Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Vledder, Mark G. van; Kwakernaak, Vicky; Hagenaars, Tjebbe; Lieshout, Esther M.M. Van; Verhofstad, M.H.J.

doi:10.1007/s00068-018-0969-9

Cited by 43 publications

(41 citation statements)

References 15 publications

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“…In severe cases, the rib fragments harm the inner organs, such as the lungs, the liver, the kidneys, or the spleen [1,3,9,11,12]. Since rib fractures are often related to specific intrathoracic and intraabdominal traumas, predictions of the probability, progression, and complication rate of the inner organ injuries are possible [12–15]. Detailed knowledge about the fracture patterns of serial rib fractures is therefore essential to improve the treatment strategy of these types of injury.…”

Section: Introductionmentioning

confidence: 99%

Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

et al. 2019

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Rib fractures represent the most common bone fracture, occurring in 10–20% of all blunt trauma patients and leading to concomitant injuries of the inner organs in severe cases. The purpose of this study was to identify specific serial rib fracture patterns after blunt chest trauma. 380 serial rib fracture cases were investigated. Fractures were assigned to five different locations within the transverse plane. Rib level, fracture type, and dislocation grades were recorded and related to the cause of accident. In total, 3735 rib fractures were identified (9.8 per patient). 54% of the rib fractures were detected on the left thorax. Rib fracture distribution exhibited a hotspot at rib levels 4 to 7 in the lateral and posterolateral segments. On average, most rib fractures occurred in crush/burying injuries (15.8, n = 13) and pedestrian accidents (12.8, n = 13), least in car/truck accidents (8.9, n = 75). In the car/truck accident group, 47% of all rib fractures were in the lateral segment, in case of frontal collision (n = 24) even 60%. Fall injuries (n = 141) entailed mostly posterolateral rib fractures (35%). In case of falls >3 m (n = 45), 48% more rib fractures were detected on the left thorax. In cardiopulmonary resuscitation related serial rib fractures (n = 33), 70% of all rib fractures were located anterolaterally. Infractions were the most observed fracture type (44%), followed by oblique (25%) and transverse (18%) fractures, while 46% of all rib fractures were dislocated (15% ≥ rib width). Serial rib fractures showed distinct fracture patterns depending on the cause of accident. When developing a serial rib fracture classification system, data regarding patterns, fracture types, dislocation grades, and associated fractures should be included.

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Section: Introductionmentioning

confidence: 99%

Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

et al. 2019

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“…In elderly patients aged 65 years or older, over 50% have sustained rib fractures following low-energy trauma (LET) such as a fall from standing height [6,7]. The number of rib fractures, pre-existent pulmonary pathology, and age are known risk factors for rib fracture-associated mortality and morbidity [2][3][4][7][8][9][10][11][12][13]. Rib fractures are the most common fractures in men and second most common in women over 65 years [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Rib fractures after blunt thoracic trauma in patients with normal versus diminished bone mineral density: a retrospective cohort study

et al. 2019

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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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“…Surprisingly, concomitant injuries of the thoracic cage had no statistical impact on clinical outcome scores. In contrast, several studies reported negative effects of thoracic cage injuries such as serial rip fractures in the elderly [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

Spiegl¹,

Hölbing²,

Jarvers³

et al. 2021

BMC Musculoskelet Disord

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Background The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly. Methods Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization. Results Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.

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Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Abstract: Pneumonia and death occur in about 10% of elderly patients with rib fractures. Apart from the severity of thoracic injuries, the presence and severity of extra-thoracic injuries and cardiopulmonary comorbidities are associated with poor outcome.

Cited by 43 publications

References 15 publications

Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

Rib fractures after blunt thoracic trauma in patients with normal versus diminished bone mineral density: a retrospective cohort study

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

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