vascular injury.
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33
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Khosla A, Ocel J, Rad AE, Kallmes DF. Correlating first- and second-rib fractures noted on spine computed tomography with major vessel injury. Emerg Radiol 2010; 17:461-4. [PMID: 20549285 DOI: 10.1007/s10140-010-0879-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/18/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Ankaj Khosla
- Mayo Medical School, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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34
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Kamath GS, Borkar S, Chauhan A, Chidanand B, Kashyap N, Warrier R. Isolated Cervical Rib Fracture. Ann Thorac Surg 2010; 89:e41-2. [DOI: 10.1016/j.athoracsur.2010.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 02/08/2010] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
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35
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Sandri PDA, de Almeida JC, Sandri JL. BILATERAL FIRST RIB FRACTURE IN A DIVE WITH LIFE VEST. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2010; 45:302-5. [PMID: 27022557 PMCID: PMC4799112 DOI: 10.1016/s2255-4971(15)30373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
First-rib fractures are uncommon and are generally related to major thoracic trauma: so much so that they serve to indicate the severity of the trauma. Isolated bilateral first-rib fractures without major thoracic trauma are rarely described in the literature. The symptoms may go unnoticed and be minimized, thus making this condition difficult to diagnose. The present report presents a case of direct trauma on the supraclavicular region with symptoms of contusion of the brachial plexus, caused by a fall from a jet ski while a life vest was being used. The literature was reviewed to show the various facets of the problem and the treatment for this condition was discussed.
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Affiliation(s)
- Pietro de Almeida Sandri
- Sixth-year medical student at Iguaçu University (UNIG), Itaperuna, RJ
- Correspondence: Rua Chapot Presvot 99, apto. 502, 29055-410 Vitória, ESCorrespondence: Rua Chapot Presvot 99apto. 502VitóriaES29055-410
| | - Joelmar César de Almeida
- Titular Professor of Orthopedics and Traumatology, School of Higher Sciences, Santa Casa de Misericórdia (EMESCAM), Vitória, ES
| | - João Luiz Sandri
- Vascular Surgeon and Assistant Professor of Clinical and Surgical Care, School of Higher Sciences, Santa Casa de Misericórdia (EMESCAM), Vitória, ES
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36
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Zeckey C, Frink M, Wilhelmi M, Mommsen P, Brunnemer U, Probst C, Krettek C, Hildebrand F. [Injury to the subclavian and vertebral arteries in childhood following blunt force trauma]. Unfallchirurg 2010; 113:673-5. [PMID: 20411229 DOI: 10.1007/s00113-010-1782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Injuries of great vessels, such as the subclavian or vertebral arteries in childhood are rare. More frequent and therefore better described are dissections of the vertebral artery, which frequently occur following low energy trauma. The combination of dissection of the vertebral and subclavian arteries described in this case study led to sensory affections of the left arm. Therapeutic anticoagulation is the therapy of choice to avoid possible ischemic insults. The therapeutic approach of injuries to the subclavian artery remains unclear and is in the focus of discussions.
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Affiliation(s)
- C Zeckey
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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37
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Giuffre JL, Kakar S, Bishop AT, Spinner RJ, Shin AY. Current concepts of the treatment of adult brachial plexus injuries. J Hand Surg Am 2010; 35:678-88; quiz 688. [PMID: 20353866 DOI: 10.1016/j.jhsa.2010.01.021] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 01/24/2010] [Indexed: 02/02/2023]
Abstract
As the number of survivors of motor vehicle accidents and extreme sporting accidents increases, the number of people having to live with brachial plexus injuries increases. Although the injured limb will never return to normal, an improved understanding of the pathophysiology of nerve injury and repair, as well as advances in microsurgical techniques, have enabled the upper extremity reconstructive surgeon an opportunity to improve function in these life-altering injuries. The purpose of this review is to detail some of the current concepts of the treatment of adult brachial plexus injuries and give the reader an understanding of the nuances of the timing, available treatment options, and outcomes of treatment.
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Affiliation(s)
- Jennifer L Giuffre
- Division of Hand Surgery, Departments of Orthopedic Surgery and Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
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38
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Carlsen BT, Bishop AT, Shin AY. Late reconstruction for brachial plexus injury. Neurosurg Clin N Am 2009; 20:51-64, vi. [PMID: 19064179 DOI: 10.1016/j.nec.2008.07.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traumatic brachial plexus injuries are devastating and management is complex. Treatment involves a multidisciplinary approach. Primary reconstruction involves nerve repair, grafting, and transfer techniques. Secondary reconstruction includes microneurovascular free-functioning muscle transfer, tendon transfers, and arthrodesis to improve or restore function. These procedures are indicated when patients present more than 12 months from injury or when primary reconstruction procedures fail, and should focus on elbow flexion and shoulder stability. A free-functioning muscle transfer is often indicated for elbow flexion, with double free-functioning muscle transfers providing possible prehension. Shoulder reconstruction focuses on restoring stability to the glenohumeral joint and restoring abduction. This article outlines these techniques, their principles, and important details.
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Affiliation(s)
- Brian T Carlsen
- Mayo Clinic, Division of Hand Surgery, Rochester, MN 55905, USA
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Abstract
A 20-year-old woman elite weightlifter presented with acute onset debilitating right shoulder pain while attempting the "clean and jerk." There was no previous relevant history, including no prior fracture in the region. Examination confirmed vague tenderness in the right supraclavicular fossa with no discernible neurologic or vascular deficit within the right arm. X-ray was normal. The patient had a bone scan, including SPECT, suggesting a fracture of the right first rib, subsequently confirmed on CT examination.
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40
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Vascular Injuries of the Thorax: Multi-Detector-Row CT and 3D Imaging. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Min YI. Emergency Management of Thoracic Trauma. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2007. [DOI: 10.5124/jkma.2007.50.8.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yong Il Min
- Department of Emergency Medicine, Chonnam National University College of Medicine, Korea.
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42
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First rib fracture with compression of the distal roots of the brachial plexus. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2006. [DOI: 10.1007/s00590-006-0097-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Chest radiography remains the primary screening study for the assessment of victims of chest trauma, but computed tomography (CT), particularly multidetector CT (MDCT), has progressively changed the imaging approach to these patients. MDCT acquires thinner sections with greater speed, allowing higher quality axial images and nonaxial reformations than conventional or single-detector helical CT. The speed of MDCT, both in acquiring data and in reconstructing images, makes the performance of total body surveys in the blunt polytrauma patient practicable. In general, CT has been well documented to offer major advantages over chest radiography in both screening for thoracic injuries and in characterizing such injuries. This capacity has been enhanced by the application of multichannel data acquisition. The greater sensitivity of MDCT has been well demonstrated in diagnosing vascular and diaphragmatic injuries. This article reviews current concepts of diagnostic imaging in acute chest trauma from blunt force and penetrating mechanisms emphasizing the spectrum of diagnostic imaging findings for various injuries, based primarily on radiographic and CT appearances. The advantages of MDCT for selected injuries are emphasized.
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Affiliation(s)
- Stuart E Mirvis
- Department of Diagnostic Radiology and Maryland Shock-Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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44
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Abstract
Functioning free-muscle transfers are now an important, even essential, tool in the current management of patients with brachial plexus injury. They are indicated for the restoration of elbow flexion in patients who delay presentation(those seen after 6 to 9 mo). Double free-muscle transfers provide the possibility of simple grasp function when combined with nerve transfers or grafts for restoration of shoulder motion, hand sensation, and triceps function.
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Affiliation(s)
- Allen T Bishop
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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45
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Abstract
In recent years, the advent of multidetector CT (MDCT) has begun to change the imaging approach to patients sustaining blunt or penetrating thoracic injury. The ability to directly detect some injuries that are often occult on chest radiography, such as pericardial hemorrhage, major thoracic vascular injury, small pneumothorax, and diaphragm tears, as well as the ability to better define the extent of other injuries, such as lung contusion and laceration, account for this transition. This article reviews current concepts of diagnostic imaging in acute chest trauma from both blunt force and penetrating mechanisms, emphasizing the spectrum of diagnostic imaging findings for various injuries, primarily based on multidetector MDCT.
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Affiliation(s)
- Stuart E Mirvis
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore 21201, USA.
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46
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Galanski M. Thoraxtrauma. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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47
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Abstract
Chest pain in the athlete has a wide differential diagnosis. Pain may originate from structures within the thorax, such as the heart, lungs or oesophagus. However, musculoskeletal causes of chest pain must be considered. The aim of this review is to help the clinician to diagnose chest wall pain in athletes by identifying the possible causes, as reported in the literature. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations or myofascial structures. The cause is usually evident in the case of direct trauma. Additionally, athletes' bodies may be subjected to sudden large indirect forces or overuse, and stress fractures of the ribs caused by sporting activity have been extensively reported. These have been associated with golf, rowing and baseball pitching in particular. Stress fractures of the sternum reported in wrestlers cause pain and tenderness of the sternum, as expected. Diagnosis is by bone scan and limitation of activity usually allows healing to occur. The slipping rib syndrome causes intermittent costal margin pain related to posture or movement, and may be diagnosed by the 'hooking manoeuvre', which reproduces pain and sometimes a click. If reassurance and postural advice fail, good results are possible with resection of the mobile rib. The painful xiphoid syndrome is a rare condition that causes pain and tenderness of the xiphoid and is self-limiting. Costochondritis is a self-limiting condition of unknown aetiology that typically presents with pain around the second to fifth costochondral joints. It can be differentiated from Tietze's syndrome in which there is swelling and pain of the articulation. Both conditions eventually settle spontaneously although a corticosteroid injection may be useful in particularly troublesome cases. The intercostal muscles may be injured causing tenderness between the ribs. Other conditions that should be considered include epidemic myalgia, precordial catch syndrome and referred pain from the thoracic spine.
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Affiliation(s)
- Peter L Gregory
- Centre for Sports Medicine, Queens Medical Centre, Nottingham, UK
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48
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Surgical diseases of the great vessels. Curr Probl Surg 2000. [DOI: 10.1016/s0011-3840(00)80019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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49
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Abstract
Elbow dislocation is a rare injury in elite athletes. We report an unusual case of simultaneous bilateral elbow dislocations with a unilateral radial head fracture in an international female athlete competing on the asymmetrical bars. These injuries require prompt reduction and immediate mobilisation if an abrupt end to a promising career is to be prevented.
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Affiliation(s)
- A A Syed
- Department of Orthopaedic Surgery, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland
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50
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Abstract
Injuries to the first rib synchondrosis are uncommon in sport. The potential for serious complications following posterior displacement is similar to that seen with posterior sternoclavicular joint dislocation. Clinical examination and plain radiography may not provide a definitive diagnosis. Computerised tomography is the most appropriate imaging modality if this injury is suspected. Posterior dislocation of the first rib costal cartilage with an associated fracture of the posterior sternal aspect of the synchondrosis has not been previously reported.
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Affiliation(s)
- S P Kemp
- Centre for Sports Medicine, Queens Medical Centre, Nottingham, United Kingdom
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