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Results for “RIB FRACTURES”

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PubMed2001

[Is seat belt sign a predictor for physicians in management of trauma patients in emergency settings?].

Seat belt sign (SBS) is frequently seen as a clinical finding in motor vehicle accidents. The purpose of this study is to determine the diagnostic value of SBS. All adult patients presenting with an history of motor vehicle accident to a tertiary care university hospital emergency department was included in this prospective, observational study covered the time period between July 01, 1999 and February 01, 2000. 213 patients were included in this study; 135 (63.4%) were male, and 76 patients (35.7%) were seat-belted. SBS was seen on 27 (35.5%) belted patients. Fourteen of seat-belted had rib fractures nine of those patients with rib fractures were found to have SBS. There was a statistically significant difference between the patient groups with or without SBS in rib fractures (p = 0.0128) While no significant differences were detected between groups regarding the frequency of intra-cranial, intra-thoracic, intra-abdominal and extremity injuries three of four patients who had sternum and clavicular fractures took place in SBS(+) group (p = 0.090). The presence of SBS in trauma patients may create a high index of suspicion for thoracic injuries, especially for rib fractures. It is widely accepted that any delay in the diagnosis may increase morbidity and mortality following thoracic injuries. Further studies are needed to investigate the possible role of SBS in the prediction of the severity of injuries following thoracic trauma.

Accidents, Traffic↗
PubMed1982

Indications for aortography in blunt thoracic trauma: a reassessment.

The indications for aortography in patients sustaining blunt chest trauma have increased as the number of radiographic and clinical findings associated with traumatic rupture of the thoracic aorta (TRA) proliferate. No studies, however, have demonstrated whether these findings are useful in selecting patients for aortography. In order to determine the predictive value of reported associations in TRA, the presence or absence of nine radiographic and nine clinical findings associated with TRA were tabulated and tested for correlation with the results of aortography in 173 consecutive patients who underwent arch aortography from 1975 to 1980 to rule out TRA following blunt trauma. Mediastinal widening was the most reliable indicator of TRA. All patients less than 65 years old with TRA presented with mediastinal widening. In patients under 65, the reliability of mediastinal widening to predict TRA was not enhanced by any other clinical or radiographic finding studied. On the other hand, only two of six TRA's in patients over 65 had mediastinal widening. Only in this group over 65 did other publicized indications for aortography, including pulmonary contusions or multiple rib fractures including ribs 1 and 2, have any association singly or in combination with TRA. We conclude that all trauma victims who have a widened mediastinum should undergo aortography. Other reported associations by themselves are not absolute indications for aortography except in patients 65 years old or older.

Adolescent↗
PubMed1992

[Bone scintigraphy in two cases with cough related stress fractures of rib].

Two patients of unusual cough related stress fractures of the ribs are presented. Both patients complained of cough and chest pain with respiratory infection, and the initial chest radiographs showed only an infiltrative shadow due to bronchopneumonia in the lung field, however, failed to reveal any definite osseous abnormality of the ribs. Follow up chest radiographs revealed a callus formation in the fracture sites. In both patients, fracture sites were multiple and located at the axillary line, and radionuclide bone scan disclosed focal abnormal concentrations of activity in these characteristic locations of the lesions. Moreover, there were abnormal accumulation sites in the adjacent above and below ribs, and this finding also seemed to be characteristic of cough related stress fractures of the ribs.

Adult↗
PubMed1982

[Epidural fentanyl analgesia for the relief of postoperative pain (author's transl)].

The results are reviewed which were obtained with epidural administration of fentanyl for the relief of pain in 134 patients who had undergone abdominal surgery or had sustained multiple fractures of the ribs. Single doses of 0.1 mg of fentanyl were given epidurally via an indwelling catheter inserted between L1/L2 or L2/L3 or, in the case of 7 patients with multiple rib fractures, between Th8/Th9. The results were satisfactory to excellent. An increase in the volume of the fentanyl solution from 10 ml to 20 ml increased the number of patients who were free from pain from 61 per cent to 81 per cent. The analgesic effects of individual doses lasted 2-8 hours (average 5.5 h). Persons with multiple rib fractures needed further injections on average every 3.5 hours. In these cases epidural fentanyl administration also proved valuable in combination with artificial ventilation. There were no serious side-effects. A comparison of the clinical efficacy of fentanyl proved that the same doses of the drug were more effective if given epidurally than if injected intramuscularly. The serum concentrations of fentanyl showed considerable individual variations after both intramuscular and epidural administration with peak values varying correspondingly. Epidural injections caused a steeper rise in concentration than did intramuscular administration. Although none of the patients developed respiratory depression the possibility of respiratory failure should be taken into account when employing epidural fentanyl analgesia. The method is very effective in intensive therapy for relieving postoperative or post-traumatic pain, but is unsuitable for the relief of chronic pain because the analgesic effect is comparatively short-lived.

Adult↗
PubMed1996

Management of rowers with rib stress fractures.

Stress fractures of the ribs in rowers occur mostly along the anterior axillary line, but also anteriorly and posteriorly. Management has previously consisted of rest, but symptoms can recur on return to training. Earlier return to rowing can be achieved with management that includes ice and TENS for pain relief, pulsed magnetic field therapy and passive mobilisation of the thoracic spine and costovertebral joints. Aerobic fitness is maintained with stationary cycling. Rowing is progressively introduced according to symptoms and strapping is used to support the ribs during training. Posture and technique is reviewed with the coach to eliminate unusual movements of the shoulder girdle.

Journal Article↗
PubMed2003

Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse.

AIM: To compare the effectiveness of radiological skeletal survey and bone scintigraphy for the detection of bony injuries in cases of suspected child abuse. METHODS: All cases with a discharge diagnosis of child abuse that presented to the Royal Children's Hospital between 1989 and 1998 were retrieved, and those children that had undergone both skeletal survey and bone scintigraphy (radioisotope bone scan) within a 48 hour period were included in this study. Both examinations followed rigid departmental protocols and protocols remained identical throughout the timeframe of the study. The reports of the skeletal surveys and bone scans were retrospectively reviewed by a paediatric radiology fellow and consultant paediatric radiologist. RESULTS: The total number of bony injuries identified was 124 in 30 children. Of these, 64 were identified on bone scan and 77 on skeletal survey. Rib fractures represented 60/124 (48%) of the bony injuries and were present in 16/30 children (53%), of which 62.5% had multiple rib fractures. Excluding rib fractures, there were 64 (52%) bony injuries, of which 33% were seen on both imaging modalities, 44% were seen on skeletal survey only, and 25% were seen on bone scans alone. Metaphyseal lesions typical of child abuse were present in 20 cases (31%) on skeletal survey; only 35% of these were identified on bone scan. Six children (20%) had normal skeletal surveys, with abnormalities shown on bone scan. There were three children (10%) with normal bone scans who were shown to have injuries radiographically. CONCLUSIONS: Skeletal survey and bone scintigraphy are complementary studies in the evaluation of non-accidental injury, and should both be performed in cases of suspected child abuse.

Arm Injuries↗
PubMed1989

[Biomechanical analysis of the pulmonary trauma by localized blunt force--thoracic force-deflection in pigs].

Thoracic force-deflection characteristics have been measured in the living little pigs as a step towards the analysis of thoracic injury in the field of forensic medicine. Mechanisms of injury by hand impact with a small stone were investigated by means of high speed video/camera and load cell. Initial velocity by hand impact ranges from 5.8 to 11.1 m/s, with corresponding peak force from 24 to 122 kgf. The thoracic force-deflection of the pig shows a progress change with increasing impact velocity, showing more of a spring-mass like response with an initial linear region of stiffness during a short interval immediately after the impact. Peak force up to 122 kgf was developed for 77 mm in the localized thoracic displacement with rib fractures and serious lung injury. A few rib fractures occurred with initial velocity near 9 m/s and displacement near 50 mm, these data suggest an outbreak limit of rib fractures of the little pig.

Animals↗
PubMed1998

Upper extremity and rib stress fractures in a child.

Stress fractures in children are rare compared with the incidence in adults. This report describes an 11-year-old girl with stress fractures of the acromion, clavicle, and first rib on the left and contralateral fractures of the first and second ribs. It was eventually discovered that these fractures were caused by a nervous tic consisting of repetitive, vigorous shrugging and translation of the shoulders.

Acromion↗
PubMed1981

[Scintigraphic diagnosis of sport injuries: multiple fractures of ribs by golf-players (author's transl)].

Three untrained golf-players suffered from pain in the dorsal region of the left thorax after some training hours. Three to four weeks after the pains had begun serial fractures of ribs were diagnosed by 99mTc-MDP bone-scan-examinations. All fractures were localized near the costal angulus (paravertebral) of these ribs. The fractures are causal by manual tensions. The difficulties in timing the bone-scan and in identifying the morphologic substrate are demonstrated. It is recommended, that golf-players suffering from thoracic pain ought to be examined by bone scan.

Adult↗
PubMed2006

Blunt chest trauma: utility of radiological evaluation and effect on treatment patterns.

Minor chest wall trauma is a common complaint in the emergency department (ED) (Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J of Surgery 2002;45(1):43-6; Lee RB, Bass SM, Morris JA, Mackenzie EJ. Three or more rib fractures as an indicator for transfer to a level I trauma center. J Trauma 1990;30:689-94; Dubinsky I, Low A. Non-life-threatening blunt chest trauma: Appropriate investigation and treatment. Am J Emerg Med 1997;15(3):240-3). Up to 50% of rib fractures may be missed on standard x-ray (Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37:975-9; Palvanen M, Kannus P, Niemi S, Parkkari J. Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoperosis International). Little consensus exists among emergency physicians with respect to the workup of minor blunt chest trauma. The purpose of this study was to evaluate the accuracy of emergency physicians in interpreting rib radiographs and to determine if that interpretation resulted in any variance in treatment patterns. Our study is a retrospective study of 271 charts from a community-based teaching hospital from August 2000 to August 2002. Patients were excluded if they suffered major trauma. The treatment rendered was categorized. Categories included over-the-counter medication, nonsteroidal anti-inflammatory drugs, narcotics, and muscle relaxants. The overall chi2 calculation showed no differences between the fractured group and the no fracture group (P=.072). From this, it can be concluded that there were no between-group differences in drugs prescribed based on whether a fracture was diagnosed by the ED physician. Indicating that the interpretation of the rib series does not influence the physicians treatment plan.

Adolescent↗