Perils of Rib Fractures

Abstract

Rib fractures (RF) are noted in 4 to 12 per cent of trauma admissions. To define RF risks at a Level 1 trauma center, investigators conducted a 10-year (1995–2004) retrospective analysis of all trauma patients. Blunt chest trauma was seen in 13 per cent (1,475/11,533) of patients and RF in 808 patients (55% blunt chest trauma, 7% blunt trauma). RF were observed in 26 per cent of children (<18 years), 56 per cent of adults (18–64 years), and 65 per cent of elderly patients (≥65 years). RF were caused by motorcycle crashes (16%, 57/347), motor vehicle crashes (12%, 411/3493), pedestrian-auto collisions (8%, 31/404), and falls (5%, 227/5018). Mortality was 12 per cent (97/808; children 17%, 8/46; adults 9%, 46/522; elderly 18%, 43/240) and was linearly associated with a higher number of RF (5% 1–2 RF, 15% 3–5 RF, 34% ≥6 RF). Elderly patients had the highest mortality in each RF category. Patients with an injury severity score ≥15 had 20 per cent mortality versus 2.7 per cent with ISS <15 ( P < 0.0001). Increasing age and number of RF were inversely related to the percentage of patients discharged home. ISS, age, number of RF, and injury mechanism determine patients’ course and outcome. Patients with associated injuries, extremes of age, and ≥3 RF should be admitted for close observation.

Epidemiology of major paediatric chest trauma

“…Rib fractures were present in 23% of our patients. Although rib fractures are relatively common, our percentage is lower than previous reports (35–50%) 7,9,14,15 . This is despite the high frequency of pedestrian (26%) and vehicle occupants (33%) in our study 2,6,8 …”

“…Penetrating injuries were rare in this population, with only six (4%) reported cases. Our results are lower than other series, 9,10,14 possibly because of stringent gun laws in Australia, and limited conflict and poverty when compared internationally 10,17 . Inci and colleagues 17 list the common injuries resulting from penetrating trauma as haemothorax and pneumothorax.…”

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

“…Fractures of the lower ribs 9 to 12 can compromise the diaphragm, liver, spleen, kidneys, and adrenal glands, and it has also been suggested that laterally located rib fractures contribute to a higher risk of mortality, especially in patients aged over 45 years . Table outlines the relationship of the rib fracture location with visceral organ injury …”

“…Apart from being a nonfeasible imaging modality for claustrophobic patients, a limitation in its detection of rib fracture encompasses the possibility of a nondisplaced fracture being falsely diagnosed due to partial volume effects . Artefacts resulting from respiratory motion can also hinder the detection of rib fractures, especially those located in the anterior chest wall …”

“…Fractures at the anterior arc have a higher risk of failed detection on axial scans due to their oblique orientation, and buckle fractures are commonly missed as there is not a sufficient discontinuity of the cortical surface of the rib to allow for diagnosis . Furthermore, if axial sections are obtained using a slice thickness greater than 4 mm, nondisplaced fractures may not be detected due to partial volume averaging …”