[Closed treatment of multiple fractures of the ribs and sternum].
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Adult↗
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Results for “RIB FRACTURES”
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[Case of sympathetic post-traumatic opthalmoplegia with fracture of the first rib].
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Fractures, Bone↗
[Fractures of the rib in chronic diseases of the lung: fissural osteosis of the rib due to chronic respiratory insufficiency].
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Chronic Disease↗
Fractures and low axial bone density in perimenopausal women.
The relationship between past fractures and current bone density (BMD) was analyzed in a population sample of 3222 women aged 48-58. BMD was determined with dual X-ray absorptiometry (DXA) at the spine and femoral neck. 702 women reported fractures. Wrist and ankle were the most common fracture sites. Fracture history increased the risk [OR (95% CI)] of low spinal BMD (of more than 1 SD below the study population mean) by 1.75 (1.41; 2.18). The sensitivity and specificity of fracture history to detect a low spinal BMD were 31 and 80%, respectively. One SD decreases of spinal and femoral BMD equalled to respective overall fracture risks (adjusted ORs) of 1.36 (1.24; 1.50) and 1.38 (1.25; 1.51). Both BMDs related more strongly to wrist fracture [1.73 (1.47; 2.05)/1.69 (1.43; 1.99)] than to all nonwrist fractures combined [1.24 (1.11; 1.37)/1.27 (1.14; 1.42)]. Ankle and rib fractures related only to spinal [1.21 (1.00; 1.46)/1.45 (1.12; 1.87)] but tibia and foot bone fractures only to femoral [2.04 (1.37; 3.04)/2.20 (1.42; 3.41)] BMD. Spinal BMD related more strongly to fractures due to falls on same level than to fractures due to all other trauma combined. Fracture history poorly screens out low perimenopausal BMD. The results suggest that pre- and perimenopausal fractures relate to low axial bone density and that the magnitude of this relation depends on the sites of fracture and densitometry as well as on the type of trauma.
Absorptiometry, Photon↗
The multi-institutional validation of the new screening index for physical child abuse.
BACKGROUND/PURPOSE: There is currently no evidence-based screening instrument to assist in the detection of physical child abuse patients. The screening index for physical child abuse (SIPCA) was previously developed as a potentially new tool for this need. It is a scale that assigns point values, on the basis of variable weights from logistic regression models, to age and patterns of injuries (including fracture of base or vault of skull, contusion of eye, rib fracture, intracranial bleeding, multiple burns), with higher scores indicating greater suspicion for abuse. The purpose of this study is to validate this new tool in another independent data set. METHODS: A cross-sectional hospital discharge database from 1961 hospitals in 17 states is used (n = 58558). Children aged 14 years or younger with International Classification of Diseases, Ninth Revision, Clinical Modification codes 800 to 959 are included for analysis. Child abuse cases are identified by E codes and certain International Classification of Diseases, Ninth Revision, Clinical Modification codes in the 995.5x range. Screening index for physical child abuse performance is evaluated by discrimination (receiver operating characteristic) and goodness of fit (pseudo r2). RESULTS: A total of 447 abused patients (0.76%) was identified. The receiver operating characteristic of SIPCA in this data set is 0.89 as compared with 0.86 in the development data set. The pseudo r 2 of SIPCA in this data set is 0.26 as compared with 0.28 in the development data set. A SIPCA score of 3 has a sensitivity of 86.6% and a specificity of 80.5% for detecting physical abuse; raising the threshold to a score of 4 improves the specificity to 93.1% but at a loss of sensitivity to 71.8%. CONCLUSIONS: The validity of the new SIPCA instrument is supported by its performance in an independently derived data set. A score of 3 on SIPCA represents a balanced trade off in the sensitivity and specificity of the instrument in detecting physical abuse and is an optimal threshold above which to begin considering abuse in differential diagnosis. Application of the instrument could assist clinicians in detecting physical child abuse cases among pediatric trauma patients.
Age Factors↗
The tip of the iceberg for child abuse: the critical roles of the pediatric trauma service and its registry.
BACKGROUND: The incidence of child abuse is approximately 10% of all children presenting to an emergency department (ED), with a mortality rate less than 1%. By contrast, the characteristics of the subset of abused children presenting to a pediatric trauma service (PTS) is not well defined. METHODS: This study was a retrospective evaluation of prospectively collected information from an urban Level I pediatric trauma registry from 1990 to 2002 (n = 11,919). Child abuse cases and their perpetrators were identified by E-codes. Patterns of injuries were examined by integer International Classification of Diseases, Ninth Revision codes, and diagnostic model was evaluated by discrimination and goodness-of-fit. RESULTS: A total of 171 cases of child abuse (1.4%) were identified, and the majority were boys (59%, p > 0.05 vs. nonabuse cases). The median age of the abused cohort was younger than 1 year old, and the number of abuse cases did not differ over time (mean, 11 per year.) Abused children present with a higher median Injury Severity Score (10 vs. 4, p < 0.01), more severe injuries of the head and integument, longer hospital lengths of stay (4 vs. 1 day, p < 0.01), and a higher mortality rate (12% vs. 2%, p < 0.01). The following variables emerged with significant association to abuse: fracture of base or vault of skull, contusion of eye, rib fracture, intracranial bleeding, multiple burns, and age. A new Diagnostic Index for Physical Child Abuse was created. CONCLUSION: Significant characteristics of the abused children in this pediatric trauma service include higher Injury Severity Score (especially in the head and integument), requirement for longer lengths of stay, and a nearly 10-times higher risk of death compared with the ED population. The Diagnostic Index for Physical Child Abuse is proposed as a new tool to assist in the identification of child abuse among pediatric trauma patients. An epidemiologic triangle for child abuse is described, with different prevalence and severity of child abuse seen at different levels of our health care system, starting with primary care providers, followed by the ED, the PTS, and ultimately the medical examiners. The number of cases decreases from the bottom to the top of the health care system, but the mortality rate increases as abuse escalates through the triangle. This establishes the PTS as possibly the final gatekeeper before an abused case becomes a fatality. These data emphasize the need for rigorous registry evaluation and subsequent evidence-based prevention initiatives.
Baltimore↗
[Contusion of the lungs in childhood].
The authors evaluated in a retrospective study a group of 45 patients with contusion of the lungs (age 1 to 15 years) who were treated at the Faculty Hospital in Motol in 1989-1993. In 38 children contusion of the lungs was part of multiple injuries with signs of failure of vital functions. These children were admitted after the injury to the in-patient department of the Anaesthesiological and Resuscitation Clinic. Seven children without alterations of vital functions were treated at the Department of Paediatric Surgery. The diagnosis was based on the case-history, clinical examination, X-ray examination and laboratory signs of lung injuries. An isolated pneumothorax was found in 17.8% of the injured children, haemothorax in 8.9% and in 24.5% pneumothorax and haemothorax. Severe craniocerebral injuries were diagnosed in 71% of patients, 37.8% children had concomitant injuries of the abdominal organs and retroperitoneum and 42% had fractures of the long bones. 46.6% of the children had rib fractures. The condition of 35 injured children called for endotracheal intubation (on average for 17 days) and artificial ventilation (on average for 14.4 days). 98% of the injured children were given antibiotics, in 84% steroids were administered, in 18 of the injured children (40%) drainage of the thoracic cavity was essential. Six patients (13.3%) drainage of the thoracic cavity was essential. Six patients (13.3%) died--the cause of death were severe injuries of the CNS.
Adolescent↗
Importance of correct interpretation of postmortem artifacts in medicolegal autopsies.
PURPOSE: To study whether various injuries labelled as antemortem are in fact postmortem artifacts. STUDY SUBJECTS: 780 postmortems conducted in mortuary of S.M.C. Karachi from 1-1-95 to 20-9-95. MAIN FINDINGS: Out of 780 autopsies, 229 showed postmortem artifacts which included decomposition in 78, animal and insects producing changes in 45, injuries due to rough handling in 40, breaking of rigor mortis and shifting of postmortem lividity during transportation in 37, iatrogenic fracture of skull during opening in 15, fractured ribs during resuscitation after death in 8 and exhumation producing fractures of bones in 6 bodies.
Artifacts↗
Case report--stress fracture of the rib in a golfer.
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Fractures, Stress↗
Fracture of the first rib.
Fifteen cases of isolated fracture of the first rib are submitted. The mechanism of the fracture is discussed. It proved compatible with the descriptions in the literature, caused either by direct trauma to the shoulder, a sudden violent contraction of juxtacostal muscles; or else it was a chance finding, without any history of trauma and as such interpreted as a fatigue fracture. A case of Horner's syndrome complicating a fracture of the first rib is also described.
Accidents, Traffic↗
[Indications for thoracotomy and rib stabilization in thoracic trauma in the aged].
In trauma patients with chest injuries, serial rib fractures and intrathoracic lacerations, the indication for primary thoracotomy is usually limited to life-threatening organ ruptures. In our own experience with 13 patients, primary thoracotomy offers the chance of immediate closure of lung lacerations, suture of pleural and pericardial tears, ligature of torn intercostal vessels, and stabilization of the chest wall by rib plating. Postoperative, respiration, free of pain, is restored immediately. Complications and duration of respirator treatment can be reduced. This will reduce the high lethality rates of chest injuries significantly.
Aged↗
[Early thoracotomy and chest wall stabilization with elastic rib clamps (author's transl)].
In patients with chest injuries, serial rib fractures and intrathoracic lacerations the indication for primary thoracotomy is usually limited to life-threatening organ ruptures. In our own experience with 18 patients primary thoracotomy offers the chance of immediate closure of lung lacerations, suture of pleural and pericardial tears, ligature of torn intercostal vessels and stabilization of the chest wall by elastic rib clamps "Essener Model". Postoperative respiration, freedom of pain, is restored immediately and therefore complications and duration of high-risk respirator treatment can be reduced.
Adult↗
Stress fracture of the rib in an elite oarsman.
This paper documents an unusual case of a stress fracture of the ninth rib in an elite oarsman. A 25-year-old male presented with a 3-day history of right-sided chest pain aggravated by deep inspiration and movements simulating rowing. The athlete was treated initially as having a soft tissue injury; however, a technetium-99 bone scan confirmed the diagnosis. Routine radiographs of the ribs were negative. The pain and symptoms were confined to the anatomical area of the fracture along the anterolateral portion of the rib where the serratus anterior muscle originates. An analysis of the stroke mechanics involved in rowing implicated the serratus anterior muscle as being a major contributor to the repetitive stress that resulted in the injury. The primary etiological factor was errors in the training program. The athlete responded to simple conservative measures and was able to return to competitive rowing in 1 month's time.
Adult↗
Systemic effects of prostaglandin E2 on vertebral trabecular remodeling in beagles used in a healing study.
Prostaglandin E2 (PGE2) at a dose of 10 mg/kg was administered orally to beagles used in a study of rib fracture and drill hole defect healing. Double fluochrome labels were given prior to surgical manipulation and before necropsy at 30 days. Bone remodeling was evaluated in trabecular bone of the fourth lumbar vertebra. There was a decrease in the number and extent of posttreatment labels (P less than 0.05) in the controls, with decreased mineral apposition rate (P less than 0.05) and decreased active bone formation rate (P less than 0.01). In dogs given PGE2 for 30 days following surgery, the extent of posttreatment labels (P less than 0.05) and bone formation rate (P less than 0.01) were increased. There was no difference found, however, in static morphometric parameters, including osteoid and osteoblast-covered surface, indicating that the stimulation of bone formation may have been transitory and matrix synthesis had declined. In another group of dogs given PGE2 for 5 days prior to surgical manipulation and between the first and second pretreatment labels, the extent of the double-labeled surface was increased (P less than 0.05) indicating an acute PG effect to sustain formation at remodeling sites. These studies show that PGE2 given orally has a systemic effect on bone remodeling in vertebral trabeculae that involves the stimulation of formation activity.
Animals↗
[Mandibular fracture caused by absolute close-range gunshot with a blank cartridge fright weapon].
Bony injuries caused by starter's pistols were repeatedly observed in the form of fractures of the temporal squama and other thin osseous lamellae; in experiments rib fractures could also be produced. In the presented case a contact shot from a blank cartridge pistol caused a fracture of the lower jaw (transverse fracture with a bone fragment split off in reg. 46). The friend of the 17-year-old victim had fired a shot to the right mandibular region during an argument. In the depth of the gunshot entrance wound, which communicated with the oral cavity, intense soot deposits were found as signs of the contact shot.
Adolescent↗
Stress fracture of the first rib in a weightlifter.
An isolated fracture of the first rib is rare. Stress fractures of the first rib have previously been reported in various sports and the mechanism of fractures of the first rib has been well documented. Stress fractures of the first rib have also been reported in laborers involved in heavy lifting. The course is insidious, and identification of the lesion is usually made on the basis of an incidental roentgenogram. No reported case of stress fracture of the first rib in a weightlifter has hitherto been available. This paper describes such a case for the first time.
Adolescent↗
The effects of screw number and length on two methods of tension band plating.
Bovine ribs were used to evaluate the effects that screw length and number have on two types of tension bands. Five trials each were done with one, two, three, or four screws per segment, using screws 4, 8, 12, or 16 mm in length and 2-mm adaptation plates or 2-mm mini-dynamic compression plates. The fractured ribs were subjected to increasing weights until failure. With the 2-mm adaptation plate, screw length played no role in the amount of weight resisted. Increasing the number of screws per segment increased the weight resisted to up to three screws per segment, after which no additional benefit was realized (P < .001). For the 2-mm mini-dynamic compression plate, increasing screw length increased the weight resisted up to three screws per segment, after which length had no effect (P < .001). Increasing the number of screws per segment increased the weight resisted up to three screws per segment, after which no additional benefit was realized (P < .001).
Analysis of Variance↗
Thoracic surgery techniques of Serefeddin Sabuncuoğlu in the fifteenth century.
Serefeddin Sabuncuoğlu (1385 to 1470?) is known to be the author of the first surgery textbook, namely Cerrahiyyet'ül Haniyye (Imperial Surgery), written in Turkish in 1465. It is the first book to contain colored illustrations of surgical procedures, incisions, and instruments in the Turkish-Islamic medical literature. He was the first man to illustrate and mention introduction of a tube into the pharynx and upper esophagus, removal of foreign bodies in the esophagus by special instruments of his own design, and use of a silver ringlet in a man after tracheotomy. He also described and illustrated reduction of sternal fractures, thoracic puncture through the intercostal space for drainage of empyema cavities, and treatment of rib fractures that have severed the diaphragm. He was a humble, curious, and intelligent surgeon, and also a calligrapher and a miniature artist.
History, 15th Century↗