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At least 181 records · Page 10Linked to original sources
PubMed2006

Influence of rib structure on detection of subtle lung nodules.

PURPOSE: To access the influence of anatomic noise on the detectability of subtle lung nodules depicted on chest radiographs. MATERIAL AND METHODS: From normal chest radiography images, 132 square regions were extracted, of which the centers were on the upper margin of a rib, the inside of a rib, the lower margin of a rib, and the central region between two adjoining ribs. Simulated nodules were digitally superimposed at the centers of these extracted square images. Twelve radiologists viewed 50 soft-copy images consisting of these 792 processed images, including the noise-added images. The observer's confidence level for the square images containing single nodules was used as an index of observer performance. RESULTS: Results indicated statistically reliable effects of the relationship between rib structures and nodule positions on the detection performance (P < 0.001). The nodule detectability on the images with a center located between two adjoining ribs was significantly the best, whereas it was significantly the worst on the noise-added images with a center located between two adjoining ribs. CONCLUSION: The rib structures overlying a subtle lung nodule on chest X-ray images have a detrimental effect on nodule detection performance as anatomic noise, regardless of the nodule location on ribs.

Adult↗
PubMed2001

Thoracic outlet syndrome caused by first rib hemangioma.

We report a case of first rib hemangioma that caused thoracic outlet syndrome. A 50-year-ole woman who was admitted to our hospital with a clinical diagnosis of thoracic outlet syndrome presented with fullness and easy fatigue of her right arm. Her right arm discomfort was associated with intermittent engorgement of superficial veins over the shoulder girdle. A chest radiograph revealed an enlargement of the anterior aspect of the first rib with fine bony trabeculations. Computed tomography scan showed contrast enhancement over the enlarged rib. Our tentative preoperative diagnosis was a benign first rib hypertrophic change, such as an old fracture with exuberant callus formation. A right-arm venogram revealed a patent subclavian vein with an extrinsic compression, which occluded on arm abduction. The findings of neural conduction studies of both upper extremities were symmetric and normal. The patient agreed to surgery because of the occlusive condition of the subclavian vein on arm abduction and progressive arm weakness in recent months. Segmental transection of the offending portion of the enlarged first rib was complicated by difficulty in isolating the whole length of the compressed but normal-appearing subclavian vein by our initial transaxillary and infraclavicular approaches because the medial aspect of the subclavian vein was obstructed by the enlarged first rib, which extended medially to the junction of the right jugular and subclavian veins. Successful segmental transection of the enlarged first rib was finally accomplished by combined transaxillary, infraclavicular, and supraclavicular approaches. A moderate amount of rib bleeding from resection ends was noted during segmental resection of the enlarged first rib, resulting in local hematoma formation. A 470-mL bloody discharge was collected from the vacuum ball inserted via the transaxillary route during her 12-day hospitalization. Pathologic examination revealed an intraosseous hemangioma. The patient had a prolonged course to partial recovery of her arm numbness, but signs of venous compression were much improved at 6 months' follow-up. Although hemangioma is benign, its hypervascular nature may cause catastrophic intraoperative bleeding.

Bone Neoplasms↗
PubMedDate not supplied

Supernumerary ribs in developmental toxicity bioassays and in human populations: incidence and biological significance.

Supernumerary or accessory ribs (SNR), either lumbar (LR) or cervical (CR), are a common finding in standard developmental toxicology bioassays. The biological significance of these anomalies within the regulatory arena has been problematic and the subject of some debate. In rodents, the spontaneous incidence of SNR is species and strain related and ranges from <1% to >30%. Compound-induced LR are induced by a wide variety of chemical and physical agents when pregnant animals are exposed during specific gestational periods. A significant portion of the agent-induced LR may be due to maternal factors, as it has been shown that stress alone will induce LR in rodents. SNR are not isolated phenomena and signify basic alterations in the architecture of the axial skeleton. LR are associated with longer ribs, increased numbers of vertebrosternal ribs, and the presence of extra presacral vertebrae ("anteriorization"). CR are associated with reduced numbers of vertebrosternal ribs (posteriorization). It is evident that SNR are not a single anomaly, but consist of two unrelated structures: an extra rib that has a cartilaginous segment at the distal end, and an ossification site that lacks cartilage. These have a bimodal size distribution, with the population of extra ribs being significantly longer than the ossification sites, and 0.6 mm can be used as an approximate length for distinguishing the two populations in mice. Extra ribs are permanent structures in contrast to ossification sites that disappear postnatally, probably becoming part of the lateral transverse vertebral processes. SNR are also found in humans although, in contrast to laboratory species, CR are more commonly noted. SNR are associated with adverse heath effects, and CR with inducing thoracic outlet disease characterized by diminished blood flow and altered position of the ganglia and nerve roots in the area of the C7-T1 vertebrae. LR are associated with lower back pain and L4-5 degeneration. The incidence of CR is greatly reduced in adult humans as compared to fetuses, and it has been hypothesized that fetal "SNR" may be largely composed of ossification sites that disappear postnatally. The mechanisms involved in the formation of extra ribs are not understood at this time, although the fact that the early sensitive periods for their initiation during embryogenesis is coupled with the associated changes in the axial skeleton argues for their induction being due to fundamental changes in gene expression. The sum of the experimental evidence supports the idea of SNR being composed of two different structures: extra ribs that are permanent dysmorphological structures that may be induced by xenobiotics and/or maternal stress, and ossification sites that may be transient variations in the formation of the lateral processes of the vertebrae.

Adult↗
PubMedDate not supplied

The length and ash weight of the ribs of normal and scoliotic persons.

The length and ash weight of ribs were studied in cadaveric specimens from 10 women and eight men with normal spines and from 15 women with scoliosis, six of them with idiopathic right convex thoracic curves. In each case, three rib pairs were removed, those from the scoliotic women corresponding to the apex and the suprajacent and subjacent vertebrae, and those from the normal male and female subjects usually being the 7th-9th. Between the female and the male control groups, there was a significant difference in rib length asymmetry, expressed as the mean of the left minus right difference for the three rib pairs for each person. The difference in ash weight was not significant. There was a significant mean difference in rib length asymmetry between the six patients with right convex thoracic idiopathic scoliosis (concave minus convex rib) and the group of normal females (left minus right rib). Ash weight displayed no significant differences. In five of the six patients with right convex thoracic scoliosis the left ribs of the three examined pairs were on average longer than the right ribs, but the difference was not significant.

Aged↗
PubMed1990

An analysis of the effect of the Zielke operation on the rib cage of S-shaped curves in idiopathic scoliosis.

This report evaluates the rib cage in 16 patients with S-shaped idiopathic scoliosis having the Zielke operation and followed-up for an average period of 30 months. Methods used include Cobb angle and a segmental evaluation (T7-T12) of each of convex and concave rib-vertebra angles (RVAs), rib-vertebra angle differences (RVADs), vertebral rotation, tilt and displacement. Preoperatively, the apical convex ribs droop more than the concave ribs, but the most striking difference is an asymmetry of RVAs, with increasing droop of the concave RVAs from T7-T12. The effect of the Zielke operation (on the lower curve) is: (a) to correct the Cobb angle, vertebral tilt, and displacement of the upper (thoracic) curve; (b) to derotate the spine; (c) to elevate the mobile concave ribs; (d) to have little or no effect on the stiff apical convex ribs; and (e) to increase the droop of the mobile lower convex ribs. During follow-up, six of the upper (thoracic) curves progressed. The apical RVAD and apical convex RVA are not prognostic. The concave RVAs maintain their position while convex RVAs elevate relative to the concave ribs.

Adolescent↗
PubMed2005

Rib length in experimental scoliosis induced by pinealectomy in chickens.

STUDY DESIGN: This study was designed to investigate the difference of rib length of idiopathic scoliosis using experimentally induced scoliosis by pinealectomy in chickens. OBJECTIVE: To find whether the difference of rib length may play a role for the development of scoliosis in pinealectomized chickens. SUMMARY OF BACKGROUND DATA: In experimental and clinical studies, asymmetric growth of the rib has been considered to be one of factors for the development of idiopathic scoliosis. Pinealectomy in chickens consistently produces scoliosis with lordosis, vertebral rotations, and rib humps, which have anatomic characteristics similar to those of human idiopathic scoliosis. METHODS: A total of 30 chickens were divided into two groups: pinealectomy in 15 chickens and sham operation in 15 chickens served as control. The surgeries were performed on the second day after hatching. The chickens in both groups were killed at 3 months of age. The spines were examined radiologically for the presence of a scoliotic curve. Also, the ribs at each level were measured and compared between left and right sides. RESULTS: All pinealectomized chickens that developed scoliosis showed rib humps. In contrast, none of chickens in a sham operation developed scoliosis. In both groups, there were no significant asymmetries in the rib length. CONCLUSION: Our results indicated that rib length was not related to the experimental scoliosis examined in this study. Further study is encouraged to investigate if the asymmetric rib length plays a role in causing or promoting other types of scoliosis, especially in primate or human idiopathic scoliosis.

Animals↗
PubMed2003

Investigation of the safety and accuracy of intraoperative gamma probe directed biopsy of bone scan detected rib abnormalities in prostatic adenocarcinoma.

PURPOSE: We evaluated the technique of intraoperative gamma probe directed rib biopsy in patients with suspected metastatic prostate adenocarcinoma. This technique can be used to identify accurately the rib in question, reliably obtain sufficient tissue for diagnosis, be performed with minimal patient morbidity and potentially alter the course of therapy. MATERIALS AND METHODS: From 1996 to 2001, 8 patients with biopsy proved adenocarcinoma of the prostate and suspicious rib lesions on radionuclide bone scanning underwent open rib biopsy as part of the evaluation for metastatic disease. Mean prostate specific antigen in the patient population was 17.1 ng/ml (range 6.1 to 36.5) and clinical stage was T1c to T3c. A new technique of intraoperative gamma probe directed biopsy was used to localize and resect the rib in question. At 6 to 12 hours before the operation each patient received an intravenous injection of 28 mCi. (99m)technetium-oxidronate. The hand held, pencil sized gamma probe in a sterile sleeve was used to localize the area of greatest activity in the target bone and 3 cm. of bone were resected. RESULTS: Of the 8 patients who underwent the procedure 2 had metastatic prostate cancer on final rib pathological findings. Four of the remaining 5 patients had benign rib lesions (an old rib fracture) and 1 had metastatic lung cancer. The hot spot on bone scan was localized with 100% accuracy using our technique and a pathological diagnosis was made in all cases. Mean operative time was 61 minutes and estimated blood loss was less than 20 ml. in all cases. Seven of the 8 patients were discharged home the same day, while 1 required overnight hospitalization. There was 1 intraoperative complication of inadvertent entry into the pleural cavity, resulting in a small pneumothorax, which was treated with small chest catheter drainage and observation. CONCLUSIONS: Intraoperative gamma probe directed rib biopsy of suspected metastatic lesions in patients with prostate cancer can be safely and accurately performed with minimal patient morbidity. The information obtained using this technique can be used to tailor treatment decisions for this subset of patients with prostate cancer.

Adenocarcinoma↗
PubMed2003

Rib fracture pain and disability: can we do better?

OBJECTIVE: The purpose of this study was to determine the magnitude and duration of pain and disability in patients with rib fractures treated using current standard therapy. This was a prospective case series. METHODS: Injured patients with a chest radiographic diagnosis of one or more rib fractures between June 1, 2001, and October 31, 2001, were asked to participate. Pain levels were assessed at days 1, 5, 30, and 120 after injury using a visual pain scale (0-10). Disability at 30 days was assessed using the SF-36 Health Status Survey, and the total number of days lost from work/usual activity was recorded at day 120. The setting was a university-based Level I trauma center. RESULTS: Forty patients with a mean of 2.7 +/- 1.6 rib fractures were enrolled. Twenty-three patients had isolated rib fractures and 17 patients had associated extrathoracic injuries. Mean rib fracture pain was 3.5 +/- 2.1 at 30 days and 1.0 +/- 1.4 at 120 days. For patients with associated extrathoracic injuries, rib pain was equivalent to pain in the rest of the body at all intervals. When compared with the chronically ill reference population of the RAND Medical Outcomes Study, our patients as a group were more disabled at 30 days (p < 0.001) in all categories except emotional stability, where they showed equivalent disability, and in their perception of general health, where they were significantly less disabled (p < 0.001). The total mean days lost from work/usual activity was 70 +/- 41. Patients with isolated rib fractures went back to work/usual activity at a mean of 51 +/- 39 days compared with 91 +/- 33 days in patients with associated extrathoracic injuries (p < 0.01). CONCLUSION: Rib fractures are a significant cause of pain and disability in patients with isolated thoracic injury and in patients with associated extrathoracic injuries. Developing new therapies to accelerate pain relief and healing would substantially improve the outcome of patients with rib fractures.

Activities of Daily Living↗
PubMed1985

The significance of first and second rib fractures.

There are differing opinions in the literature regarding the significance of first rib fractures. The plan at Westmead Centre is to standardize the initial assessment of patients with such fractures. A 3 year retrospective study of 170 trauma victims who sustained fractured ribs, was undertaken. Of the 15 patients with first rib fracture, all were involved in motor vehicle accidents. Over two-thirds of these patients sustained major chest injuries. Multisystem trauma involving cranial, abdominal or skeletal injury was common. One patient died as a result of head injury. Similar results were observed in 13 patients with second rib fractures. Brachial plexus injuries were noted in two patients with first rib fracture. Despite follow-up of high-risk patients at an interval which varied from 1 to 2 1/2 years after the original injury, major subclavian artery injury was not detected in patients with first rib fracture. From this experience and a literature review, we suggest that the general nature of trauma is similar in patients with first rib fracture to that in patients with second rib fracture. Patients with first rib fracture should be closely examined for neurovascular compromise. Guidelines for the use of angiography are discussed. If there is no evidence of neurovascular injury at presentation, and there is no other thoracic injury, recovery should be uneventful.

Adult↗
PubMed1981

The ribs in thalassemia. I. The relationship to therapy.

A spectrum of rib changes was seen in 32 patients with thalassemia. Eleven patients had normal ribs, and 21 patients demonstrated at least one abnormality. The rib changes in patients who had been treated with a low transfusion regimen (designed to maintain the hemoglobin level at 5-6 g/100 ml) were compared with the changes in patients who had been treated with a hypertransfusion regimen (designed to maintain the hemoglobin level above 9.4-19 g/100 ml). Ten of the 11 patients (91%) with normal ribs were younger than five years when first hypertransfused, while only three of the 21 patients (14%) with abnormal ribs were younger than five. The type of rib abnormality was related to the age of onset of the low transfusion regimen. Those patients with abnormal but nonwidened ribs had been started on the low transfusion regimen earlier than those patients with the same abnormality and widened ribs. Fifteen of the 21 patients showed regression of the abnormal findings; approximately two thirds of the rib abnormalities did not regress until after the onset of a hypertransfusion regimen.

Adolescent↗
PubMed1995

Fractures of the first rib in child abuse.

PURPOSE: To evaluate the incidence and specificity of fracture of the first rib as an indicator of child abuse and to determine a mechanism of fracture. MATERIALS AND METHODS: All infants and young children with rib fractures who were seen at the radiology department of an academic medical center over a 2-year period were identified from the radiology data base. RESULTS: Rib fractures were attributed to child abuse in 12 of 35 children identified. Apart from a neonate with congenital osteogenesis imperfecta, only three children, all abused, had first-rib fracture, one bilaterally. Two additional children with first-rib fracture were identified from years prior to the study period. In four children, first-rib fractures were "isolated," without fractures of adjacent bones. CONCLUSION: Child abuse should be considered in cases of pediatric rib fracture, particularly fracture of the first rib. Possible mechanisms for first-rib fracture include impact force, compressive force, and shaking or acute axial load (slamming), which cause an indirect fracture.

Academic Medical Centers↗
PubMed1986

An analysis of possible movements of human upper rib cage.

A geometrically realistic mathematical model of the first six ribs and vertebrae of the human rib cage is described. Under the assumption that the individual elements of the rib cage do not deform significantly, the possible range of movements of the model are determined subject to the constraint that the joint surfaces remain in contact. It is shown that normal movements of the ribs cannot be described as a rotation about a single fixed axis. The possible movements of the ribs are analyzed in terms of the misfit incurred at the costovertebral joint surfaces. This analysis shows that there is a movement, corresponding to lateral expansion of the rib for an increase in anteroposterior diameter, in which the misfit at the joint is minimized and also that small deviations from this movement involve only very small degrees of misfit at the joint surfaces. It is concluded that many observed "deformations" of the chest wall can be explained by rigid ribs and normal movements at the costovertebral joints. The interaction between the ribs and the spine is analyzed. It is shown that there can be considerable independent movement of the sternum and the spine, thus allowing mobility of the spine without forcing concomitant movements of rib cage.

Biomechanical Phenomena↗
PubMed1992

Analysis of human chest wall motion using a two-compartment rib cage model.

We present a model of chest wall mechanics that extends the model described previously by Macklem et al. (J. Appl. Physiol. 55: 547-557, 1983) and incorporates a two-compartment rib cage. We divide the rib cage into that apposed to the lung (RCpul) and that apposed to the diaphragm (RCab). We apply this model to determine rib cage distortability, the mechanical coupling between RCpul and RCab, the contribution of the rib cage muscles to the pressure change during spontaneous inspiration (Prcm), and the insertional component of transdiaphragmatic pressure in humans. We define distortability as the relationship between distortion and transdiaphragmatic pressure (Pdi) and mechanical coupling as the relationship between rib cage distortion and the pressure acting to restore the rib cage to its relaxed configuration (Plink), as assessed during bilateral transcutaneous phrenic nerve stimulation. Prcm was calculated at end inspiration as the component of the pressure displacing RCpul not accounted for by Plink or pleural pressure. Prcm and Plink were approximately equal during quiet breathing, contributing 3.7 and 3.3 cmH2O on average during breaths associated with a change in Pdi of 3.9 cmH2O. The insertional component of Pdi was measured as the pressure acting on RCab not accounted for by the change in abdominal pressure during an inspiration without rib cage distortion and was 40 +/- 12% (SD) of total Pdi. We conclude that there is substantial resistance of the human rib cage to distortion, that, along with rib cage muscles, contributes importantly to the fall in pleural pressure over the costal surface of the lung.

Adult↗
PubMed2000

Cause and clinical characteristics of rib fractures in infants.

OBJECTIVE: Rib fractures are uncommon in infancy and, when diagnosed, often raise the suspicion of child abuse. However, the prevalence of other causes of rib fractures has not been well defined. The purpose of this study was to determine the causes and clinical presentations of rib fractures in infants <12 months old. METHODS: Retrospectively, we identified all infants with rib fractures under 12 months old over a 3-year period using computerized databases at the Children's Hospital Medical Center in Cincinnati, Ohio and at the Children's Hospital, Winnipeg, Manitoba, Canada. Data extracted from the individual patient charts included: age, sex, chief complaint, number and location of rib fractures, associated injuries, birth history, history of cardiopulmonary resuscitation, and any evidence of bone dysplasia. After the chart review and a review of the radiographs by a pediatric radiologist, all fractures were determined to be attributable to one of the following causes: child abuse, birth injury, bone fragility, or accidental trauma. A determination of abuse was made when there were other injuries indicative of abuse, there was no clinical or radiographic evidence of bone fragility, there was a confession of abuse, when no reasonable history of trauma was provided, or when the history was not plausible to explain the rib fractures. Standard practice at these hospitals involves obtaining skeletal surveys on all children <2 years old when abuse is suspected. The child abuse team, which consists of physicians, nurses, and social workers, conducts these investigations and works closely with police in evaluating these children. RESULTS: Thirty-nine infants with rib fractures were identified. Thirty-two (82%) were caused by child abuse. Three (7. 7%) were attributable to accidental injuries, 1 (2.6%) was secondary to birth trauma, and 3 (7.7%) were attributable to bone fragility. All 3 infants with fractures from accidental injury had sustained notable trauma (a motor vehicle collision, a forceful direct blow, and a fall from a height). Of the 3 infants with fractures secondary to bone fragility, 1 infant had osteogenesis imperfecta, 1 infant had rickets, and 1 infant, who was born at 23 weeks' gestation, had fragile bones attributable to prematurity. CONCLUSIONS: Most rib fractures in infants are caused by child abuse. Although much less common, rib fractures can also occur after serious accidental injuries, birth trauma, or secondary to bone fragility. A thorough clinical and imaging evaluation is mandatory.

Birth Injuries↗
PubMed2006

Effects of polyvinyl chloride overwrap film, high-oxygen modified atmosphere packaging, or ultra-low-oxygen modified atmosphere packaging on bone marrow discoloration in beef humerus, rib, thoracic vertebra, and scapula.

Meat retailers have reported bone marrow discoloration to be a problem, especially in modified atmosphere packages (MAP). Therefore, it is important to determine the prevalence and cause(s) of bone marrow discoloration in different beef bones and packaging systems. Thirty-six beef humeri, ribs, scapulas, and thoracic vertebrae from USDA Select and Choice carcasses were obtained from a commercial abattoir, cut into 2.54-cm-thick sections at 4 d postmortem, and packaged into 1 of 3 systems: 1) polyvinyl chloride film (PVC) overwrap; 2) high-oxygen (80% O2, 20% CO2) MAP; and 3) ultra-low-oxygen (70% N2, 30% CO2) MAP. Instrumental reflectance and visual color scores were taken on d 0, 2, and 4, and on d 0 to 4 of display, respectively. Bone marrow was extracted from humeri, ribs, and thoracic vertebrae for analysis but not from scapulas. Ribs, scapulas, and thoracic vertebrae packaged in PVC and high-oxygen MAP developed undesirable gray or black discoloration. In ultra-low-oxygen MAP, mean visual color scores were acceptable throughout the entire display period. Discoloration (darkening) was more extensive for ribs, scapulas, and thoracic vertebrae than for humeri, especially for bones packaged in PVC and high-oxygen MAP. Humeri had lower (P < 0.05) a* values (larger positive a* values indicate a redder color) than the other bones. The a* values for ribs, scapulas, and thoracic vertebrae decreased (P < 0.05) over time. Chroma showed that bone marrow discolored during display, but graying was dramatically less for all bones packaged in ultra-low-oxygen MAP and for humeri in PVC and high-oxygen MAP. Humeri marrow had lower (P < 0.05) 2-thiobarbituric acid reactive substances (TBARS) than did ribs and thoracic vertebrae marrow. Ultra-low-oxygen MAP resulted in the least amount of change in TBARS from d 0 to 4, whereas thoracic vertebrae marrow had greater (P < 0.05) TBARS values at d 4 of display than at d 0 in PVC and high-oxygen MAP. Humeri marrow had dramatically less total Fe and hemoglobin than did that of ribs and thoracic vertebrae for all packaging systems. Myoglobin was undetectable in humeri marrow. The much larger amounts of Fe and hemoglobin in ribs and thoracic vertebrae likely contribute to marrow discoloration. Bone marrow discoloration was distinct in ribs, scapulas, and thoracic vertebrae packaged in PVC or high-oxygen MAP. Bones packaged in ultra-low-oxygen MAP had minimal discoloration.

Animals↗
PubMed1998

A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions.

OBJECT: Autogeneic bone graft is often incorporated into posterior cervical stabilization constructs as a fusion substrate. Iliac crest is used frequently, although donor-site morbidity can be substantial. Rib is used rarely, despite its accessibility, expandability, unique curvature, and high bone morphogenetic protein content. The authors present a comparative analysis of autogeneic rib and iliac crest bone grafts, with emphasis on fusion rate and donor-site morbidity. METHODS: A review was conducted of records and radiographs from 600 patients who underwent cervical spinal fusion procedures in which autogeneic bone grafts were used. Three hundred patients underwent rib harvest and posterior cervical fusion. The remaining 300 patients underwent iliac crest harvest (248 for an anterior cervical fusion and 52 for posterior fusion). The analysis of fusion focused on the latter subgroup; donor-site morbidity was determined by evaluating the entire group. Fusion criteria included bony trabeculae traversing the donor-recipient interface and long-term stability on flexion-extension radiographs. Graft morbidity was defined as any untoward event attributable to the graft harvest. Statistical comparisons were facilitated by using Fisher's exact test. CONCLUSIONS: Demographic data obtained in both groups were comparable. Rib constructs were placed in the following regions: occipitocervical (196 patients), atlantoaxial (35 patients), and subaxial cervical spine (69 patients). Iliac crest grafts were placed in the occipitocervical (28 patients), atlantoaxial (10 patients), and subaxial cervical (14 patients) regions. Fusion occurred in 296 (98.8%) of 300 rib graft and 49 (94.2%) of 52 iliac crest graft constructs (p = 0.056). Graft morbidity was greater with iliac crest than with rib (p < 0.00001). Donor-site morbidity for the rib graft was 3.7% and included pneumonia (eight patients), persistent atelectasis (two patients), and superficial wound dehiscence (one patient). Pneumothorax, intercostal neuralgia, and chronic chest wall pain were not encountered. Iliac crest morbidity occurred in 25.3% of the patients and consisted of chronic donor-site pain (52 patients), wound dehiscence (eight patients), pneumonia (seven patients), meralgia paresthetica (four patients), hematoma requiring evacuation (three patients), and iliac spine fracture (two patients). Even when chronic pain was not considered, morbidity encountered in obtaining iliac crest still exceeded that encountered with rib harvest (p = 0.035). The fusion rate and donor-site morbidity for rib autograft compare favorably with those for iliac crest when used in posterior cervical constructs. To the authors' knowledge, this represents the largest series to date in which the safety and efficacy of using autogeneic bone graft materials in spinal surgery are critically analyzed.

Adult↗
PubMed2005

[A modified retroperitoneal approach to the kidney in patients with a highly deformed thorax: obtaining a wide operative field through subperiosteal resection of the 10th, 11th and 12th ribs].

We herein report a technique which facilitates a retroperitoneal approach to the kidney in cases of highly deformed thorax due to kyphoscoliosis. The operation consists of a lumbar oblique incision with removal of the 11th rib, combined with the additional removal of the 12th and 10th ribs. Resection of the upper two ribs was performed subperiosteally, leaving the periosteum of the deep side untouched. However, the deep side periosteum of the 12th rib was incised caudal from the pleural margin in order to facilitate exposure of the diaphragm. The retroperitoneal space was entered through the tip of the 11th rib bed. The diaphragm was incised dorso-medially at a level 1 cm caudal from the lower margin of the pleura, to an extent necessary to enable the pleura together with the cranial diaphragm to be manoeuvred in an upward direction. Two cases with renal tuberculosis associated with high-grade kyphosis and one case with staghorn calculi accompanied with lordosis were operated on utilizing this technique. In the former two cases, the thoracic cage was in direct contact with the iliac bone and there was practically no space between the rib border and the iliac crest. This was also true of the third case, but the grade of deformity was not as extensive as in the former two cases. Removal of the 10th, 11th and 12th ribs could be achieved without injuring the pleura and a satisfactorily large operating field could thus be developed which enabled a simple nephrectomy to be performed without difficulty. The characteristic feature of the described approach is that resection of the 10th and 11th ribs is simply to facilitate manoevrability of the wound margin, without going through the rib bed. The technique could be advantageous in selected cases where there is a highly deformed thorax.

Humans↗
PubMed2000

Rib fracture patterns and radiologic detection--a restraint-based comparison.

This paper presents a study of the rib fracture patterns generated in simulated frontal collisions and the visibility of the rib fractures on plain film radiographs. Using 29 cadaver subjects, rib fractures were identified on oblique, lateral, and anteroposterior chest films by five radiologists independently and were compared with fractures found during a detailed necropsy. Physical, geometric, and experimental factors demonstrated an influence on the ability of a radiologist to identify rib fractures on an x-ray. Specifically, the restraint system configuration, the total number of fractures, the circumferential location of the fracture, the rib number, and the aspect (right or left) affected fracture identification. The results verify that torso belt loading produces rib fractures generally located along the path of the belt whereas superimposed airbag loading results in a more distributed and posterolateral fracture pattern. A higher proportion of rib fractures was identified on x-ray for occupants restrained by only a belt (44% of fractures) than for occupants restrained by both a belt and an airbag (24% of fractures). Overall, less than 40% of the rib fractures were detected upon an initial examination of radiographs. After being provided with the location of all fractures, detection increased to 49%. On average, occult rib fractures resulted in an average underreporting of injury severity of more than one AIS level.

Acceleration↗