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Chai Z, Luo L, Lin H, Heng PA, Chen H. Deep Omni-Supervised Learning for Rib Fracture Detection From Chest Radiology Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1972-1982. [PMID: 38215335 DOI: 10.1109/tmi.2024.3353248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Deep learning (DL)-based rib fracture detection has shown promise of playing an important role in preventing mortality and improving patient outcome. Normally, developing DL-based object detection models requires a huge amount of bounding box annotation. However, annotating medical data is time-consuming and expertise-demanding, making obtaining a large amount of fine-grained annotations extremely infeasible. This poses a pressing need for developing label-efficient detection models to alleviate radiologists' labeling burden. To tackle this challenge, the literature on object detection has witnessed an increase of weakly-supervised and semi-supervised approaches, yet still lacks a unified framework that leverages various forms of fully-labeled, weakly-labeled, and unlabeled data. In this paper, we present a novel omni-supervised object detection network, ORF-Netv2, to leverage as much available supervision as possible. Specifically, a multi-branch omni-supervised detection head is introduced with each branch trained with a specific type of supervision. A co-training-based dynamic label assignment strategy is then proposed to enable flexible and robust learning from the weakly-labeled and unlabeled data. Extensive evaluation was conducted for the proposed framework with three rib fracture datasets on both chest CT and X-ray. By leveraging all forms of supervision, ORF-Netv2 achieves mAPs of 34.7, 44.7, and 19.4 on the three datasets, respectively, surpassing the baseline detector which uses only box annotations by mAP gains of 3.8, 4.8, and 5.0, respectively. Furthermore, ORF-Netv2 consistently outperforms other competitive label-efficient methods over various scenarios, showing a promising framework for label-efficient fracture detection. The code is available at: https://github.com/zhizhongchai/ORF-Net.
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Dixon J, Rankin I, Diston N, Goffin J, Stevenson I. Surgical Rib Fracture Fixation: Early Operative Intervention Improves Outcomes. J Chest Surg 2024; 57:120-125. [PMID: 38225829 DOI: 10.5090/jcs.23.095] [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: 07/25/2023] [Revised: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 01/17/2024] Open
Abstract
Background This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.
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Affiliation(s)
- James Dixon
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Iain Rankin
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | | | - Joaquim Goffin
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Iain Stevenson
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
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Buchholz CJ, Jia L, Manea C, Petersen T, Wang H, Stright A, Young J, Calland JF. Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures. Am Surg 2023; 89:4668-4674. [PMID: 36120831 DOI: 10.1177/00031348221123087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with rib fractures have variable clinical courses and it is difficult to predict which patients will do poorly. Ideally this prediction would happen at the time of admission to facilitate effective triage. One scoring system devised to this end, is the Battle score. This study aims to evaluate the efficacy of the Battle score as triage tool, and to re-tool it for performance in an inpatient trauma setting. METHODS A multivariate logistic regression model was trained on patients admitted to a level one trauma center with at least one rib fracture. A composite outcome was used to classify those who had poor outcomes. Eighteen candidate predictors were analyzed in univariate analysis, then the most promising fed into the logistic model until a triage score was built and internally validated by bootstrapping. RESULTS Of the 838 patients who met the inclusion criteria, 145 (17.3%) patients had a defined poor outcome. The relevant predictors included in the final scoring system were number of ribs fractured, chest tube, pulmonary contusions, chronic obstructive pulmonary disease, and Glasgow coma score. Age was not found to be predictive. This score was found to have higher fidelity in predicting poor outcomes than the original Battle score (AUROC .858 vs .649.). DISCUSSION An easy to calculate clinical scoring system was created to triage patients with rib fractures at the time of admission. Age may be of less importance than previously thought, while injury burden and history of lung disease may play a larger role.
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Affiliation(s)
- Carl J Buchholz
- Department of Surgery, Virginia Tech Carilion Clinic, Roanoke VA, USA
| | - Leon Jia
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Calin Manea
- Department of General Surgery, Wellspan Health York Hospital, York, PA, USA
| | - Taylor Petersen
- Department of Pediatrics, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Haowei Wang
- Department of Surgery, Strong Memorial Hospital, Rochester, NY, USA
| | - Adam Stright
- Department of Trauma and Acute Care Surgery, NYU Langone Health, New York, NY, USA
| | - Jeffrey Young
- University of Virginia Health System, Charlottesville VA, USA
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Marturano MN, Thakkar V, Wang H, Cunningham KW, Lauer C, Sachdev G, Ross SW, Jordan MM, Dieffenbaugher ST, Sing RF, Thomas BW. Intercostal nerve cryoablation during surgical stabilization of rib fractures decreases post-operative opioid use, ventilation days, and intensive care days. Injury 2023; 54:110803. [PMID: 37193637 DOI: 10.1016/j.injury.2023.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/16/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Intercostal nerve cryoablation is an adjunctive measure that has demonstrated pain control, decrease in opioid consumption, and decrease in hospital length of stay (LOS) in patients who undergo surgical stabilization of rib fractures (SSRF). METHODS SSRF patients from January 2015 to September 2021 were retrospectively compared. All patients received multimodal pain regimens post-operatively and the independent variable was intraoperative cryoablation. RESULTS 241 patients met inclusion criteria. 51 (21%) underwent intra-operative cryoablation during SSRF and 191 (79%) did not. Patients with standard treatment consumed 9.4 more daily MME (p = 0.035), consumed 73 percent more post-operative total MME (p = 0.001), spent 1.55 times as many days in the intensive care unit (p = 0.013), and spent 3.8 times as many days on the ventilator than patients treated with cryoablation, respectively. Overall hospital LOS, operative case time, pulmonary complications, MME at discharge, and numeric pain scores at discharge were no different (all p>0.05). CONCLUSION Intercostal nerve cryoablation during SSRF is associated with fewer ventilator days, ICU LOS, total post-operative, and daily opioid use without increasing time in the operating room or perioperative pulmonary complications.
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Affiliation(s)
- Matthew N Marturano
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Vandan Thakkar
- Campbell University School of Osteopathic Medicine, Lillington NC, USA
| | - Huaping Wang
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Kyle W Cunningham
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Cynthia Lauer
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Gaurav Sachdev
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Samuel W Ross
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Mary M Jordan
- Department of Trauma and Acute Care Surgery, Atrium Health Cabarrus, Concord NC, USA
| | - Sean T Dieffenbaugher
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Ronald F Sing
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA
| | - Bradley W Thomas
- Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA.
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Ye J, Li H, Zhang M, Lin F, Liu J, Chen J, Peng Y, Xiao M. Oblique Axis Rib Stretch and Curved Planar Reformats in Patients for Rib Fracture Detection and Characterization: Feasibility and Clinical Application. Emerg Med Int 2023; 2023:4904844. [PMID: 37674861 PMCID: PMC10480015 DOI: 10.1155/2023/4904844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To assess the use of CT with oblique axis rib stretch (OARS) and curved planar reformats (CPRs) for rib fracture detection and characterization. Methods A total of 108 forensically diagnosed patients with rib fractures were evaluated retrospectively. OARS and CPRs were independently used during the diagnosis in two groups. In each group, the final diagnosis was made after a junior radiologist's initial diagnosis was reviewed by a senior radiologist. The images were evaluated for the presence and characterization of rib fractures. Results A total of 2,592 ribs were analyzed, and 326 fractured ribs and 345 fracture sites were diagnosed using reference standard. Two groups of radiologists identified 331 and 333 fracture sites using the OARS method, 291 and 288 fracture sites using the CPRs method, and 274 fracture sites in forensically diagnosed patients (CR: conventional reconstruction), respectively; and all missed diagnoses were nondisplaced rib fractures. The ROC Az value of OARS1,2 was 0.98, which is higher than CPRs1,2 0.91, and CR 0.90 (all p < 0.01). The Az value for detecting rib fractures using CPRs1,2 and CR has no statistical difference (p = 0.14 and 0.29). More misdiagnosed patients were found using CPRs1,2 (42 and 44 cases) than OARS1,2 (1 and 2 cases) and CR (2 cases). The displaced fracture detection ratio of all methods showed no difference. Conclusions Doctors using the OARS method could improve diagnostic performance for detecting rib fractures without the requirement of specialized software and workstation when compared with CPRs.
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Affiliation(s)
- Jingzhi Ye
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Hongyi Li
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Meng Zhang
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Fenghuan Lin
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jingfeng Liu
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jun Chen
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Ye Peng
- The Second People's Hospital of Xiangzhou District, 21 Nanquan Road, Zhuhai City, Guangdong Province, China
| | - Mengqiang Xiao
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
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Albert DL, Katzenberger MJ, Hunter RL, Agnew AM, Kemper AR. Effects of loading rate, age, and morphology on the material properties of human rib trabecular bone. J Biomech 2023; 156:111670. [PMID: 37352737 DOI: 10.1016/j.jbiomech.2023.111670] [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: 07/26/2022] [Revised: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
The material and morphometric properties of trabecular bone have been studied extensively in bones bearing significant weight, such as the appendicular long bones and spine. Less attention has been devoted to the ribs, where quantification of material properties is vital to understanding thoracic injury. The objective of this study was to quantify the compressive material properties of human rib trabecular bone and assess the effects of loading rate, age, and morphology on the material properties. Material properties were quantified via uniaxial compression tests performed on trabecular bone samples at two loading rates: 0.005 s-1 and 0.5 s-1. Morphometric parameters of each sample were quantified before testing using micro-computed tomography. Rib trabecular bone material properties were lower on average compared to trabecular bone from other anatomical locations. Morphometric parameters indicated an anisotropic structure with low connectivity and a sparser density of trabeculae in the rib compared to other locations. No significant differences in material properties were observed between the tested loading rates. Material properties were only significantly correlated with age at the 0.005 s-1 loading rate, and no morphometric parameter was significantly correlated with age. Trabecular separation and thickness were most strongly correlated with the material properties, indicating the sparser trabecular matrix likely contributed to the lower material property values compared to other sites. The novel trabecular bone material properties reported in this study can be used to improve the thoracic response and injury prediction of computational models.
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Affiliation(s)
- Devon L Albert
- Virginia Tech, Center for Injury Biomechanics, United States.
| | | | - Randee L Hunter
- The Ohio State University, Injury Biomechanics Research Center, United States
| | - Amanda M Agnew
- The Ohio State University, Injury Biomechanics Research Center, United States
| | - Andrew R Kemper
- Virginia Tech, Center for Injury Biomechanics, United States
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Thomas CN, Lindquist TJ, Schroder LK, Cole PA. Rib Fracture Map in High-Energy Injuries. J Orthop Trauma 2023; 37:e165-e169. [PMID: 36730005 DOI: 10.1097/bot.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To use a novel rib unfurling technology to investigate the locations of multiple rib fractures occurring from high-energy trauma to discern if there are reproducible rib fracture patterns. METHODS Patients between the ages of 18 and 48 years presenting to a Level 1 academic trauma center with ≥2 rib fractures after a high-energy mechanism of injury between 2017 and 2019 were identified. Curved planar reformatting of CT scans was used to create two-dimensional unfurled rib images by flattening out the view of the ribs from a CT scan. Rib fractures were placed on a template map using a standardized measurement method, and subsequent frequency and heat maps were created. RESULTS Among 100 consecutive patients, 534 fractures on 454 ribs were identified. The most common high-energy mechanism of injury was motor vehicle accidents (41%). Flail chest occurred in 8% of patients. The mean number of ribs fractured per patient was 4.54 ± 3.14 and included a mean of 5.34 ± 4.38 total fractures. Among all fractures, 50.9% were located on ribs 4 through 7. The most common fracture location was located in the lateral or anterolateral zone of the rib cage. CONCLUSIONS Patients with multiple rib fractures from high-energy trauma have rib fractures with locations of common occurrence. An understanding of location and frequency of rib fractures can help inform surgical approaches, prognosis, indications, classifications, and implant design in the management of a complex population of patients with chest wall injury after trauma. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Claire N Thomas
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
| | | | - Lisa K Schroder
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- HealthPartners Orthopaedics & Sports Medicine, Bloomington, MN
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Morgan B, Prakash K, Mayberry JC, Brickley MB. Thoracic trauma: Clinical and paleopathological perspectives. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:50-63. [PMID: 36219928 DOI: 10.1016/j.ijpp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Although trauma is one of the most significant areas of study in paleopathology, most studies focus on fractures of single anatomical elements. Paleopathological research on regional trauma, such as of the thorax, is rare. This paper explores the causes, complications, and consequences of adult thoracic trauma using clinical data in order to inform paleopathological research. MATERIALS AND METHODS Trends in paleopathological thoracic trauma literature were assessed by evaluating publications from Bioarchaeology International, International Journal of Osteoarchaeology, International Journal of Paleopathology, and American Journal of Biological Anthropology. Clinical publications on thoracic trauma throughout time were also assessed through a PubMed search, and modern prevalence data was found through trauma databases such as the National Trauma Databank. RESULTS Consideration of thoracic trauma involving concomitant injuries is a recent trend in clinical literature and patient care, but paleopathological research on thoracic trauma has been limited. Since thoracic fractures tend to occur in conjunction with other injuries, assessing them together is critical to the interpretation of trauma in the past. CONCLUSIONS Clinical research into thoracic fractures and concomitant injuries provides valuable data for paleopathological research. Evaluating the likelihood and consequences of concomitant injury in skeletal remains provides a more robust understanding of trauma in the past and its impact on past lifeways. SIGNIFICANCE This paper provides a review of current clinical and paleopathological literature on thoracic trauma and demonstrates the importance of moving beyond the analysis of fractures or trauma of single anatomical elements. LIMITATIONS Thoracic bones are often taphonomically altered and differentially preserved leading to difficulty in identifying and interpreting fractures. SUGGESTIONS FOR FURTHER RESEARCH Practical application of the data presented here to archaeological samples will help to advance paleopathological understandings of thoracic trauma.
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Affiliation(s)
- Brianne Morgan
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
| | - Karanvir Prakash
- Virginia Commonwealth University, Department of Orthopedic Surgery, Richmond, VA, USA.
| | - John C Mayberry
- University of Washington, Department of Surgery, Seattle, WA 98195, USA.
| | - Megan B Brickley
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
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Battle C, Carter K, Newey L, Giamello JD, Melchio R, Hutchings H. Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis. Emerg Med J 2022; 40:369-378. [PMID: 36241371 DOI: 10.1136/emermed-2021-212184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Over the last 10 years, research has highlighted emerging potential risk factors for poor outcomes following blunt chest wall trauma. The aim was to update a previous systematic review and meta-analysis of the risk factors for mortality in blunt chest wall trauma patients. METHODS A systematic review of English and non-English articles using MEDLINE, Embase and Cochrane Library from January 2010 to March 2022 was completed. Broad search terms and inclusion criteria were used. All observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. Where sufficient data were available, ORs with 95% CIs were calculated using a Mantel-Haenszel method. Heterogeneity was assessed using the I2 statistic. RESULTS 73 studies were identified which were of variable quality (including 29 from original review). Identified risk factors for mortality following blunt chest wall trauma were: age 65 years or more (OR: 2.11; 95% CI 1.85 to 2.41), three or more rib fractures (OR: 1.96; 95% CI 1.69 to 2.26) and presence of pre-existing disease (OR: 2.86; 95% CI 1.34 to 6.09). Other new risk factors identified were: increasing Injury Severity Score, need for mechanical ventilation, extremes of body mass index and smoking status. Meta-analysis was not possible for these variables due to insufficient studies and high levels of heterogeneity. CONCLUSIONS The results of this updated review suggest that despite a change in demographics of trauma patients and subsequent emerging evidence over the last 10 years, the main risk factors for mortality in patients sustaining blunt chest wall trauma remained largely unchanged. A number of new risk factors however have been reported that need consideration when updating current risk prediction models used in the ED. PROSPERO REGISTRATION NUMBER CRD42021242063. Date registered: 29 March 2021. https://www.crd.york.ac.uk/PROSPERO/%23recordDetails.
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Affiliation(s)
- Ceri Battle
- Physiotherapy Department, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Kym Carter
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Luke Newey
- Physiotherapy Department, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Jacopo Davide Giamello
- School of Emergency Medicine, Università degli Studi di Torino Dipartimento di Scienze Mediche, Torino, Italy.,Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Remo Melchio
- Department of Internal Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
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Craxford S, Marson BA, Nightingale J, Forward DP, Taylor A, Ollivere B. Surgical fixation of rib fractures improves 30-day survival after significant chest injury : an analysis of ten years of prospective registry data from England and Wales. Bone Joint J 2022; 104-B:729-735. [PMID: 35638213 DOI: 10.1302/0301-620x.104b6.bjj-2021-1502.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS The last decade has seen a marked increase in surgical rib fracture fixation (SRF). The evidence to support this comes largely from retrospective cohorts, and adjusting for the effect of other injuries sustained at the same time is challenging. This study aims to assess the impact of SRF after blunt chest trauma using national prospective registry data, while controlling for other comorbidities and injuries. METHODS A ten-year extract from the Trauma Audit and Research Network formed the study sample. Patients who underwent SRF were compared with those who received supportive care alone. The analysis was performed first for the entire eligible cohort, and then for patients with a serious (thoracic Abbreviated Injury Scale (AIS) ≥ 3) or minor (thoracic AIS < 3) chest injury without significant polytrauma. Multivariable logistic regression was performed to identify predictors of mortality. Kaplan-Meier estimators and multivariable Cox regression were performed to adjust for the effects of concomitant injuries and other comorbidities. Outcomes assessed were 30-day mortality, length of stay (LoS), and need for tracheostomy. RESULTS A total of 86,838 cases were analyzed. The rate of SRF was 1.2%. SRF significantly reduced risk of mortality (odds ratio (OR) 0.27 (95 confidence interval (CI) 0.128 to 0.273); p < 0.001) and need for tracheostomy (OR 0.22 (95% CI 0.191 to 0.319); p < 0.001) after adjustment for other covariables across the whole cohort. SRF remained protective in patients with a serious chest injury (hazard ratio (HR) 0.24 (95% CI 0.13 to 0.45); p < 0.001). The benefit in more minor chest injury was less clear. Mean LoS for patients who survived was longer in the SRF group (24.29 days (SD 26.54) vs 16.60 days (SD 26.35); p < 0.001). CONCLUSION SRF reduces mortality after significant chest trauma associated with both major and minor polytrauma. The rate of fixation in the UK is low and potentially underused as a treatment for severe chest wall injury. Cite this article: Bone Joint J 2022;104-B(6):729-735.
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Laterality in modern medicine: a historical overview of animal laterality, human laterality, and current influences in clinical practice. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kyriakakis R, Johnson B, Krech L, Pounders S, Lypka M, Chapman A, Valdez C. Planning for the Worst: The impact of a comprehensive, risk associated treatment protocol on unanticipated ICU admissions in patients affected by rib fractures. Am J Surg 2022; 224:602-606. [DOI: 10.1016/j.amjsurg.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
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Spies AJ, Steyn M, Brits D. Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model. MEDICINE, SCIENCE, AND THE LAW 2022; 62:134-143. [PMID: 34825618 DOI: 10.1177/00258024211049591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The accurate radiological detection of skeletal trauma is crucial for the investigation of blunt force trauma (BFT) cases. The sensitivities of CTs, X-rays and Lodox in identifying BFT fractures and minimum number of impacts in pigs, used as proxies for adult humans, were assessed. Ten human sized pig carcasses were struck with a mallet and scanned, after which the number of fractures and minimum number of impacts detected radiologically were recorded. Pig carcasses were then macerated, and the defleshed, skeletonized remains were considered the gold standard as far as number and location of fractures were concerned. CTs were most sensitive in identifying fractures and impacts in all body regions, with overall sensitivities of 55.4% and 71.5% respectively, while X-rays and Lodox had sensitivities of 25.8% and 29.3% for fractures, and 43.5% and 41.1% for impacts, respectively. All modalities were highly specific for identifying fractures (CT: 99.1%; X-ray: 98.9%; Lodox: 99.4%). CTs should be used to analyze blunt force trauma when a radiological assessment is required, but an examination of the defleshed bones remains the gold standard for the deceased whenever feasible. X-rays and Lodox have limited diagnostic value in these cases and relying on them to detect fractures may compromise the accurate forensic investigation of blunt trauma victims. However, the use of Lodox for initial screening of major trauma is still of value. Sensitivities are generally higher for detecting fractures in pigs compared to piglets, indicating that increased diagnostic value is achieved when imaging pigs compared to piglets.
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Affiliation(s)
- Amy Joy Spies
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, 37708University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Maryna Steyn
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, 37708University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Desiré Brits
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, 37708University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
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Coffey MR, Bachman KC, Ho VP, Worrell SG, Moorman ML, Linden PA, Towe CW. Iatrogenic rib fractures and the associated risks of mortality. Eur J Trauma Emerg Surg 2022; 48:231-241. [PMID: 33496799 PMCID: PMC8310895 DOI: 10.1007/s00068-020-01598-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/27/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE Rib fractures, though typically associated with blunt trauma, can also result from complications of medical or surgical care, including cardiopulmonary resuscitation. The purpose of this study is to describe the demographics and outcomes of iatrogenic rib fractures. METHODS Patients with rib fractures were identified in the 2016 National Inpatient Sample. Mechanism of injury was defined as blunt traumatic rib fracture (BTRF) or iatrogenic rib fracture (IRF). IRF was identified as fractures from the following mechanisms: complications of care, drowning, suffocation, and poisoning. Differences between BTRF and IRF were compared using rank-sum test, Chi-square test, and multivariable regression. RESULTS 34,644 patients were identified: 33,464 BTRF and 1180 IRF. IRF patients were older and had higher rates of many comorbid medical disorders. IRF patients were more likely to have flail chest (6.1% versus 3.1%, p < 0.001). IRF patients were more likely to have in-hospital death (20.7% versus 4.2%, p < 0.001) and longer length of hospitalization (11.8 versus 6.9 days, p < 0.001). IRF patients had higher rates of tracheostomy (30.2% versus 9.1%, p < 0.001). In a multivariable logistic regression of all rib fractures, IRF was independently associated with death (OR 3.13, p < 0.001). A propensity matched analysis of IRF and BTRF groups corroborated these findings. CONCLUSION IRF injuries are sustained in a subset of extremely ill patients. Relative to BTRF, IRF is associated with greater mortality and other adverse outcomes. This population is understudied. The etiology of worse outcomes in IRF compared to BTRF is unclear. Further study of this population could address this disparity.
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Affiliation(s)
- Max R. Coffey
- Case Western Reserve University School of Medicine, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, United States
| | - Katelynn C. Bachman
- Case Western Reserve University School of Medicine, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, United States
| | - Vanessa P. Ho
- Case Western Reserve University School of Medicine, Cleveland, OH, United States,MetroHealth Medical Center, Department of Surgery, Division of Trauma, Critical Care, Burns, & Acute Care Surgery, Cleveland, OH, United States
| | - Stephanie G. Worrell
- Case Western Reserve University School of Medicine, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, United States
| | - Matthew L. Moorman
- Case Western Reserve University School of Medicine, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, United States
| | - Philip A. Linden
- Case Western Reserve University School of Medicine, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, United States
| | - Christopher W. Towe
- Case Western Reserve University School of Medicine, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, United States
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15
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Davoodabadi A, Mosavibioki N, Mashayekhil M, Gilasi H, Kashi EA, Haghpanah B. Correlation of rib fracture patterns with abdominal solid organ injury: A retrospective observational cohort study. Chin J Traumatol 2022; 25:45-48. [PMID: 34303569 PMCID: PMC8787232 DOI: 10.1016/j.cjtee.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma. METHODS This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient. RESULTS Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures. CONCLUSION There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.
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Affiliation(s)
- Abdoulhossein Davoodabadi
- Department of Surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran,Corresponding author.
| | - Noshin Mosavibioki
- Department of Surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Mashayekhil
- General Surgery Department, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamidreza Gilasi
- Department of Epidemiology & Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Esmail Abdorrahim Kashi
- Department of Surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Babak Haghpanah
- Department of Orthopedic Surgery, Kashan University of Medical Sciences, Kashan, Iran
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16
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Yao L, Guan X, Song X, Tan Y, Wang C, Jin C, Chen M, Wang H, Zhang M. Rib fracture detection system based on deep learning. Sci Rep 2021; 11:23513. [PMID: 34873241 PMCID: PMC8648839 DOI: 10.1038/s41598-021-03002-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023] Open
Abstract
Rib fracture detection is time-consuming and demanding work for radiologists. This study aimed to introduce a novel rib fracture detection system based on deep learning which can help radiologists to diagnose rib fractures in chest computer tomography (CT) images conveniently and accurately. A total of 1707 patients were included in this study from a single center. We developed a novel rib fracture detection system on chest CT using a three-step algorithm. According to the examination time, 1507, 100 and 100 patients were allocated to the training set, the validation set and the testing set, respectively. Free Response ROC analysis was performed to evaluate the sensitivity and false positivity of the deep learning algorithm. Precision, recall, F1-score, negative predictive value (NPV) and detection and diagnosis were selected as evaluation metrics to compare the diagnostic efficiency of this system with radiologists. The radiologist-only study was used as a benchmark and the radiologist-model collaboration study was evaluated to assess the model's clinical applicability. A total of 50,170,399 blocks (fracture blocks, 91,574; normal blocks, 50,078,825) were labelled for training. The F1-score of the Rib Fracture Detection System was 0.890 and the precision, recall and NPV values were 0.869, 0.913 and 0.969, respectively. By interacting with this detection system, the F1-score of the junior and the experienced radiologists had improved from 0.796 to 0.925 and 0.889 to 0.970, respectively; the recall scores had increased from 0.693 to 0.920 and 0.853 to 0.972, respectively. On average, the diagnosis time of radiologist assisted with this detection system was reduced by 65.3 s. The constructed Rib Fracture Detection System has a comparable performance with the experienced radiologist and is readily available to automatically detect rib fracture in the clinical setting with high efficacy, which could reduce diagnosis time and radiologists' workload in the clinical practice.
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Affiliation(s)
- Liding Yao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Xiaowei Song
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Yanbin Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Chun Wang
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China
| | - Chaohui Jin
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China
| | - Ming Chen
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China
| | - Huogen Wang
- Hithink RoyalFlush Information Network Co., Ltd, No. 18 Tongshun Street, Yuhang District, Hangzhou, 310012, Zhejiang, China.
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
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17
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Head W, Kumar N, Thomas C, Leon S, Dieffenbaugher S, Eriksson E. Are rib fractures stable? An analysis of progressive rib fracture offset in the acute trauma setting. J Trauma Acute Care Surg 2021; 91:917-922. [PMID: 34407002 DOI: 10.1097/ta.0000000000003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rib fractures serve as both a marker of injury severity and a guide for clinical decision making for trauma patients. Although recent studies have suggested that rib fractures are dynamic, the degree of progressive offset remains unknown. The purpose of this study was to further characterize the change that takes place in the acute trauma setting. METHODS A 4-year (2016-2019) retrospective assessment of adult trauma patients with rib fracture(s) admitted to a level I trauma center was performed. Initial and follow-up computed tomography scans were analyzed to determine the magnitude of offset. Relevant clinical course variables were examined, and location of chest wall instability was examined using the difference of interquartile range of median change. Statistical Product and Services Solutions (Version 25, IBM Corp. Armonk, NY) was then used to generate a neural network-multilayer perceptron that highlighted independent variable importance. RESULTS Fifty-three patients met the inclusion criteria for severe injury. Clinical course variables that either trended or significantly predicted the occurrence of progressive offset were Abbreviated Injury Scale Thoracic Scores (3.1 ± 0.4 no progression vs. 3.4 ± 0.6 yes progression; p = 0.121), flail segment (14% no progression vs. 43% yes progression; p = 0.053), and number of ribs fractured (4 [2-8] no progression vs. 7 [5-9] yes progression; p = 0.023). The location of progressive offset largely corresponded to the posterolateral region as demonstrated by the differences of interquartile range of median change. The neural network demonstrated that ribs 4 to 6 (normalized importance [NI], 100%), the posterolateral region (NI, 87.9%), and multiple fractures per rib (NI, 66.6%) were valuable in predicting whether progressive offset occurred (receiver operating characteristic curve - area under the curve = 0.869). CONCLUSION Rib fractures are not stable, particularly for those patients with multiple fractures in the mid-to-upper ribs localized to the posterolateral region. These findings may identify both trauma patients with worse outcomes and help develop better management strategies for rib fractures. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- William Head
- From the Department of Surgery (W.H., N.K., C.T., S.L., E.E.), Medical University of South Carolina, Charleston, South Carolina; and Department of Surgery (S.D.), Atrium Health Carolinas Medical Center, Charlotte, North Carolina
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18
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Thomas CN, Lindquist TJ, Paull TZ, Tatro JM, Schroder LK, Cole PA. Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures. J Trauma Acute Care Surg 2021; 91:940-946. [PMID: 34417408 DOI: 10.1097/ta.0000000000003382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment. METHODS Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map. RESULTS A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6. CONCLUSION Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures. LEVEL OF EVIDENCE Diagnostic test, level IV.
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Affiliation(s)
- Claire N Thomas
- From the Department of Orthopaedic Surgery (C.N.T., T.Z.P., J.M.T., L.K.S., P.A.C.), University of Minnesota, Minneapolis; Department of Orthopaedic Surgery (C.N.T., J.M.T., L.K.S., P.A.C.), Regions Hospital, University of Minnesota, St. Paul, Minnesota; Department of Biology (T.J.L.), Wheaton College, Wheaton, Illinois; and HealthPartners Orthopaedics and Sports Medicine (P.A.C.), Bloomington, Minnesota
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19
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Bauman ZM, Loftus J, Raposo-Hadley A, Samuel S, Ernst W, Evans CH, Cemaj S, Kaye AJ. Surgical stabilization of rib fractures combined with intercostal nerve cryoablation proves to be more cost effective by reducing hospital length of stay and narcotics. Injury 2021; 52:1128-1132. [PMID: 33593526 DOI: 10.1016/j.injury.2021.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/16/2020] [Accepted: 02/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intercostal nerve cryoablation (INCA) coupled with surgical stabilization of rib fractures (SSRF) has been shown to reduce post-operative pain scores but at what monetary cost. We hypothesize that in-hospital outcomes improve with the addition of INCA to SSRF and potential increased hospital charges are justified by patient benefits. METHODS Multi-institutional, retrospective review of patients undergoing SSRF with and without INCA over an 8-year period. Institutions involved were Level II or higher trauma centers. Basic demographics were obtained. Patients were included if SSRF was performed during the index hospitalization. Primary outcomes included total hospital length of stay (HLOS) and HLOS after SSRF, total hospital charges (HC), HC the day of surgery and HC after surgery. Secondary outcome included total narcotic consumption in morphine milliequivalents (MME) after SSRF. Mann-Whitney U test was used for analysis. Statistical significance p < 0.05. RESULTS 136 patients analyzed; 92 underwent SSRF only and 44 underwent SSRF with INCA. Demographics were similar between groups. Number of ribs stabilized was comparable; 4.78 ± 1.64 SSRF only and 4.73 ± 1.66 SSRF with INCA (p = 0.463). Median ISS [16 (IQR 11.5-16) SSRF only and 14 (IQR 9-18.75) SSRF with INCA (p = 0.463)] was not statistically different. The INCA group showed a decrease in the median total HLOS, 9 versus 10 days (U = 1517.5, p = 0.026) and HLOS after SSRF, 4 versus 6 days (U = 1217.5, p < 0.001). HC the day of surgery were higher for the INCA group, $93,932 versus $71,143 (U = 1106, p < 0.001). However, total HC were similar between groups and total HC after SSRF was significantly less for the INCA group, $10,556 versus $20,269 (U = 1327, p = 0.001). Total median narcotic use after SSRF was significantly less for the INCA group, 88.6 vs 113.7 MME (U = 1544.5, p = 0.026). CONCLUSION SSRF with INCA is safe and does not increase overall HC with the added benefit of decreased HLOS post-operatively and decreased narcotic consumption.
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Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198.
| | - John Loftus
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198.
| | - Ashley Raposo-Hadley
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198.
| | - Shradha Samuel
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198.
| | - Weston Ernst
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198.
| | - Charity H Evans
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198.
| | - Samuel Cemaj
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198.
| | - Adam J Kaye
- Division of Trauma Surgery, Overland Park Regional Medical Center, Overland Park, KS, USA 66215
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20
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Chen XK, Liu YJ, Guo FZ, Deng JX, Xiong J, Wang TB, Jiang BG. Assessment of thoracic volume changes after the collapse of lateral rib fractures based on chest computed tomography data: computer simulation and a multiple variable linear regression analysis. J Cardiothorac Surg 2020; 15:167. [PMID: 32646474 PMCID: PMC7346514 DOI: 10.1186/s13019-020-01213-z] [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: 02/11/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background Chest blunt trauma (CBT) and the resultant rib fractures often lead to thoracic collapse. The purpose of this study was to explore the effect of displacement of the rib fracture and thoracic collapse on the thoracic volume by using normal chest CT data. Methods In this retrospective study, seven consecutive normal participants were selected from our hospital between June and July 2018. Normal thoracic models were reconstructed, followed by simulation of lateral fractures through the 4th to 9th ribs under three collapse modes with 1–5 cm of collapse. The thoracic collapse models (n = 630) were reconstructed using 3Dmax 2014. We calculated the thoracic volume and reduction percentage for each thoracic collapse model. Linear regression-based comparisons of thoracic volume reductions were performed. Results In all three collapse modes, the degree of the collapse was linearly correlated with the mean thoracic volume reduction. The reduction percentage in the posterior collapse mode was higher than that in the anterior collapse mode (P < 0.001). The largest volume reductions in the anterior, posterior, and simultaneous collapse models were in the 6th rib fracture model (P < 0.001), 8th rib fracture model (P < 0.001), and 7th rib fracture model (P < 0.001), respectively. Conclusions The influences of rib fracture displacement and collapse on the thoracic volume in the 6th through 8th ribs are critical in lateral rib fractures. For patients with 6th to 8th rib fractures and posterior rib collapse, surgical intervention to restore thoracic volume may be more essential.
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Affiliation(s)
- Xiao-Kun Chen
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China
| | - Yi-Jun Liu
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China
| | - Fu-Zheng Guo
- National Center for Trauma Medicine, Beijing, 100044, P. R. China
| | - Jiu-Xu Deng
- National Center for Trauma Medicine, Beijing, 100044, P. R. China
| | - Jian Xiong
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China
| | - Tian-Bing Wang
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China. .,National Center for Trauma Medicine, Beijing, 100044, P. R. China.
| | - Bao-Guo Jiang
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China. .,National Center for Trauma Medicine, Beijing, 100044, P. R. China.
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21
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Vartan P, Asmar S, Bible L, Chehab M, Khurrum M, Castanon L, Ditillo M, Joseph B. Alcohol Use Disorder Is Bad for Broken Ribs: A Nationwide Analysis of 19,638 Patients With Rib Fractures. J Surg Res 2020; 255:556-564. [PMID: 32640407 DOI: 10.1016/j.jss.2020.05.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) has deleterious effects on many organ systems. The aim of our study was to assess the impact of AUD on outcomes in patients with rib fractures. We hypothesized that AUD is associated with increased risk adverse outcomes. METHODS We performed a 2013-2014 retrospective analysis of all adult trauma patients diagnosed with rib fractures from the American College of Surgeons-Trauma Quality Improvement Program database. We excluded patients who were acutely intoxicated with alcohol. Patients were stratified into two groups: AUD + and AUD -. A 1:1 ratio propensity score matching for demographics, admission vitals, injury severity, smoking status, operative intervention, and number of rib fractures was performed. Outcome measures were in-hospital complications, mortality, hospital and intensive care unit length of stay, and ventilator days. RESULTS We matched 19,638 patients (AUD +:9,819, AUD -:9819). Mean age was 53 ± 22y, and median injury severity score was 15[10-20]. Matched groups were similar in age (P = 0.18), smoking status (P = 0.82), injury severity score (P = 0.28), chest Abbreviated Injury Scale (P = 0.24), and number of rib fractures (2[1-4] versus 2[1-4], P = 0.86). Alcoholic patients had higher rates of pneumonia (18.1% versus 9.2%, P < 0.01), unplanned intubation (18.5% versus 9.7, P < 0.001), sepsis (10.8% versus 6.3%, P < 0.001), acute respiratory distress syndrome (12.2% versus 7.4%, P < 0.001), and mortality (8.0 versus 5.7%, P < 0.001). Patients with AUD spent more days in the hospital and intensive care unit . There was no difference in ventilator days between the two groups. CONCLUSIONS Patients with AUD and rib fractures had higher rates of adverse events than patients without AUD. Early identification of patients with rib fractures with AUD may allow better resource allocation and help improve outcomes. LEVEL OF EVIDENCE Level III prognostic.
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Affiliation(s)
- Phillip Vartan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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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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23
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Kazakova T, Tafen M, Wang W, Petrov R. Rescue Re-Do Inline Osteosynthesis with Wire Cerclage for Failed Rib Plating of Multilevel Rib Nonunion. ACTA ACUST UNITED AC 2019; 4:59-62. [PMID: 32342028 PMCID: PMC7185219 DOI: 10.4103/jctt.jctt_13_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Rib nonunion is a rare occurrence that requires surgical management and has a high rate of failure that may necessitate repeated intervention. We present the case of successful rescue redo repair of previously failed plating of chronic nonunion for multilevel posterior rib fractures, reinforced by wire cerclage of the osteosynthesis plate. Our objective is to illustrate the feasibility of repeated interventions, and the technique to resolve this challenging problem.
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Makey IA, Jacob S, El-Sayed Ahmed MM, Pham S, Landolfo K, Thomas M. Latissimus muscle sparing approach to subscapular rib fracture plating. Trauma Case Rep 2019; 24:100247. [PMID: 31872020 PMCID: PMC6911933 DOI: 10.1016/j.tcr.2019.100247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/28/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022] Open
Abstract
Surgical stabilization of fractured ribs has been shown to improve trauma related outcomes, however the procedure itself can be a source of morbidity. This report details two cases of latissimus dorsi muscle sparing sub-scapular multi-rib fracture plating. We combined several techniques to make this possible. The first technique was use of a vertical skin incision along the anterior border of the latissimus muscle. The second was the use of a mammary retractor to provide adequate and sustained retraction of the latissimus and scapula. The third was utilization of a right angle screwdriver to allow placement of the posterior screws. Sparing the latissimus muscle for sub-scapular fractures is possible but requires planning and extra equipment to perform. Minimizing rib fixation related morbidity makes it a more appealing treatment.
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Affiliation(s)
- Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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Napier D. Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study. SONOGRAPHY 2019. [DOI: 10.1002/sono.12176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Donna Napier
- Department of Medical ImagingRoyal Brisbane and Women's Hospital Brisbane Australia
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