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PubMed1997

[The echographic assessment of traumatic rib lesions].

INTRODUCTION: Conventional frontal radiography is mandatory in trauma patients and usually sufficient to detect rib fractures, even though the alignment of bone fragments or projection difficulties may sometimes hinder their depiction. Therefore, there exists moderate disagreement between clinically suspected rib fractures and radiographic findings. MATERIALS AND METHODS: We report our personal experience with US in the detection of rib conditions (fractures and bruises), missed at preliminary radiography. Five symptomatic patients with suspected rib fractures underwent radiographic and US studies. All patients were examined with a real time unit (RT 2800, GE Medical Systems, Milwaukee, USA) with a 7.5 MHz linear probe. RESULTS AND CONCLUSION: US demonstrated rib fractures in 4 patients with negative radiographic findings and a parosteal hematoma in one patient. We conclude that US can detect the rib fractures missed at conventional radiography and show rib cartilage conditions, costochondral dislocations and parosteal hematomas. Therefore we suggest the routine use of this technique in all chest trauma patients, as a useful complement to frontal radiographs, for both management and forensic purposes.

Adult↗
PubMed2004

Chest wall injuries following cardiopulmonary resuscitation.

The forensic records were reviewed of 1823 deaths referred to Edinburgh City Mortuary for autopsy over a 15-month period, 2000-2001; 499 cases (343 males, 156 females) that received CPR prior to death were studied. Rib fractures were found in 29%, sternal fracture in 14%, and 11% of cases showed external chest wall bruising or abrasion. More females sustained rib fractures than males (37% versus 26%; P <0.05). There was no significant gender difference for sternal fracture (females 17%, males 12%; P=0.051). The incidence of rib fractures increased with age (P <0.001). There was no significant difference in the number of left or right ribs fractured (P=0.631). This study incorporates all cases of in and out-of-hospital CPR and does not discriminate for the CPR provider or technique employed, therefore, providing a current and representative overview of the incidence of rib and sternal fractures in non-survivors of CPR.

Adolescent↗
PubMed1992

Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer.

The frequency of brachial plexopathy, rib fracture, tissue necrosis, pericarditis, and second non-breast malignancies occurring in the treatment field among 1624 patients with early stage breast cancer treated with conservative surgery and radiation therapy at the Joint Center for Radiation Therapy between 1968 and 1985 is reported. The median follow-up time for survivors was 79 months (range 5-233 months). Brachial plexopathy was related to the use of a third field, the use of chemotherapy and the total dose to the axilla. Brachial plexopathy developed in 20 of 1117 women (1.8%) who received supraclavicular irradiation with or without axillary irradiation. The median time to its occurrence was 10.5 months (range 1.5-77 mo), and the majority (80%) of cases completely resolved. Among patients treated with a three-field technique, the incidence of brachial plexopathy was 1.3% (13/991) in patients treated with a dose to the axilla of less than or equal to 50 Gy, compared with 5.6% (7/126) in women treated with an axillary dose of greater than 50 Gy. The incidence of brachial plexopathy was 4.5% (15/330) among patients receiving chemotherapy, compared with 0.6% (5/787) when chemotherapy was not used (p less than 0.0001). Rib fracture was seen in 29 patients (1.8%), at a median time of 12 months following treatment (range 1-57). In all cases, the rib fracture healed without intervention. The incidence of rib fracture was 2.2% (28/1300) among patients treated on a 4 MV linear accelerator, compared with 0.4% (1/276) for patients treated on a 6 or 8 MV machine (p = 0.05). Of patients treated on a 4 MV machine, 0.4% (1/279) developed a rib fracture when a whole breast dose of 45 Gy or less was given, 1.4% (10/725) after receiving between 45 and 50 Gy, and 5.7% (17/296) following 50 Gy or higher. Tissue necrosis requiring surgical correction developed in three patients (0.18%) 22, 25, and 114 months after treatment. Presumed pericarditis (requiring hospitalization) was seen in 0.4% of women (3/831) who received radiation therapy to the left breast 2, 2, and 11 months after the start of treatment. Three women (0.18%) developed sarcomas in the treatments field at 72, 107, and 110 months, for a 10-year actuarial rate of 0.8%. Two of these sarcomas developed in areas of probable match-line overlap. One patient (0.06%) developed an in-field basal cell carcinoma at 42 months. In conclusion, the risk of significant complications following conservative surgery and radiation therapy for early stage breast cancer is low.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2006

Exercise-induced rib stress fractures: potential risk factors related to thoracic muscle co-contraction and movement pattern.

The etiology of exercise-induced rib stress fractures (RSFs) in elite rowers is unclear. The purpose of the study was to investigate thoracic muscle activity, movement patterns and muscle strength in elite rowers. Electromyographic (EMG) and 2-D video analysis were performed during ergometer rowing, and isokinetic muscle strength was measured in seven national team rowers with a history of RSF and seven matched controls (C). RSF displayed a higher velocity of the seat in the initial drive phase (RSF: 0.25+/-0.03, 0.25 (0.15-0.33) m/s vs C: 0.15+/-0.06, 0.18 (-0.11-0.29) m/s P=0.028) (Mean+/-SEM, median and range). Further, RSF had greater co-contraction of m. serratus anterior and m. trapezius in the mid-drive phase (RSF: 47.5+/-3.4, 48.5 (35.8-60.2)% EMG signal overlap vs C: 30.8+/-6.5, 27.0 (11.2-61.6)%P=0.043). In addition, the RSF subjects showed a lower knee-extension to elbow-flexion strength ratio (RSF: 4.2+/-0.22, 4.3 (3.5-5.1) vs C: 4.8+/-0.16, 5.0 (4.2-5.3) P=0.043), indicating stronger arms relative to legs compared with controls. In conclusion, increased thoracic muscle co-contraction, altered movement patterns and reduced leg/arm strength ratio were observed in the RSF subjects, which may all predispose toward an increased risk of RSF.

Adult↗
PubMed2002

Prediction of injuries to the heart and thoracic aorta in unrestrained drivers.

The purpose of the study was to investigate factors predicting injuries to the heart and/or thoracic aorta (H/TA) of unrestrained drivers in frontal motor vehicle collisions. We retrospectively analyzed findings of forensic autopsies of 37 unrestrained drivers of automobiles without airbags involved in frontal collisions. Mechanisms of injury, injury severity, presence of major injuries, and the number of fractured ribs were examined in each case. Victims were subdivided for comparison into those with (19 cases) and without (18 cases) H/TA injuries. The injury severity score and the abbreviated injury scale of the chest were significantly higher in persons with H/TA injuries (65.3+/-15.7 and 5.4+/-0.9) than in persons without (31.6+/-22.0 and 1.8+/-1.9). Because univariate analysis showed that the presence of multiple fractured ribs was an important predictor of H/TA injuries, we examined the relation between H/TA injuries and the number of fractured ribs. Copas's nonparametric smooth binary regression model showed that H/TA injuries were more likely in persons with eight or more fractured ribs. The presence of eight or more fractured ribs predicts H/TA injuries in unrestrained drivers.

Journal Article↗
PubMed1999

Thoracic trauma in newborn foals.

In a report describing life ending fractures (255 horses) from the Livestock Disease Diagnostic Center, Kentucky (1993 and 1994), 32 foals had rib fractures. The purpose of our study was to examine the incidence of rib fractures in newborn foals on a Thoroughbred studfarm by physical and radiographic examination, to determine factors which may contribute to the problem and to document any clinical consequences. All foals (263) included were examined within 3 days of birth. The thoracic cage was palpated externally for abnormalities and all foals were placed in dorsal recumbency to evaluate thoracic cage symmetry. Radiographs were used to diagnose foals with thoracic cage asymmetry (TCA) and rib fracture (RF). A diagnosis of costochondral dislocation (CD) was made when no radiographic evidence of fracture was present but there was severe TCA. Fifty-five foals (20.1%) had TCA (9 RF). One to 5 ribs were fractured on 9 of 40 radiographic studies. No consequences of the thoracic trauma was detected clinically, radiographically or ultrasonographically in this group of foals or at a 2- and 4-week follow-up examination. The percentage of foals with a history of abnormal parturition was higher in the TCA foals (15%) compared to the normal foals (6.8%). There were more primiparous dams in the TCA group than in the normal foal group. Fillies (56.6%) had a higher incidence of birth trauma than colts (43.4%). This study demonstrates that thoracic trauma is often present in newborn foals and may not always be of clinical significance. Dystocia foals and foals from primiparous mares should be considered high risk for thoracic trauma.

Animals↗
PubMed2005

Physiotherapy and osteoporosis: practice behaviors and clinicians' perceptions--a survey.

Physiotherapists typically use a variety of modes to treat their clients, including manual therapy. The literature cautions against the use of manual therapy in individuals with osteoporosis, (Musculoskeletal Manipulation: Evaluation of the Scientific Evidence, Charles C Thomas Publisher, Springfield, IL; Common Vertebral Joint Problems, 2nd Edition, Churchill Livingstone, New York; Maitland's Vertebral Manipulation, 6th Edition, Butterworth-Heinemann, Boston; Br. J. Sports Med. 37 (2003) 195-196) yet clinical experience (Br. J. Sports Med. 37 (2003) 195-196) and published cases (J. Manip. Physiol. Ther. 15(7) (1992) 450-454) suggest that these techniques are still being used by at least some clinicians. The purpose of this study was to measure the most common treatment modes used by a random sample of physiotherapists practicing in the province of British Columbia (BC) in the treatment of individuals with osteoporosis. To assess whether physiotherapists in BC have concerns about the use of manual therapy in individuals with osteoporosis, particularly whether physiotherapists have concerns about fracture as a complication of treatment. This cross-sectional study of 171 physiotherapists in BC used a questionnaire developed by the physiotherapist in the Osteoporosis Program at the BC Women's Health Centre (a part of the Children's & Women's Health Centre of BC). The response rate (67/171) was 39%. Ninety-seven per cent of respondents reported using strength exercises and postural reeducation, while 45% reported using manual therapy in this population. Ninety-one per cent of respondents reported having concerns about the use of manual therapy. Vertebral fracture and rib fracture were the most commonly reported concerns. These findings suggest that most physiotherapists practicing in BC, Canada use evidence-based methods (i.e. strength training) when treating individuals with osteoporosis, a large number use manual therapy, and most have concerns about its use. Physiotherapists are most concerned about fractures, in particular vertebral fracture, but injury to other musculoskeletal tissues is also of concern. Studies of safety and effectiveness of manual therapy in this population are needed to guide clinical practice.

Attitude of Health Personnel↗
PubMed1984

The management of subclavian artery injuries following blunt thoracic trauma.

The records of 15 patients who sustained blunt rupture of the subclavian artery were reviewed. The findings on physical examination included arterial hypotension, unilateral absence of the radial pulse, brachial plexus palsy, and supraclavicular hematoma. The chest roentgenographic findings included wide mediastinums, apical pleural hematomas, and first rib fractures. Fourteen patients survived to undergo angiography and operation. Arterial continuity was restored by primary anastomosis, synthetic grafts, and venous interposition grafts. Ligation of a pseudoaneurysm was carried out in 1 patient with a complete brachial plexus palsy. Amputation of an upper extremity was required in 1 patient. Two patients died postoperatively. We conclude that blunt subclavian artery injuries may be suspected clinically. Absent upper extremity pulses, a wide mediastinum, unrelenting thoracic hemorrhage, and persistent hypotension dictate the necessity for aortography. Relative indications for angiography include brachial plexus palsy, apical pleural hematoma, and a fractured first rib.

Adolescent↗
PubMed2000

Management of simple thoracic injuries at a level I trauma centre: can primary health care system take over?

BACKGROUND: Overtriage is a problem for all trauma systems, including the Greek emergency system. In this study we examined the performance of the primary care emergency system in the treatment of patients with simple thoracic injuries, in the area of a Level I hospital. Our aim was to form organizational proposals and treatment and referral guidelines in an effort to improve the system's performance. METHODS: We reviewed the notes of 488 patients with a thoracic injury as their main complaint, seen and immediately discharged from the A+E department of a Level I hospital. RESULTS: Falls and road traffic accidents were the most common mechanisms of injury. The majority of the injuries were rib fractures or rib cage contusions. Many patients sought medical advice several days after the injury. Fifteen patients required conservative treatment for orthopaedic injuries. Clinical examination, X-rays and abdominal ultrasound were the most useful tests. CONCLUSIONS: Detailed clinical examination, time from injury and a chest X-ray usually identifies the patients who can safely be treated in primary health care facilities. Simple radiology services (X-ray and US) and training of general practitioners in basic emergency care principals in primary care health centres would reduce the number of referred patients with simple thoracic injuries.

Accidental Falls↗
PubMed1983

The clinical diagnosis of ruptured subclavian artery following blunt thoracic trauma.

The clinical findings of nine patients who suffered disruption of the subclavian artery following blunt thoracic trauma were reviewed. Seven patients were men, two were women. Their ages ranged from 16 to 43 years. Five patients presented with shock at the time of admission. Five patients incurred a first rib fracture. The radial pulse was present in three patients, absent in three patients, and indeterminant in three patients due to their profound state of shock. Brachial plexus palsy was present in three patients. A palpable supraclavicular hematoma was present in two patients. The chest roentgenograms showed a localized hematoma over the area of the injured subclavian artery in two instances, a widened superior mediastinal shadow in one case, and both findings in another patient. Thus four of the seven patients who survived to undergo chest roentgenograms had films that suggested injury to the arch of the aorta or its branches. Seven patients survived long enough to undergo operative repair; one of these patients died (14%). The following five criteria should alert the physician to the possibility of subclavian arterial injury following blunt thoracic trauma: 1) fractured first rib; 2) diminished or absent radial pulse; 3) palpable supraclavicular hematoma; 4) chest film evidence of hematoma over the area of the subclavian artery or a widened superior mediastinum; and 5) brachial plexus palsy.

Adolescent↗
PubMedDate not supplied

Epidural catheter tip cultures: results of a 4-year audit and implications for clinical practice.

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate the clinical relevance of routine microbiological culture of epidural catheter tips after use in acute pain management, and to identify patterns of culture result with respect to both indications for, and duration of, epidural catheterization. METHODS: The Acute Pain Service (APS) reviews all patients under its care at least daily and keeps detailed records on each. Over a 4-year period, when APS protocol required epidural catheter tips to be sent for microbiological culture on removal, the APS saw 1,810 patients who had received epidural analgesia. The records of these patients were reviewed. RESULTS: Culture results were available for 1,443 (79.7%) patients: 1,027 catheter tips (71.2%) were sterile, while 416 (28.8%) were positive for at least 1 type of microorganism. Clinically, no epidural space infections were identified. The highest positive culture rates were found from epidural catheters used in the treatment of pain from fractured ribs or fractured pelves, while the lowest incidences occurred in elective orthopedic and thoracic surgery. The proportion of epidural catheters with positive culture results steadily increased with the duration of catheterization, but there were no clinically significant differences for catheters left in situ for either 3 or 4 days. CONCLUSIONS: We concluded that a significant proportion of epidural catheter tips may be "culture positive" after removal. It is suggested that this probably represents colonization of the skin at the catheter insertion site and subsequent contamination of the catheter tip on removal of the catheter. The large number of "culture positive" tips in the absence of clinically identifiable epidural space infection suggests that routine culture of epidural catheter tips is clinically irrelevant in the vast majority of cases, and that it is not a good predictor of the presence of an epidural space infection.

Analgesia, Epidural↗
PubMed1988

Grand mal fitting in a patient on regular haemodialysis treatment and receiving desferrioxamine therapy.

Fitting due to aluminium toxicity has been previously reported in chronic dialysis patients with prolonged exposure to aluminium, resulting in excessive aluminium accumulation. However, we report a case of a patient who fitted whilst receiving Desferrioxamine therapy, following a fall with the consequent sudden release of aluminium from fractured ribs. This suggests that sudden increases in serum aluminium levels may carry neurological sequelae.

Aluminum Hydroxide↗
PubMed2001

Ipsilateral thoraco-lumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection.

We report ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast after injection through a thoracic paravertebral catheter that was placed at the right T8-9 spinal level for pain management in a patient with multiple fractured ribs. We review the literature and describe the subendothoracic fascial communication between the thoracic paravertebral space and the retroperitoneal lumbar paravertebral region, which we propose, is the anatomical basis for ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast in our patient.

Extravasation of Diagnostic and Therapeutic Materi↗
PubMed2000

Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral bodies.

We report contralateral spread of contrast medium anterior to the vertebral bodies after injection of contrast through a thoracic paravertebral catheter that was used to manage pain in a patient with multiple fractured ribs. We review the literature and propose that the anatomical basis for this observation is spread in the extrapleural compartment of the thoracic paravertebral space along the subserous fascial plane.

Aged↗
PubMedDate not supplied

Indications for aortography. Radiography after blunt chest trauma: a reassessment of the radiographic findings associated with traumatic rupture of the aorta.

Indications for aortography in truncal trauma patients have expanded as reports of radiographic findings associated with traumatic rupture of the aorta (TRA) have proliferated. By studying to what extent these findings also occurred in trauma patients without TRA, we determined the utility of these findings in selecting patients for aortography. The detection of nine radiographic findings associated with TRA was tabulated in 173 patients undergoing arch aortography to rule out TRA from 1975 to 1980. Twenty-five of these had TRA. All patients with TRA under age 65 had a widened mediastinum (WM); this was the only finding that taken alone correlated significantly with TRA (P = 0.001). Only two of six patients with TRA over 65 had a WM. Other findings such as hemothorax, fracture of ribs 1 or 2, pulmonary contusion, or multiple rib fracture were more likely to be found in patients without TRA. Formal radiographic interpretation by staff radiologists detected more radiographic abnormalities than physicians caring for the patient emergencly, who had access to a junior radiology resident. However, these physicians were as successful as staff radiologists in detecting WM when it was associated with TRA. A widened mediastinum is the best single criterion for aortography in young trauma patients; all elderly persons with severe truncal trauma should probably have aortography even in the absence of mediastinal widening. Radiologic consultation is important for complete detection of thoracic pathology in trauma patients, but in this study late interpretation of more subtle findings did not detect additional patients with TRA.

Adolescent↗
PubMed1995

Emergency diagnosis and management of physical abuse and neglect of children.

Injuries due to child abuse have continued to attract the attention of investigators. There was new evidence to show that cardiopulmonary resuscitation is a rare cause of rib fracture and that posterior rib fractures without a history of significant trauma are highly suggestive of abuse. An autopsy study examined ocular nerve sheath hemorrhage in deaths caused by abuse. The incidence and characteristics of abuse and neglect were studied for drowning victims. Female circumcision was well described, and physicians need to familiarize themselves with this cultural practice. The American Academy of Pediatrics published policy statements on sudden infant death and shaken baby syndrome. They stressed the need for protocols to deal with unexpected childhood deaths and to obtain autopsies in such cases. Reviews of fractures of abuse and retinal hemorrhages were enlightening. Reporting abuse and coping with violence remained topics of interest.

Adaptation, Psychological↗
PubMed1975

Reactivation of pulmonary tuberculosis due to trauma.

A 53-year-old man developed pulmonary tuberculosis, presumably reactivation, with ten days of sustaining multiple fractured ribs. Tuberculous bronchopneumonia developed in the right lung adjacent to the site of injury and spread to the contralateral lung. Sputum smears were positive for acid-fast bacilli three weeks after trauma. Theories for the reactivation of pulmonary tuberculosis secondary to trauma are reviewed.

Humans↗