Cough fracture of ribs in infants with dyspnoea.
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Bronchitis↗
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Results for “RIB FRACTURES”
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A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients.
BACKGROUND: We initiated a multidisciplinary clinical pathway targeting patients greater than 45 years of age with more than 4 rib fractures. The purpose of the current study was to evaluate the effect of this pathway on infectious morbidity and mortality. METHODS: This was a prospective cohort study. Data evaluated included patient demographics, injury characteristics, pain management details, lengths of stay, morbidity, and mortality. Univariate and multivariate analyses were performed using a significance level of P < .05. RESULTS: When adjusting for age, injury severity score, and number of rib fractures, the clinical pathway was associated with decreased intensive care unit length of stay by 2.4 days (95% confidence interval [CI] -4.3, -0.52 days, P = .01) hospital length of stay by 3.7 days (95% CI -7.1, -0.42 days, P = .02), pneumonias (odds ratio [OR] 0.12, 95% CI 0.04 to 0.34, P < .001), and mortality (OR 0.37, 95% CI 0.13 to 1.03, P = .06). CONCLUSIONS: Implementation of a rib fracture multidisciplinary clinical pathway decreased mechanical ventilator-dependent days, lengths of stay, infectious morbidity, and mortality.
Aged↗
Lower mortality in patients with scapular fractures.
BACKGROUND: The purpose of this research was to compare associated injuries and mortality in multiply injured patients with scapular fractures with those without scapular fractures. METHODS: A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score >12 admitted to a level I regional trauma center during from January 1, 1996, to December 31, 2001, was reviewed to assess skeletal and organ injuries associated with a scapular fracture. RESULTS: Of 2,538 motor vehicle occupants, 94 occupants with concomitant scapular fractures and 2,444 occupants without scapular fractures revealed that 76.6% of motor vehicle occupants who sustained scapular fractures were males with a mean age of 44.3 years (SD=18.9). The presence of a scapular fracture reduced the risk of mortality by 44% (95%CI: 1-75%). Patients with scapular fractures had a greater proportion of flail chest injuries [relative risk (RR), 8.8; p < 0.001], clavicle fractures (RR, 4.5; p < 0.001), rib fractures (RR, 3.1; p < 0.01), spine fractures (RR, 2.7; p < 0.001), and tibia and fibular fractures (RR, 1.7; p < 0.025). The presence of a chest injury, either a pneumothorax (RR, 3.7; p < 0.001) or a pulmonary contusion (RR, 3.5; p < 0.001), was significantly more likely in patients with scapular fractures than control patients. Injuries to the spleen (RR, 2.4; p < 0.01) and liver (RR, 2.2; p < 0.025) were also significantly more common in patients with scapular fractures when compared with those without them. CONCLUSIONS: In an observational study of multiply injured trauma patients from motor vehicle crashes, we report the following: (1) scapular fractures occur 3.7% of the time; (2) the presence of a scapular fracture was associated with a lower mortality; and (3) scapular fractures should alert healthcare personnel to the presence of other injuries, such as chest injuries, clavicle fractures, rib fractures, spine fractures, tibial fractures, and spleen and liver injuries. Our findings should be interpreted cautiously, because the mechanism of the association between scapular fractures and mortality remains unclear.
Accidents, Traffic↗
Rib stress fractures in elite rowers. A case series and proposed mechanism.
The potential cause of stress fractures of the rib in elite rowers was examined by a retrospective review of 14 fractures in 10 patients. Fractures occurred on the antero- to posterolateral aspects of ribs 5 through 9 and were most often associated with long-distance training and heavy load per stroke. A review of the literature yields striking similarities between these stress fractures and fractures caused by cough. It is suggested that actions of the serratus anterior and external oblique muscles on the rib cause stress fracture because of the repetitive bending forces in both rowing and coughing. A technique involving less use of both muscles through a truncated arm pull-through and a decreased layback position at the end of the stroke, and equipment changes to decrease length of the lever arm, should yield a decreased risk of rib stress fractures in rowing.
Arm↗
[Repair of intrathoracic visceral damage using video-assisted thoracoscopic surgery for blunt chest trauma and rib fixation at the site of mini-thoracotomy].
We treated three patients with intrathoracic visceral damage caused by severely dislocated fractured ribs resulting from blunt trauma by using video-assisted thoracoscopic surgery (VATS) and rib fixation through a mini-thoracotomy. Under general anesthesia and unilateral respiration, the thoracic cavity was inspected with a thoracic video scope through the port inserted through the thoracic drainage opening which was made upon arrival at hospital. As the visceral damage seemed restorable under VATS, a mini-thoracotomy was positioned just above the rib fracture. Two thoracic ports were inserted through the site of rib fracture or through the intercostal space and then VATS was performed using three ports. After the restoration of intrathoracic visceral damage, the fractured rib was fixated using a bioabsorbable poly-L-lactide rib fixation pin or a marlex mesh. Lung injuries were sutured and ligated under VATS in two of our cases and a spur of the fractured rib was shaved in one case. Only severely dislocated ribs were fixated through the mini-thoracotomy in all cases. Air leakage stopped just after this procedure and there were no complications. The rib fixation and bone regeneration were excellent after this procedure. The advantages of this method are the visceral restoration under VATS through a mini-thoracotomy and the ability to perform rib fixation without injuries to the intercostal muscle, artery, vein or nerve. This operative procedure is recommended for intrathoracic visceral damage caused by severely dislocated rib fracture.
Adult↗
The value of physical examination in the diagnosis of patients with blunt abdominal trauma: a retrospective study.
Between 1 January 1993 and 1 January 1994, 204 consecutive patients with possible blunt abdominal injury were analysed retrospectively. All patients underwent a standardized diagnostic approach on admission to the emergency room. Abdominal ultrasound (AUS) was performed in all cases. If there was evidence of intra-abdominal injury on physical examination or AUS, without signs of persistent hypovolaemia after initial assessment, contrast-enhanced computed tomographic scanning (CECT) of the abdomen was carried out without exception. Physical examination was equivocal in 13 and 3 per cent, respectively, of patients with 'isolated' abdominal trauma (N = 23) or with fractures of lower ribs 7-12 as a sole diagnosis (N = 30). In multiple injury patients (N = 95) or those with suspected 'isolated' head injury (N = 56), these figures reached 45 and 84 per cent, respectively. AUS (N = 204) revealed intra-abdominal injury in 20 per cent of patients, and CECT (N = 43) resulted in additional information in 49 per cent. Patients with 'isolated' head injury showed 9 per cent abnormalities on abdominal evaluation versus 32 per cent in multiple injury patients. In lower rib fractures (7-12) in multiple injury patients abdominal injury was diagnosed in 67 per cent of the cases. We conclude that: (1) negative findings following reliable physical examination of patients with 'isolated' head injury show very high values (NPV 100 per cent), but reliable physical examination is very infrequent (16 per cent); (2) NPV in lower rib fractures due to low energy impact is very high (100 per cent), with a reliable physical examination in most patients (97 per cent); (3) in patients with isolated abdominal trauma 87 per cent have a reliable physical examination with a moderately high NPV (71 per cent); (4) almost half the multiple injury patients have an unequivocal physical examination (45 per cent), with a high NPV following reliable physical examination for abdominal injury (85 per cent); (5) abdominal ultrasonography should be the first step in the radiological assessment of all patients with possible blunt abdominal injury; (6) in multiply injured patients with fractures of their lower ribs (7-12) due to high energy impact the incidence of abdominal injury is very high and CECT might be indicated even in the case of normal AUS findings.
Abdominal Injuries↗
First rib stress fractures in throwing athletes.
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Baseball↗
Exercise-induced rib stress fractures: influence of reduced bone mineral density.
Exercise-induced rib stress fractures have been reported frequently in elite rowers during the past decade. The etiology of rib stress fractures is unclear, but low bone mineral density (BMD) has been suggested to be a potential risk factor for stress fractures in weight-bearing bones. The present study investigated BMD in seven Danish national team rowers with previous rib stress fracture (RSF) and 7 controls (C) matched for gender, age, height, weight and training experience. Total body scan and specific scans of the lumbar spine (L2-L4), femoral neck and distal radius were performed using a DEXA scanner. The RSF subjects showed significantly lower L2-L4 BMD: RSF: 1.22+/-0.05 g cm(-2) (mean+/-SEM) (median 1.19 g cm(-2), range 1.02-1.37 g cm(-2)) compared to C: 140+/-0.04 g cm(-2) (median 1.41 g cm(-2), range 1.27-1.57 g cm(-2)) (P=0.028). The present results suggest that low bone mineral density may be a potential risk factor for the development of exercise-induced rib stress fractures in elite rowers.
Absorptiometry, Photon↗
Two consecutive rib stress fractures in a female competitive swimmer.
We present a case of two consecutive stress fractures in a female swimmer. The diagnosis of the present stress fracture of the ninth rib was based on clinical history and examination and on a new fracture line and callus formation seen in consequent conventional radiographs. Based on the clinical history and radiography, the patient had suffered another rib stress fracture in the fifth rib 15 months earlier. No external trauma had preceded either of the fractures, and no secondary cause of stress fracture was found. Her anatomical and biomechanical characteristics and training errors seem to have been responsible for the stress fractures. Sports physicians should be aware of rib stress fractures. With prompt diagnosis the rest period is short.
Adult↗
Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers.
In a prospective study of 38 cadavers of patients older than 18 without previous chest injury or cardiopulmonary resuscitation (CPR), active compression-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was performed for 60 s, with compression and decompression forces being continuously recorded. A stepwise logistic regression analysis was applied. Factors analyzed were age, gender, use of a compression cushion beneath the piston of the ACD device (Ambu CardioPump), and maximal compression and decompression forces. After ACD, the cadavers were autopsied and thoracic injuries were assessed. There was a significant correlation between sternal fractures and gender (P = 0.008), and between rib fractures and age (P = 0.008). Women were found to have a higher risk for sternal fractures, whereas older patients had a higher risk for rib fractures. Maximal compression force was another factor in sternal and/or rib fracture (P = 0.048). Even though a significantly higher incidence of sternal fractures was observed when the compression cushion was used (P = 0.045), inclusion of this variable in the regression analysis only marginally improved the prediction for correct classification of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the incidence of rib fracture. Sternal fractures were more common in female cadavers.
Age Factors↗
Chest injury due to blunt trauma.
OBJECTIVE: Given its importance in trauma practice, we aimed to determine the pathologies associated with blunt chest injuries and to analyze the accurate identification of patients at high risk for major chest trauma. METHODS: We reviewed our experience with 1490 patients with blunt chest injuries who were admitted over a 2-year period. Patients were divided into three groups based on the presence of rib fractures. The groups were evaluated to demonstrate the relationship between the number of rib fractures and associated injuries. The possible effects of age and Injury Severity Score (ISS) on mortality were analyzed. RESULTS: Mean hospitalization time was 4.5 days. Mortality rate was 1% for the patients with blunt chest trauma, 4.7% in patients with more than two rib fractures and 17% for those with flail chest. There was significant association between the mortality rate and number of rib fractures, the patient's age and ISS. The rate of development of pneumothorax and/or hemothorax was 6.7% in patients with no rib fracture, 24.9% in patients with one or two rib fractures and 81.4% in patients with more than two rib fractures. The number of rib fractures was significantly related with the presence of hemothorax or pneumothorax. CONCLUSION: Achieving better results in the treatment of patients with chest wall injury depend on a variety of factors. The risk of mortality was associated with the presence of more than two rib fractures, with patients over the age of 60 years and with an ISS greater than or equal to 16 in chest trauma. Those patients at high risk for morbidity and mortality and the suitable approach methods for them should be acknowledged.
Adolescent↗
Topical application of nerve growth factor improves fracture healing in rats.
The aim of the present study was to examine the effects of nerve growth factor on the healing of unsplinted fractured ribs. After fracture of a rib in male rats, nerve growth factor was delivered by a miniosmotic pump to the fracture site for 7 days at the rate of 1.4 micrograms/day. Callus catecholamine concentrations, bone callus size, histomorphometry, and biomechanical properties of the repairing rib were measured at 7, 21, and 42 days after fracture. After 21 days, concentrations of norepinephrine and epinephrine were significantly increased in the group treated with nerve growth factor compared with those in the control group (211% norepinephrine and 322% epinephrine). Also, the midline longitudinal area of non-osseous (fibrous tissue and cartilage) callus of the fracture was significantly smaller (54%) and had a higher proportion of cartilage in the treated group than in the controls. By 42 days, there was only bony callus between the fracture ends in both the control group and the treated group. The treated group, however, again showed significantly elevated concentrations of norepinephrine and epinephrine (286 and 382%, respectively) and significantly elevated breaking stress (50%) and Young's modulus (51%), together with a reduction in the transverse cross-sectional area of the repair site (57%). The resultant increases in effectiveness and rate of repair of bone with administration of nerve growth factor suggest that it may play an important role in the healing processes of fractured bone.
Administration, Topical↗
[Characteristics of thoracic injuries in children].
Thoracic trauma is uncommon in children. It should not be managed any more as adult's trauma. We present our experience with 85 children form 1 to 16 years of age, presenting severe thoracic trauma treated in Lausanne, Switzerland, between 1976 and 1990. The specific features of diagnosis, treatment and outcome are presented. Most of them were involved in traffic accidents (62%), 55% had multisystemic injuries. The mortality rate was not a function of the Injury Seventy Score as in adults, but was only related to the Glasgow Score. Only 3 patients (3.5%) had hemodynamic instability on admission in relation with their thoracic injury. Patients with intrathoracic lesions showed dyspnoea (65%), cyanosis (25%), or clinical suspicion of a pleural effusion or a pneumothorax (47%). However 12 children had an asymptomatic severe thoracic injury. In 53 patients (62%) the auscultation was found abnormal either with absent or diminished breath sounds or other pathological findings. 10 out of 26 cases of pneumothorax could be suspected by percussion dullness. Chest X-rays showed a lesion in 76% of cases. Only 30% of the pneumothorax were associated with visible rib fractures. 10 children suffered from 4 to 12 fractures of the ribs (mean 6.6). None of these patients presented a flail chest as in adults, even when multiple rib fractures existed. 31 thoracic drainages were performed, during a mean period of 3.3 days. 30 patients were intubated and ventilated, 22 of these due to a neurosurgical condition. All patients had physiotherapy starting on day 2, under analgesia if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Cough induced stress fracture and arthropathy of the ribs at extreme altitude.
Cough and chest wall pain at high altitude have only received passing mention in the medical literature. Increased minute ventilation of cold dry air at very high altitude is likely to cause airway irritation. This in turn may result in airway drying, mucus production, postnasal drip from vasomotor rhinitis, and bronchospasm acting individually or in combination to stimulate the vagal cough reflex. The cough is exacerbated further at extreme altitudes above 5500 m, and may result in intercostal muscle strain and single or multiple rib fractures. We present a case of multiple cough induced stress fractures and arthropathy documented by technetium-99 bone scan in a high altitude climber and suggest the addition of the term High Altitude Cough Syndrome (HACS) to the medical syntax to identify this discrete medical problem of exposure to very high altitude.
Adult↗
Spontaneous fractures of ribs.
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Fractures, Spontaneous↗
[The role of the radiological hemithorax examination in closed trauma of the chest].
January, 1992, to September, 1994, a hundred and seventy-eight blunt chest trauma patients were examined with plain chest films and detailed rib studies. The patients were subdivided into three groups according to: a) the presence/absence of rib fractures correlated with clinical data; b) the depiction of rib fractures and/or thoracic complications; c) treatment customization in the presence/absence of rib fractures. In our series of patients the clinical data and the presence of rib fractures were poorly correlated. The detection rates of minor and major complications were also investigated on plain chest films and detailed rib studies. Plain chest films most frequently depicted the complications requiring conservative or surgical management and gave the indication for further imaging investigations. The detailed rib studies of the involved hemithorax yielded no further information useful to therapy except in few cases: and should therefore be limited to the cases exhibiting complications on chest films, which may benefit from surgical fixation. The accurate study of rib fractures is paramount in the cases where legal action may be undertaken.
Humans↗
Fractures on the chest radiograph in detection of alcoholic liver disease.
The presence of fractures seen on routine chest radiography was assessed in patients with liver disease to see whether it might provide a useful marker of alcoholism. Chest radiographs taken at the time of liver biopsy were examined in 149 patients--72 with alcoholic liver disease (32 (44%) cirrhotic) and 77 with various forms of non-alcoholic liver disease (15 (19 . 5%) cirrhotic)--and in 149 controls. Fractures (85 rib, two clavicular) were much more common in patients with alcoholic liver disease (20 subjects; 28%) than in patients with non-alcoholic liver disease (1; 1 . 3%) or controls 10; 6 . 7%). In alcoholic liver disease rib fractures were significantly more likely to be bilateral or multiple (more than two) or both (p less than 0 . 01). Of patients with alcoholic liver disease, those with fractures were significantly older than those without, but there was no difference in sex, social class, the proportion with cirrhosis, or the proportion known to be alcoholic at the time of the radiograph. In liver disease fractures on the chest radiograph diagnosed alcoholism with 95% specificity and 28% sensitivity. These often overlooked or ignored findings in the chest radiograph may have a wider role in the detection of alcoholism.
Adult↗
Transient and localized expression of bone morphogenetic protein 4 messenger RNA during fracture healing.
Temporal and spatial distribution of a gene encoding murine bone morphogenetic protein 4 (mBMP-4) during fracture repair were investigated in mice by RT-PCR and in situ hybridization. For in situ hybridization, fractured ribs and surrounding tissues were decalcified and hybridized with a mBMP-4-specific complementary RNA probe labeled with digoxigenin-11 UTP. mBMP-4 messenger RNA (mRNA) was not detected in ribs without fracture, whereas it was detected only in the early phase of fracture from 12 to 72 h after the onset of fracture before new cartilage or bone formation. The mBMP-4 mRNAs were present in cells distributed in three distinct regions, namely, the proliferating periosteum, the medullary cavity, and the muscles near the fracture site. These BMP-4-positive cells did not express bone gla protein mRNA, which is a marker of the mature osteogenic cell. RT-PCR also showed a transient increase in the level of BMP-4 mRNA in the early phase of fracture repair. The findings provide us with some new information. (1) The BMP-4 gene is produced by less differentiated osteoprogenitor cells, not by differentiated osteoblasts. (2) The BMP-4 gene is enhanced by the impact of fracture and localized in callus-forming tissue before callus formation. Together with the activities of BMP-4, as was previously described, our results suggest that newly produced BMP-4 gene product is one of the local contributing factors in callus formation in the early phase of fracture healing.
Animals↗