Cardiac injury due to the rapid progress of the dislocation of rib fractures: A rare case that required urgent open reduction and internal rib fixation

Abstract

Background Most rib fractures are treated conservatively, but patients with severe trauma may require surgical treatment. We report a rare case of delayed pericardial injury due to a fractured rib stump. Case presentation A 61-year-old man fell while riding a bicycle and was transferred to our hospital. A computed tomography (CT) scan showed mild rib fractures on the 4th-6th ribs, and he was hospitalized because of acute pain. A few days later, his respiratory condition had worsened. CT showed that the rib fractures progressed significantly, and the stump was in contact with the heart, so we performed an urgent surgical rib fixation. Operative findings revealed intrathoracic hemorrhage by the pericardial laceration because of the rib stump. The 4th-7th ribs were internally fixed using a screwless titanium metal plate, and he was discharged without complications on the 20th postoperative day. Conclusion We experienced a rare case of pericardial injury caused by a rapid dislocation of rib fractures. Urgent surgical treatment was able to prevent a serious complication.

A case of hemorrhagic shock due to intercostal artery injury that occurred during initial trauma care with multiple displaced rib fractures and traumatic head injury

“…In contrast, vascular injury is quite rare, and some cases have been associated with hemorrhagic shock [1] , [3] , [4] , [5] . In some instances, vascular injury occurs after admission, with the time of the onset ranging from 17 h to 16 days [3] , [4] , [5] , [6] , [7] . The mechanism of injury involves bone fragments protruding into the thoracic cavity [5] or the stump coming in contact with an organ [6] .…”

“…In some instances, vascular injury occurs after admission, with the time of the onset ranging from 17 h to 16 days [3] , [4] , [5] , [6] , [7] . The mechanism of injury involves bone fragments protruding into the thoracic cavity [5] or the stump coming in contact with an organ [6] . In the present case, since the hemorrhaging from the ICA was induces by a displaced RF, the stump might have come in contact the ICA.…”

“…Rib fractures (RFs) can cause injury to some organs [1] , [2] , [3] , [4] , [5] , [6] , [7] , and displaced rib fractures are particularly dangerous [3] , [4] , [5] , [6] , [7] . We herein report a case of hemorrhagic shock due to intercostal artery injury that occurred during initial trauma care treated by resuscitative thoracotomy (RT) and transcatheter arterial embolization (TAE) with multiple displaced RFs and traumatic head injury (THI).…”

Clinical evaluation of AI software for rib fracture detection and its impact on junior radiologist performance

“…In addition, fracture patterns can be highly variable and inconspicuous such as buckle or hairline fractures. It has been shown that readers are particularly prone to overlook subtle and mild fractures in asymptomatic patients (13). In the present study, the overall sensitivity of AF detection in the radiologist-only group was 58.45% (1103/1887) at the lesion level, which was substantially lower than that of DF-only detection (58.45% vs. 78.40%; P < 0.001).…”

Surgical Stabilization of Rib Fractures

“… Stabilization of all displaced ribs that are accessible through the main incision is preferred. The reason for plating the maximum possible number of ribs is to avoid the risk of subsequent displacement, which may occur rapidly and cause cardiopulmonary injuries 18 . The other reasons include the prospect of deformity formation and recalcitrant pain in cases of nonunion.…”