Pseudarthrosis at the first sternocostal synchondrosis

Brower, A C; Woodlief, RM

doi:10.2214/ajr.135.6.1276

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…The first rib differs anatomically from the others by having a short radius and by forming a synchondrosis with the manubrium of the sternum. Different stages of calcification and/or ossification in the first rib synchondrosis and the often cleftlike appearance of the costosternal joint complicates the evaluation of acute signs of trauma in this location (5,8,(26)(27)(28). Fractures of the first rib have been reported to indicate high trauma energy (6,29,30), a finding that our study cohort confirms, and which we suggest to be applicable also to the CC fracture of the first rib.…”

Section: Discussionsupporting

confidence: 69%

Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma

et al. 2018

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Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. RSNA, 2017.

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Section: Discussionsupporting

confidence: 69%

Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma

et al. 2018

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“…To our knowledge, only a few cases of injury to the first sternocostal synchondrosis have been reported [7, 8]. One of these cases showed nonunion similar to the present case, but no specific etiology was mentioned.…”

Section: Discussionsupporting

confidence: 57%

“…The mechanism of first rib injury in car collisions is thought to be violent contraction of the scalene muscles brought about by the sudden forward movement of the head and neck and, in a car collision, consequent sudden arrest by the seatbelt [8, 9]. Another possible cause of this type of fracture is inflation of the driver's airbag [10].…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, isolated fractures might occur as stress fractures attributed to repeated muscle contraction [5, 6]. On the other hand, injury to the sternocostal synchondrosis of the first rib is quite rare [7, 8]. Here, we present a case of nonunion of the first sternocostal synchondrosis accompanied by synovitis of the sternoclavicular joint.…”

Section: Introductionmentioning

confidence: 99%

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Nonunion of the First Sternocostal Synchondrosis Accompanied by Sternoclavicular Joint Synovitis

Takeuchi

Goto

Yukata

et al. 2014

Case Reports in Orthopedics

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Injury to the sternocostal synchondrosis of the first rib is quite rare. We report one such case in a 50-year-old man with nonunion of the first sternocostal synchondrosis accompanied by synovitis of the sternoclavicular joint. He first underwent arthroscopic surgery of the left sternoclavicular joint. Postoperatively, the patient's symptoms decreased by half, but another pain and crepitus at the inferior lateral portion of the sternoclavicular joint developed. Since MRI and functional CT reexaminations revealed nonunion of the first sternocostal synchondrosis, resection arthroplasty of the first sternocostal joint was performed. This resulted in immediate resolution of the symptoms. At 2-year follow-up, his symptoms disappeared entirely with no limited range of motion of the shoulder.

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“…Besides, in post-polio syndrome, the paralysis and subsequent muscle atrophy lead to the alteration in the load axis of the spine (with or without scoliosis), resulting in degenerative changes (Grados et al, 2015), namely spinal OA, which may be exacerbated with age. Regarding the pseudoarthrosis observed at the right first sternocostal synchondrosis, it can be related to three different factors: congenital anomaly, acute fracture, or even chronic stress fractures (Brower and Woodlief, 1980). On the other hand, and according to current clinical studies, pseudarthrosis of the first rib is frequent in older individuals, as progressive calcification of cartilaginous parts is common.…”

Section: Discussionmentioning

confidence: 99%

An identified case of poliomyelitis: contribution to diagnosis in ancient human remains

Gómez-González,

González-Garrido,

Rodríguez

et al. 2024

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This article describes the skeletal remains of a 20th-century individual diagnosed with poliomyelitis in childhood who suffered from atrophy and muscle weakness as an adult. The study provides a detailed analysis of both the primary effects of polio in the skeleton and the secondary effects across a lifetime, and contributes to the future identification of this pathology in osteoarchaeological assemblages. A skeleton of an 82-year-old male with poliomyelitis, from Tierra de la Reina, León (Spain) was submitted to bone densitometry, morphological, metric, cross-sectional, and palaeopathological analyses. Conventional X-rays and computed tomography scans were also performed. Skeletal alterations were categorized as directly and indirectly related to polio. The latter were probably acquired during life, resulting from mobility problems, malposition, and/or advanced age. Discrepancies in size, primarily related to polio, were observed between the right and left sides of the skeleton, with the left side being smaller and more gracile. However, while the asymmetry of the upper limbs is mainly in robustness, in the lower limbs the differences are in both robustness and length. This paper illustrates the skeletal alterations that may be present with poliomyelitis, demonstrating the complexity of diagnosing this pathology in an individual who lived a long life. In fact, many of the observed alterations can be found in other pathological conditions. Therefore, it is concluded that extreme caution be taken when analysing archaeological skeletal remains that are not as complete and well-preserved as this individual. The present work contributes to the diagnosis of poliomyelitis in human remains and underscores its impact in human history. Destructive methods were not authorized; medical records were no longer available. In the future, 3D reconstruction analysis/micro-computed tomography may add new and valuable information.

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Pseudarthrosis at the first sternocostal synchondrosis

Cited by 5 publications

References 6 publications

Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma

Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma

Nonunion of the First Sternocostal Synchondrosis Accompanied by Sternoclavicular Joint Synovitis

An identified case of poliomyelitis: contribution to diagnosis in ancient human remains

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