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

Abstract

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.

Analysis of Injury Patterns and Outcomes of Blunt Thoracic Trauma in Elderly Patients

“…Unintentional falls have also been reported to be a common cause of BTT, and increased age remains an independent predictor of mortality [5]. Reduced bone mineral density predisposes the elderly patients to increased rib fractures after thoracic trauma and may consequently result in a more prolonged and complicated clinical course [6]. Exposure to higher risk of traumatic events and significant co-morbidities result in higher injury sensitivity in geriatric patients [1].…”

Empyema associated with a cough-induced rib fracture

“…1 Prins et al reported that patients with osteopenia or osteoporosis had a higher risk of rib fracture than patients with normal bone density on blunt thoracic trauma. 14 In our case, no oral steroids or immunosuppressive drugs were used, but a detailed medical history revealed that the patient had received regular intramuscular injections of triamcinolone acetonide for over 10 years. Any association between cough-induced rib fractures and steroid-induced bone loss is unclear.…”

Fragility fracture of the fourth rib in a patient with a cardiac pacemaker: an uncommon case

“…Other complications, such as nerve impairment or bone lesions, are extremely infrequent [1]. Low bone mineral density (BMD) was found significantly associated with a higher rate of rib fractures after blunt thoracic trauma in patients 50 years and older [2]. In addition, there are case series of non-traumatic rib fractures following a severe cough or sneeze, not only in the elderly but also in young and middle-aged patients with one common pre-existing condition; osteoporosis [2,3].…”

“…Low bone mineral density (BMD) was found significantly associated with a higher rate of rib fractures after blunt thoracic trauma in patients 50 years and older [2]. In addition, there are case series of non-traumatic rib fractures following a severe cough or sneeze, not only in the elderly but also in young and middle-aged patients with one common pre-existing condition; osteoporosis [2,3]. Though rib fractures are the most common fractures in men over 65 years, a rib fracture caused by a pacemaker has never been reported in elderly [2].…”

“…In addition, there are case series of non-traumatic rib fractures following a severe cough or sneeze, not only in the elderly but also in young and middle-aged patients with one common pre-existing condition; osteoporosis [2,3]. Though rib fractures are the most common fractures in men over 65 years, a rib fracture caused by a pacemaker has never been reported in elderly [2]. We present an uncommon case of 4th rib fracture in an elderly male with a permanent pacemaker.…”