Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment

Abstract

The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. RSNA, 2017.

Thoracic wall trauma—misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging

“…Ultrasonography (US) is increasingly being used for trauma patients to help identify fractures, haemothorax, pneumothorax and to evaluate cardiac function. Magnetic resonance imaging (MRI) is not routinely used to identify acute traumatic thorax injury; however, it can be used to help identify stress fractures, rib fractures, adjacent softtissue injury, and intercostal muscle strains (7). This article aimed to review the role of different imaging methods in evaluating thoracic wall trauma.…”

“…In fact, up to 50% of rib fractures are missed at radiography, even when images with dedicated oblique rib views are obtained. Dedicated rib views rarely provide any additional information that would change management and should be avoided (7). The American College of Radiology (ACR) has established an algorithm for the imaging evaluation of rib fractures (11).…”

“…These injuries are rare, although possibly underdiagnosed, and most often seen in workers who perform repetitive motions and athletes. Detection of non-displaced and stress rib fractures on radiographs is difficult, and these injuries may be seen radiographically only at follow-up imaging, after signs of healing have manifested (7). On the contrary, MRI can show immediately an area of oedema (high T2 signal) after a traumatic event.…”

“…Some researchers have reported that the term buckle is derived from engineering terminology that describes disruption of the inner or tensile side of a structure that is placed under force (7,17). Flail chest ("volet") is a traumatic condition in which there are three or more contiguous ribs with fractures in two or more places ( Figure 3).…”

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

“…Rib fracture is reported to be the most commonly encountered aetiology following blunt chest trauma, but despite this, it is frequently regarded as insignificant. Unfortunately, this ideology is compounded when the limitations of conventional imaging modalities are evaluated.…”