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At least 217 records · Page 12Linked to original sources
PubMed1997

Rib cage-spine coupling patterns involved in brace treatment of adolescent idiopathic scoliosis.

STUDY DESIGN: The three-dimensional (3-D) interrelations in the correction of the spine and rib cage produced by the Boston brace were analyzed in a group of adolescents with idiopathic scoliosis. OBJECTIVES: To investigate the coupling movements between the spine and rib cage initiated by brace wear (i.e., the displacements of the spine that take place in other directions than the ones generated by brace pressures on the thorax). SUMMARY OF BACKGROUND DATA: The effects of thoraco-lumbo-sacral orthosis in the frontal plane have been well documented, but they have never been studied in terms of 3-D coupled movements between the spine and rib cage. METHODS: The spine and rib cage of 36 adolescents with idiopathic scoliosis with and without their Boston brace were reconstructed in 3-D using a stereo-radiographic technique. Several geometric indices were evaluated on the trunk, and the relative motions of the spine and rib cage resulting from brace wearing were compared by means of Student t tests, Pearson correlation matrices, and linear regressions. RESULTS: Rib cage transverse plane translations resulting from brace pressures are related to those of the spine. Coupled movements between the spine and rib cage were found to alter substantially the expected 3-D correction of the trunk. Significant anterior displacements of the thorax were observed and were statistically associated with lateral displacements of the spine and with an increase of spinal thoracic curvatures in the frontal and sagittal planes. CONCLUSION: Brace loads are not applied in an optimal way to correct the 3-D deformities associated with thoracic idiopathic scoliosis. Loads applied on the posterior rib hump should be reequilibrated to reduce anterior displacement of the trunk.

Biomechanical Phenomena↗
PubMed1997

Scoliosis and fused ribs. A case report.

STUDY DESIGN: This case report illustrates a scoliotic patient with congenital fusion of several ribs associated with a thoracic curvature. OBJECTIVES: To report the procedure used to correct scoliosis in association with congenitally fused ribs. SUMMARY OF BACKGROUND DATA: All cases of congenitally fused ribs reported in the literature are associated with malformed vertebrae. For this reason, the only proposed treatment for patients with progressive scoliosis is a spinal fusion. This report presents the first case of progressive scoliosis associated with fused ribs, but without vertebral malformation, that was managed by resection of these ribs. METHODS: When worsening of the thoracic scoliosis was observed from 30 degrees at 13 months to 44 degrees at 4 years, the three fused ribs were resected en bloc. No spinal fusion was performed. The spine was held in correction by a localizer cast for 3 months. RESULTS: Fourteen years after treatment, the spine is almost normal; thoracic and lumbar curves are 10 degrees. CONCLUSIONS: When malformed fused ribs are on the concave side of a progressive scoliosis with no vertebral malformation at the same level, resection of these ribs is probably an efficient and sufficient method of treatment.

Humans↗
PubMed2005

Stability provided by the sternum and rib cage in the thoracic spine.

STUDY DESIGN: Multidirectional flexibility tests were conducted on 10 human thoracic spines with intact rib cage. OBJECTIVES: To determine the amount of stability the rib cage imparts to the thoracic spine and to show the amount of stability lost by a sternal fracture. SUMMARY OF BACKGROUND DATA: There is no published study of biomechanical testing of human cadaveric specimens with the rib cage intact. METHODS: In this study, 10 human cadaveric thoracic spines with the rib cage intact were tested using a biaxial material testing machine and an opto-electronic three-dimensional motion measuring device (Opto-trak 3020). The specimens were tested in axial compression, axial rotation, lateral bending, and flexion/extension. First, the specimens were tested through all four loading types with the sternum and rib cage intact. Next, the sternum was fractured at the sternomanubrial junction displacing the proximal fragment posteriorly. Lastly, the entire rib cage was removed. RESULTS: The rib cage increased the stability of the thoracic spine by 40% in flexion/extension (P = 0.012), 35% in lateral bending (P = 0.008), and 31% in axial rotation (P = 0.008). An indirect flexion-compression type of sternal fracture decreased the stability of the thoracic spine by 42% in flexion/extension (P = 0.036), 22% in lateral bending (P = 0.038), and 15% in axial rotation (P = 0.011). CONCLUSION: The rib cage significantly increases the stability of the thoracic spine in flexion/extension, lateral bending, and axial rotation. A sternal fracture significantly decreases the stability of the thorax.

Aged↗
PubMed2003

The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children.

BACKGROUND: Rib fractures have a strong association with nonaccidental trauma (NAT) and severe trauma. The purposes of this study were to evaluate rib fractures in children to determine (1) the positive predictive value of a rib fracture in defining NAT and (2) the frequency of rib fractures as the only skeletal manifestation of NAT. METHODS: We reviewed the medical records and imaging of all children with rib fractures over a 6-year period. NAT was determined by the Child Advocacy and Protection team. RESULTS: In children younger than 3 years of age, the positive predictive value (PPV) of a rib fracture as an indicator of NAT was 95%. The positive predictive value increased to 100% once historical and clinical circumstance excluded all other causes for rib fractures. CONCLUSION: In this study, rib fracture(s) were the only skeletal manifestation of NAT in 29% of the children.

Adolescent↗
PubMed1992

The electro-mechanical response of canine inspiratory intercostal muscles to increased resistance: the cranial rib-cage.

1. The effect of graded increases in inspiratory airflow resistance on the electrical activity and the mechanical behaviour of the three groups of inspiratory intercostal muscles (parasternal intercostal, external intercostal, levator costae) situated in the cranial portion of the rib-cage has been studied in ten anaesthetized, spontaneously breathing dogs. The mechanical behaviour of the muscles was determined by measuring the respiratory changes in muscle length and the displacements of the rib. 2. During unloaded inspiration, the three muscles were active, the rib moved in the cranial direction, and the parasternal intercostal and levator costae muscles shortened; in most animals, the external intercostals shortened as well. 3. Graded increases in inspiratory airflow resistance elicited a progressive inhibition of parasternal intercostal activity and a gradual facilitation of external intercostal and levator costae activities. Concomitantly, the parasternal intercostals continued to shorten during inspiration. However, both the external intercostals and the levator costae progressively lengthened, and the rib was gradually displaced in the caudal direction. This pattern persisted after increases in chemical respiratory drive had developed. 4. Sectioning the phrenic nerve roots did not alter the electrical or the mechanical response of the parasternal intercostal muscles to loading, but it markedly affected the response of the external intercostals and levator costae. After phrenicotomy, the external intercostals and levator costae continued to shorten during loaded breaths, the rib continued to be displaced in the cranial direction, and although the rate of inspiratory muscle shortening and of rib motion decreased, the facilitation of external intercostal and levator costae activities was markedly reduced or abolished. 5. Lengthening of the external intercostals and caudal displacement of the rib was reproduced by isolated stimulation of the phrenic nerves. 6. The reflex facilitation of external intercostal and levator costae activities that takes place during inspiratory resistive loading thus results primarily from the collapsing action of the diaphragm on the cranial portion of the rib-cage and the consequent lengthening of these muscles. The mechanical effectiveness of this reflex facilitation, however, appears to be relatively small.

Airway Obstruction↗
PubMed1982

Action of costal and crural parts of the diaphragm on the rib cage in dog.

We studied the action of the costal and crural (vertebral) parts of the diaphragm on the lower rib cage in normal supine dogs. The two parts of the diaphragm were separately stimulated by electrodes directly implanted in the muscle or via the different phrenic nerve roots in the neck. The results of the experiments indicate the following. 1) The costal and crural parts of the diaphragm have a different segmental innervation and a different mechanical action on the rib cage. 2) The costal diaphragm expands the lower rib cage when it contracts. This rib-cage expansion is due mostly to the fulcrum of the abdominal contents and partly to the rise in abdominal pressure that takes place during diaphragmatic contraction. The pericardial attachments play no role in this action of the diaphragm. 3) The action of the crural diaphragm on the lower rib cage depends only on the balance between the inspiratory force exerted by the rise in abdominal pressure and the expiratory force exerted by the fall in pleural pressure. In the intact animal at functional residual capacity, these two opposite effects cancel each other. 4) The inflationary action of both parts on the rib cage decreases progressively as lung volume increases. The findings also suggest that the rise in abdominal pressure which occurs when the diaphragm contracts expands the lower rib cage by acting through the area of apposition of the diaphragm to the rib cage. These findings also strengthen the idea that the diaphragm actually consists of two muscles.

Abdomen↗
PubMed1986

An analysis of action of intercostal muscles in human upper rib cage.

The actions of the intercostal and paraspinal muscles in stabilizing the human upper rib cage have been analyzed using a geometrically realistic mathematical model of the first six ribs, vertebrae, and associated musculature. The model suggests roles of the deep layers of erector spinae in stabilizing the vertebral column so that it can support the loads placed upon it by the ribs under physiological load. If we assume that the tension exerted by an intercostal muscle is proportional to its local thickness, the model predicts that the observed distribution of intercostal thickness is close to that which minimizes the stresses in ribs when the model is subjected to peak physiological load. The observed shape of the ribs are optimal to withstand the calculated pattern of loading along their length. These calculations raise the hypothesis that the arrangement of intercostal musculature and rib geometry result in an optimally light rib cage, which is capable of withstanding the loads placed upon it. The analysis of the mechanics of the entire model indicates that the geometrical simplifications made in Hamberger's model are not valid when applied to the rib cage.

Biomechanical Phenomena↗
PubMed2000

Sclerotomal origin of the ribs.

The somites of vertebrate embryos give rise to sclerotomes and dermomyotomes. The sclerotomes form the axial skeleton, whereas the dermomyotomes give rise to all trunk muscles and the dermis of the back. The ribs were thought to be ventral processes of the axial skeleton and therefore to be derived from the sclerotomes; however, recently a dermomyotomal origin of the distal rib (the costal shaft) was suggested, with only the proximal parts (head and neck of the rib) being of sclerotomal origin. We have re-investigated the development of the ribs in quail-chick chimeras and carried out three experimental series. (1) Single dermomyotomes and (2) single sclerotomes were grafted homotopically, and (3) the ectoderm overlying the unsegmented paraxial mesoderm was removed in the prospective thoracic region. We found that the cells of the dermomyotome gave rise to epaxial and hypaxial trunk muscles, dermis of the back and endothelial cells, but not to ribs. Cells of the sclerotome formed the axial skeleton and all parts of the ribs. Ablation of the ectoderm, which affects dermomyotome development, results in severe malformations of the ribs, probably due to disturbed interactions between dermomyotome and sclerotome. Our results strongly confirm the traditional view of the sclerotomal origin of the ribs.

Animals↗
PubMed2005

Three developmental compartments involved in rib formation.

When the thoracic somitic mesoderm was separated from the neural tube and the notochord with a piece of aluminum foil in two-day chick embryos, seven days after the operation ribs lacked their proximal part. The embryos were rescued by co-transplanting the notochord, the ventral half of neural tube, or QT6 cells transformed with Shh, on the somite side of the aluminum foil insert. Thus, proximal rib development depends on the notochord and the ventral neural tube, an effect which might be mediated through Shh secreted by these axial tissues. On the other hand, when the thoracic somitic mesoderm was separated from the surface ectoderm by a piece of polyethylene terephthalate film, the distal parts of the ribs were missing, suggesting that distal rib development depends on surface ectoderm. In these embryos, expression of Pax3 was weak and perturbed showing that the dermomyotome developed abnormally. It is not clear whether the development of distal rib is mediated by the dermomyotome, or the ectoderm. It has previously been shown that sternal rib development depends on lateral plate mesoderm. As to the distal rib, it is considered to be composed of two parts. Thus, the rib is composed of three developmental compartments, in agreement with a recently presented classification of somite derivatives as primaxial and abaxial.

Animals↗
PubMed2005

Effects of the rib cage on thoracic spine flexibility.

Besides protecting the internal organs of the thorax, the rib cage is the site of numerous muscle attachments. It also decreases the overall flexibility of the thoracic spine. This study developed finite element (FE) models of the thoracic spine with and without the rib cage, and the effects of the rib cage on thoracic spine flexibility were determined. The numerical models were validated by comparing the maximum rotation of the models for several loading cases with experimental data in the literature. After adapting the material properties for the discs and ligaments, the calculated maximum rotations differed from the measured median values by less than 1 degrees without the rib cage and by less than 2.5 degrees with it. The rib cage decreased the mean flexibility of the thoracic spine by 23% to 47%, depending on the loading plane. Assuming the ribs to be rigid beams required a corresponding reduction of ligament stiffnesses in order to achieve the same agreement of the maximum rotations with the measured median values. Interconnecting the FE thoracic spine model plus rib cage with the existing detailed FE lumbar spine model improves the simulation of force directions of muscles attached to the rib cage or thoracolumbar spine. In addition, such a model is suitable for determining the effects of lumbar spine implants on spinal balance.

Computer Simulation↗
PubMed1991

Rib fractures in athletes.

Rib fractures are the most common serious injury of the chest. They occur most commonly in the middle and lower ribs with blunt trauma, and also with direct force to a small area of the chest wall and violent muscle contractions. Diagnosis is generally not difficult. The athlete should have a chest x-ray to confirm the diagnosis. Differential diagnosis includes severe rib contusion, costochondral separations, muscle strains and pneumothorax. If no internal problems exist, treatment consists of ice, NSAIDs, analgesics and a rib belt or tape. Healing should be well on its way before a return to sports. Fractures of the first 4 ribs or the last 2 ribs, multiple fractures and flail segments are less benign than other fractures, and may result in injury to surrounding structures. First rib and floating rib fractures are uniquely athletic fractures; they are avulsion fractures caused by a sudden vigorous contraction in different directions of pull.

Athletic Injuries↗
PubMed1988

Factors affecting visualization of posterior rib fractures in abused infants.

Rib fractures frequently are encountered in abused infants and commonly occur in the posterior rib arcs. Fractures occurring near the costovertebral articulations are rarely identified radiographically in the acute phase, and callus formation usually is the first indication of injury. To assess the factors influencing the visibility of fractures near the costovertebral articulations in abused infants, 103 posterior rib fractures occurring in 16 abused infants were studied radiologically. The plain radiologic studies were correlated with the pathologic findings in 15 ribs from four patients. The limited visibility of fractures relates to (1) the frequent superimposition of the transverse process over the rib fracture site, (2) a fracture line that crosses at an obliquity to the radiographic beam, and (3) nondisplacement of rib fragments due to preservation of the posterior periosteum. Fresh fractures invisible on a frontal projection are clearly defined when the rib is viewed axially with postmortem radiography. These findings explain the reported superior sensitivity of radionuclide bone scans vs radiography in the identification of fresh posterior rib fractures. A knowledge of the factors influencing the visibility of these important injuries is useful in planning an appropriate diagnostic evaluation in cases of suspected infant abuse.

Child Abuse↗
PubMed2004

Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results.

REASONS FOR PERFORMING STUDY: Fractured ribs are encountered quite frequently in newborn Thoroughbred foals, often with fatal outcome. Surgical repair of fractures therefore requires consideration as a means of reducing mortality. OBJECTIVES: To evaluate the repair of rib fractures using internal fixation techniques in foals at 2 different equine hospitals following similar diagnostics and case selection. METHODS: The records of 14 foals that underwent internal fixation of fracture ribs were reviewed. Subject details, clinical presentation, diagnosis, surgical technique, post operative care and complications were recorded. Follow-up information was obtained in 7 foals. RESULTS: The fractured ribs were reduced and stabilised using reconstruction plate(s), self-tapping cortical screws and cerclage wire in 12 cases, Steinmann pins and cerclage wires in 1 case and both techniques in 1 case. Not every rib was reduced on each case. Surgical reduction was performed on an average of 2 ribs, range 1-3 ribs in each foal. At the time of writing, 4 foals had been sold, one age 2 years was in training and 2 others died from unrelated causes. CONCLUSIONS: Our data support the use of surgical stabilisation utilising reconstruction plates, self-tapping cortical screws and cerclage wire for selected cases of thoracic trauma in neonatal foals. The use of Steinmann pins may be suboptimal due to cyclic failure, implant migration and the potential for iatrogenic internal thoracic trauma. POTENTIAL RELEVANCE: Foals with existing extensive internal thoracic trauma resulting from rib fracture(s), or the potential for such trauma, previously considered to have a guarded to poor prognosis for survival, may be successfully managed with internal fixation of selected fracture sites.

Animals↗
PubMed1976

[Transitional forms of the cervical and first ribs].

The upper ribs possessing the signs of both cervical and first ribs (such as the size, conjunction with the sternum, dilatation of the superior intercostal spaces, double width and others) are the intermediate forms. Small dimension fluorography of 400.000 humans with roentgenographical control has revealed 468 persons with transitional forms of cervical and first ribs (0,12%), i. e. one case per 800 humans at an average. Transitional forms of cervical and first ribs can be grouped as follows: asymmetry of clavicles, asymmetry of the upper ribs, close position of the upper ribs, double width of the first ribs, conjunction of the cervical and first ribs at the vertebrum.

Clavicle↗
PubMed2002

Spine-rib rotation differences at the apex in preoperative patients with adolescent idiopathic scoliosis: evaluation of a three-level ultrasound method.

This paper evaluates a new real-time ultrasound method to assess the difference between axial spinal (laminal) rotation and rib rotation at the apex of the scoliosis curve. An Aloka SSD 500 portable ultrasound machine with a veterinary long (172mm) 3.5 MHz linear array transducer was used to assess the reproducibility of the method in 13 preoperative patients with AIS. With the subject in a prone position and her head supported, readings of laminal and rib rotation were made directly on the back at 18 and 12 levels respectively The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). All the readings were made by one observer (ASK). After plotting on graphs three levels of maximal difference between spine rotation and rib rotation about the apex were chosen visually by one observer (RGB) for which the mean apical spine-minus-rib rotation difference (SRRD) was calculated for each repeat. Findings for apical SRRDs. The mean apical SRRDs for the two repeats are 7.1 degrees and 6.9 degrees (range 2-18 degrees) with coefficients of variation of 49% and 62% respectively. Reproducibility. Graphic representation of spinal and rib rotation by 12 levels shows a fairly good agreement between repeats for most subjects. Spinal rotation is always greater than rib rotation. A paired t-test for the mean apical SRRD of the repeats shows no significant difference. Linear regression analysis of the mean apical SRRD repeats correlate significantly (r=0.70, P=0.008) with a residual mean square of 6.9 degrees (rms = 2.6 degrees). The technical error of the measurement (TEM) is 2.3 degrees and coefficient of reliability (R) 0.66. Conclusions. Real-time ultrasound can assess the difference between spinal and rib rotation about the apex of the scoliosis curve without the altered position detectably affecting the findings. The error (2-3 degrees) is high relative the mean apical SRRD (6-7 degrees). The apical SRRD findings have relevance to the pathogenesis of AIS.

Adolescent↗
PubMed2006

Semi-automatic detection of scoliotic rib borders using chest radiographs.

Stereoradiography is a well known technique to obtain 3D reconstructions of the rib cage. However, clinical applications are limited by the associated 2D rib detection method. Either this detection is widely supervised and time-consuming for the user, or it is fully automatic and not accurate enough for proper 3D reconstruction or clinical indices extraction. To address these issues, we propose a novel, semi-automated technique for detecting scoliotic rib borders in PA-0 degrees and PA-20 degrees chest X-ray images, using a modified edge-following approach. The novelty consists in following multiple promising edges simultaneously. Detections are initiated from starting points (input by the user) along the upper and lower rib edges and the final rib border is obtained by finding the most parallel pair among the detected edges. Promising results show the superiority of this approach over classical rib detection in terms of accuracy. Moreover, the proposed method is of great relevancy in the scoliotic context since scoliotic ribs present very few shape priors, due to their irregularities, and hence, standard rib detection techniques become unsuitable.

Humans↗
PubMed1982

Malignant neoplasia of canine ribs: clinical, radiographic, and pathologic findings.

An analysis was made of 17 cases of microscopically proven rib neoplasms, with the objective of evaluating the variability of clinical and radiographic findings, the neoplastic cell types, the occurrence of metastases, and the survival time following the diagnosis. In 15 dogs with primary rib neoplasms and in 2 dogs with secondary (presumably metastatic) rib neoplasms, the clinical signs commonly included dyspnea and a localized swelling on the thoracic wall. For the dogs with primary rib neoplasms, the mean age was 4.5 years, with a range of 1.3 to 16 years. On radiography, rib osteolysis, extra and/or intrathoracic soft tissue masses often containing areas of mineralization, and pleural effusion were commonly identified. Ribs 5 through 9 were the most commonly affected and the right side was involved twice as often as the left side. Osteosarcoma was the most frequently diagnosed tumor, but chondrosarcomas and hemangiosarcoma were also found. At necropsy, over 50% of the dogs with primary rib neoplasms had metastases in the lungs. Less than 10% of the dogs with primary rib osteosarcomas survived more than 4 months after the diagnosis.

Animals↗
PubMed1995

[Ultrasound detection of rib fractures for verifying fracture diagnosis. A pilot project].

Since the diagnosis of rib fractures caused by blunt thoracic trauma is often missed on X-ray, attempt have been made to detect unknown fractures with ultrasound. Ultrasound was initially researched, as a diagnostic technique in a preliminary study of 10 patients with known rib fractures. Subsequently, in the main study, 21 patients with clinically suspected rib fractures but normal thoracic X-rays were examined with ultrasound, and rib fractures were detected in 16 patients. The diagnosis of rib fractures by ultrasound was substantiated by an increase of activity in the technetium scintigram in 11 of 11 patients. We found further increases of activity in the scintigram in two more ribs in 7 of these 11 patients. This finding is explained by the presence of nondislocated rib fractures that are veiled to ultrasound when a disconnection of the rib's contour is missed during respiration. The diagnostic procedure is explained with reference to case studies. In summary, findings recorded in this study showed that ultrasound investigation is a more reliable method of diagnosis than X-rays examination.

Accidents, Traffic↗