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Tsimpinos M, Chrysikos D, Demesticha T, Piagkou M, Troupis T. Fracture of the Second Rib: An Indirect Sign of Serious Trauma Like Fracture of the First Rib? J Chest Surg 2023; 56:431-434. [PMID: 37915290 PMCID: PMC10625957 DOI: 10.5090/jcs.23.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
Background The first 3 ribs are anatomically well-protected, shielded by the large thoracic muscles, the shoulder girdle, and the arm. A significant force is required to fracture these ribs; thus, such fractures suggest a high-energy trauma and are associated with injuries to vital organs of the thorax, such as the aorta, the heart, the lungs and the great vessels. Methods A retrospective analysis was conducted over a 10-year period at a single hospital. The study assessed patients with fractures of the second rib, including their concurrent injuries and the overall severity of their trauma. Results Among the 76 patients included in the study, the average age was 47.35 years, 81.5% were men, and 19.5% were women. Thirteen patients (17.1%) survived their injuries. The most common causes of injury were road traffic accidents (63%) and pedestrian injuries (22%). The patients who did not survive sustained injuries to an average of 5 additional organs, while survivors had injuries to an average of 2.07 additional organs. Left rib fractures were the most frequently observed (46%). The most serious concurrent injuries reported were to the aorta (5.26%), heart (10.52%), lung (52.36%), head (57.89%), liver (30.2%), spleen (26.31%), and kidney (17.1%). Conclusion As indicators of serious injury to vital endothoracic organs, isolated fractures of the second rib should be considered equal to first rib fractures in clinical importance.
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Affiliation(s)
| | - Dimosthenis Chrysikos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theano Demesticha
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Anesthesiology Department, Metropolitan Hospital, Piraeus, Greece
| | - Maria Piagkou
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Troupis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Flaaten N, Dyke G. First rib fracture: Still a marker of trauma severity? Emerg Med Australas 2022; 34:808-811. [PMID: 35445531 DOI: 10.1111/1742-6723.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE First rib fractures (FRFs) have historically been a marker for severe trauma and poor outcomes. The aim of the present study was to assess whether an association still exists between a fractured first rib and global trauma scores suffered by the patient, examine mortality rates and identify other commonly associated injuries. METHODS This retrospective study examined records collected from patients from the Rockhampton Hospital with a traumatic FRF from July 2015 to June 2020. Patient demographics, mortality rate and injuries sustained were compiled. The Injury Severity Score (ISS) was utilised and calculated for each patient. Analysis was conducted to determine associations between trauma scores and FRFs. RESULTS In total, 545 patients had a rib fracture with 48 patients identified as having an FRF. Median age was 50 years. Thirty-seven (77%) were male. The most common mechanism of FRF was motor vehicle/motorbike accidents (71%). Fifty percent of patients with an observed FRF had the highest global ISS of very severe, with 13% severe, 22% moderate and 15% mild. No patients died from their injuries. Of those with an FRF, 79% experienced fractures other than ribs, 75% had other rib fractures and 52% had chest injuries. CONCLUSIONS A larger than expected proportion of FRFs were not associated with severe trauma scores or high mortality. These findings suggest that patients with an FRF may have a greater chance of surviving their traumatic FRF than previously reported. Clinicians should be aware of the potential for severity and specific associated injuries when treating a patient with FRFs.
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Affiliation(s)
- Nordan Flaaten
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Garry Dyke
- Department of Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
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Fokin AA, Hus N, Wycech J, Rodriguez E, Puente I. Surgical Stabilization of Rib Fractures: Indications, Techniques, and Pitfalls. JBJS Essent Surg Tech 2020; 10:e0032. [PMID: 32944413 PMCID: PMC7478329 DOI: 10.2106/jbjs.st.19.00032] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Rib fractures are a common thoracic injury that is encountered in 20% to 39% of patients with blunt chest trauma and is associated with substantial morbidity and mortality1,2. Traditionally, the majority of patient with rib fractures have been managed nonoperatively. Recently, the utilization of surgical stabilization of rib fractures has increased considerably because the procedure has shown improved outcomes3-5.
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Affiliation(s)
- Alexander A Fokin
- Delray Medical Center, Delray Beach, Florida.,Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Nir Hus
- Delray Medical Center, Delray Beach, Florida.,Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Joanna Wycech
- Delray Medical Center, Delray Beach, Florida.,Broward Health Medical Center, Fort Lauderdale, Florida
| | - Eugenio Rodriguez
- Delray Medical Center, Delray Beach, Florida.,Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Ivan Puente
- Delray Medical Center, Delray Beach, Florida.,Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida.,Broward Health Medical Center, Fort Lauderdale, Florida.,Florida International University Herbert Wertheim College of Medicine, Miami, Florida
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Prins JTH, Van Lieshout EMM, Reijnders MRL, Verhofstad MHJ, Wijffels MME. Rib fractures after blunt thoracic trauma in patients with normal versus diminished bone mineral density: a retrospective cohort study. Osteoporos Int 2020; 31:225-231. [PMID: 31828365 PMCID: PMC7010612 DOI: 10.1007/s00198-019-05219-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/30/2019] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate rib fracture rate as well as rib fracture characteristics after thoracic trauma in patients with normal versus diminished bone mineral density (BMD). A retrospective cohort study of persons aged 50 years or older presenting to the Emergency Department after sustaining blunt thoracic trauma between July 1, 2014, and December 31, 2017, was performed. Patient and trauma characteristics and DXA scan results were collected. Rib fracture rate and characteristics were evaluated on a radiograph and/or CT scan of the thorax. In total, 119 patients were included for analysis. Fifty-eight of them (49%) had a diminished BMD. In the remaining 61, the BMD was normal. The diminished BMD group experienced rib fractures more often than the normal BMD group (n = 43 (74%) versus n = 31 (51%); p = 0.014). Patients with diminished BMD suffered low-energy trauma more frequently than the normal BMD group (21 (36%) versus 11 patients (15%), respectively (p = 0.011)). Rib fracture characteristics such as the median number of rib fractures, concomitant intrathoracic injury rate, and rib fracture type distribution were not different between the groups. The rate of rib fractures after blunt thoracic trauma was significantly higher in patients with diminished BMD than in patients with a normal BMD. Differences in number and location of rib fractures between groups could not be proven. When assessing patients aged 50 years or older presenting to the hospital after substantial blunt thoracic trauma, the presence of diminished BMD should be taken into account and the presence of rib fractures should be investigated with appropriate diagnostic procedures. Diminished bone mineral density (i.e., osteopenia or osteoporosis) is associated with increased fracture risk. This study evaluated if diminished BMD increases the rib fracture risk. Patients with diminished BMD have a higher risk of sustaining rib fractures after substantial blunt thoracic trauma, which implicates a lower threshold for CT imaging of the chest.
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Affiliation(s)
- J T H Prins
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - M R L Reijnders
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M M E Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Fokin A, Wycech J, Chin Shue K, Stalder R, Lozada J, Puente I. Tracheostomy in trauma patients with rib fractures. Eur J Trauma Emerg Surg 2019; 47:965-974. [PMID: 31119319 DOI: 10.1007/s00068-019-01149-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Patients with rib fractures (RF) may require prolonged mechanical ventilation and tracheostomy. Indications for tracheostomy in trauma patients with RF remain debatable. The goal was to delineate characteristics of patients who underwent tracheostomy due to thoracic versus extra-thoracic causes, such as maxillofacial-mandibular injury (MFM), traumatic brain injury (TBI), and cervical vertebrae trauma (CVT), and to analyze clinical outcomes. The predictive values of chest trauma scoring systems for tracheostomy were also evaluated. We hypothesized that tracheostomized patients were more severely injured with more ribs fractured and had more pulmonary co-injuries. METHODS Retrospective review included 471 patients with RF admitted to two Level 1 trauma centers. Patients with tracheostomy (n = 124, 26.3%) were compared to patients with endotracheal intubation (n = 347, 73.7%). Analyzed variables included age, gender, injury severity score (ISS), Glasgow Coma Scale, number of ribs fractured, total fractures of ribs, prevalence of bilateral rib fractures, flail chest, clavicle fractures, MFM, TBI, CVT, co-injuries, comorbidities, RF treatment options, hospital length of stay (HLOS), intensive care unit LOS (ICULOS), duration of mechanical ventilation (DMV). RESULTS Tracheostomized compared to intubated patients had statistically higher ISS, more ribs fractured, total fractures of the ribs, bilateral and clavicle fractures, MFM, spine, chest, and orthopedic co-injuries and longer HLOS, ICULOS and DMV. Tracheostomy for thoracic reasons was performed in 64 patients (51.6%) and for extra-thoracic reasons in 60 patients (48.4%). Mean tracheostomy timing was 9.9 days and was significantly shorter in the extra-thoracic compared to the thoracic group (8.0 versus 11.6 days, p < 0.001). All chest trauma scoring system values were significantly higher in tracheostomized patients. Predictive values of scoring systems for tracheostomy increased in patients with thoracic trauma only. CONCLUSIONS A quarter of mechanically ventilated patients with RF required tracheostomy. Tracheostomized compared to intubated patients were more severely injured with more ribs fractured and were intubated longer. An increased amount of RF was associated with an increase in tracheostomies, especially for thoracic reasons.
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Affiliation(s)
- Alexander Fokin
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.
| | - Joanna Wycech
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA
| | - Kyle Chin Shue
- Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Ryan Stalder
- Wake Forest University, 1834 Wake Forest Rd, Winston-Salem, NC, 27109, USA
| | - Jose Lozada
- Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA
| | - Ivan Puente
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.,Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
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