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PubMed1992

A model for studies of the deformable rib cage.

An earlier model for the study of rib cage mechanics was modified so that rib deformity in scoliosis could be better represented. The rigid ribs of that model were replaced by five-segment deformable ribs. Literature data on cadaver rib mechanical behavior were used to assign stiffnesses to the new individual model ribs so that experimental and model rib deflections agreed. Shear and tension/compression stiffnesses had little effect on individual rib deformation, but bending stiffnesses had a major effect. Level-to-level differences in mechanical behavior could be explained almost exclusively by level to level differences in the rib shape. The model ribs were then assembled into a whole rib cage. Computer simulations of whole rib cage behaviors, both in vivo and in vitro, showed a reasonable agreement with the measured behaviors. The model was used to study rib cage mechanics in two scolioses, one with a 43 degrees and the other with a 70 degrees Cobb angle. Scoliotic rib cage deformities were quantified by parameters measuring the rib cage lateral offset, rib cage axial rotation, rib cage volume and rib distortion. Rib distortion was quantified both in best-fit and simulated computer tomography (CT) scan planes. Model rib distortion was much smaller in best-fit planes than in CT planes. The total rib cage volume changed little in the presence of the scolioses, but it became asymmetrically distributed.

Biomechanical Phenomena↗
PubMed2003

Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma.

OBJECTIVE: Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of chest X-rays in showing the rib fractures is limited particularly in those involving the cartilage part of the rib. We investigated the possible rib fractures, those overlooked on chest X-rays, with the use of ultrasonography in minor blunt chest trauma. METHODS: A total of 37 patients, with minor blunt chest trauma showing no evidence of a rib fracture on chest X-rays, were examined with ultrasonography performed with a 7.5-MHz linear transducer. Logistic regression analysis was done to outline the clinical predictors of these insidious rib fractures. RESULTS: A total of 15 (40.5%) patients showed rib lesions, whereas 22 (59.5%) patients had no evidence of rib lesions. Fracture of the rib associated with a subperiosteal hematoma was the most common finding in ten (66.7%) patients followed by the fracture of the rib alone in four (26.7%) patients, and subperiosteal hematoma alone in one (6.7%) patient. A total of eight (53.3%) patients had bony rib fractures, whereas seven (46.7%) patients had chondral rib fractures. Age (P=0.617), gender (P=0.552), type of etiology (P=0.954), duration of pain (P=0.234) and site of trauma (P=0.740) did not appear as significant predictors for these rib fractures. However, the involved part of the rib showed a significant correlation with either age (P=0.042) or duration of pain (P=0.033). Bony rib fractures significantly occurred in elderly patients, and the duration of pain in patients with bony rib fractures was significantly longer than that of patients with chondral rib fractures. CONCLUSIONS: Ultrasonography is a useful imaging method in showing the rib fractures those overlooked on chest X-rays in minor blunt chest trauma, and no significant clinical feature exists as a predictor for these insidious fractures. However, bony rib fractures significantly occur in elderly patients and result in a longer duration of pain.

Adolescent↗
PubMed1999

Clinical application of biodegradable rib connecting pins in thoracotomy.

BACKGROUND: To assess the usefulness in rib reconstruction of biodegradable connecting pins made of polylactide (PLA), PLA rib pins were compared with conventional non-absorbent aluminous ceramic rib pins (alumina rib pins) in terms of their ability for fixing and healing of cut ribs in thoracic surgery. METHODS: There were 13 cases of rib fixation after thoracotomy using PLA rib pins and 11 cases using alumina rib pins, all of which were inserted into the medulla of the stump of the ribs that had been cut at thoracotomy to secure a larger surgical field. The observation period was 6 months after the operation. RESULTS: The degree of vertical shift of the ribs connected with PLA rib pins was significantly reduced compared with the degree using alumina rib pins. In chest radiographs clear zones around the pins, indicating a delay in bone neogenesis, were observed frequently around the alumina rib pins but were absent around the PLA rib pins. Osteosynthesis using PLA rib pins was significantly more favorable than with alumina rib pins. CONCLUSIONS: These results demonstrated that the PLA rib pin was superior to the alumina rib pin for fixing and healing of the cut rib.

Adult↗
PubMed1993

Are there indications for partial rib resection in patients with adolescent idiopathic scoliosis treated with Cotrel-Dubousset instrumentation?

In adolescent idiopathic scoliosis the cosmetically unacceptable rib prominence is one of the main reasons patients seek treatment. Ninety-eight patients were reviewed with Cotrel-Dubousset (CD) instrumentation (average follow-up, 27 months; average preoperative curve, 53 degrees) and 27 patients with Harrington instrumentation and rib resection (average follow-up, 43 months; average preoperative curve, 52 degrees). Of the 98 patients who had CD instrumentation, 15 underwent concomitant rib resection. Of the 83 patients without rib resection, 71 (72%) were rated satisfactory and 12 unsatisfactory by cosmetic criteria based on residual rib deformity. These results were compared to those of 27 patients receiving Harrington rod instrumentation and rib resection, of whom 23 (85%) were rated as satisfactory. All 15 patients with CD and rib resection were rated satisfactory. The CD patients were then redivided into two groups (rib resection indicated or rib resection not indicated) as follows: the 12 unsatisfactory CD patients without rib resection (in whom a rib resection should have been done) were grouped with the 15 CD patients who underwent rib resection, for a total of 27 rib resections indicated, or 28%. This group was compared to the 71 satisfactory CD patients without rib resection (rib resection not indicated). Patients with a rib prominence of > 15 degrees preoperatively had or should have had a rib resection. Patients with a higher chance of needing rib resection included those with a curve severity greater than 60 degrees, curve flexibility less than 20%, a preoperative rib prominence > 10 degrees, or intraoperative curve correction of less than 50%.

Adolescent↗
PubMedDate not supplied

The ribs: anatomic and radiologic considerations.

The ribs are essential structures of the osseous thorax and provide information that aids in the interpretation of radiologic images. Techniques for making precise identification of the ribs are useful in detection of rib lesions and localization of lung lesions. The big rib sign and the vertical displacement sign can be used to differentiate the right and left ribs on lateral chest radiographs. The clavicle, the xiphoid process, and the sternal angle may be used as anatomic landmarks for rib counting on computed tomographic scans. For rib counting on lateral chest radiographs, the sternal angle or the 12th rib may be used. Anatomic rib variants include developmental deformities, cervical rib, and short rib and may mimic true rib diseases. Detection of thoracic deformities such as funnel chest (pectus excavatum) and barrel-shaped thorax requires an awareness of the strong correlation between the transverse appearance of the thorax and costal shape. Shadows around the rib cage (eg, rib companion shadows, sharp lines along the lower margin of the ribs, rib overlying shadows) may mimic pleural and extrapleural disease on frontal chest radiographs. It is imperative that the radiologist be familiar with normal rib anatomy, normal rib variants, and the radiologic appearance of the ribs to prevent misdiagnosis.

Humans↗
PubMed2005

Cough-induced rib fractures.

OBJECTIVES: To define the demographic, clinical, and radiological features of patients with cough-induced rib fractures and to assess potential risk factors. PATIENTS AND METHODS: For this retrospective, single-center study, we identified all cases of cough-induced rib fractures diagnosed at the Mayo Clinic in Rochester, Minn, over a 9-year period between January 1, 1996, and January 31, 2005. Bone densitometry data from patients' medical records were analyzed, and T scores were used to classify patients into bone density categories. RESULTS: The mean +/- SD age of the 54 study patients at presentation was 55+/-17 years, and 42 patients (78%) were female. Patients presented with chest wall pain after onset of cough. Rib fracture was associated with chronic cough (> or =3 weeks' duration) in 85% of patients. Rib fractures were documented by chest radiography, rib radiography, computed tomography, or bone scan. Chest radiography had been performed in 52 patients and revealed rib fracture in 30 (58%). There were 112 fractured ribs in 54 patients. One half of patients had more than one fractured rib. Right-sided rib fractures alone were present in 17 patients (26 fractured ribs), left-sided in 23 patients (35 fractured ribs), and bilateral in 14 patients (51 fractured ribs). The most commonly fractured rib on both sides was rib 6. The fractures were most common at the lateral aspect of the rib cage. Bone densitometry was done in 26 patients and revealed osteopenia or osteoporosis in 17 (65%). CONCLUSIONS: Cough-induced rib fractures occur primarily in women with chronic cough. Middle ribs along the lateral aspect of the rib cage are affected most commonly. Although reduced bone density is likely a risk factor, cough-induced rib fractures can occur in the presence of normal bone density.

Adult↗
PubMed2002

Evaluating the point of separation, during carcass fabrication, between the beef wholesale rib and the beef wholesale chuck.

This study determined whether there is a logical point of value change, related to either tenderness or consumer acceptance, at which to separate the beef carcass within the rib/chuck region. Rib/chuck rolls (RCR); (n = 30) consisting of the ribeye roll and chuck eye roll subprimals (2nd through 12th rib locations) were cut into 22 steaks each (two steaks per rib location), and Warner-Bratzler shear force and consumer purchase preference were evaluated for steaks at each rib location. Steaks from different locations of the RCR were composed of differing proportions of several muscles: longissimus muscle (LM), spinalis dorsi and multifidus dorsi (SM), and complexus (CO). The LM (4th to 12th rib) contained three tenderness regions: 7th through 12th rib, 5th and 6th ribs, and 4th rib regions (lowest, intermediate, and highest shear force values, respectively; P < 0.01). Shear force differed (P < 0.05) among rib locations for the SM (2nd to 9th rib), but no logical pattern was evident. The CO (2nd to 7th rib) was more tender toward the anterior end (P < 0.05). The region of the RCR represented by the 4th through 6th rib locations had steaks with higher weighted-average shear force (average shear force of each steak, weighted for surface area of each muscle) values than the remainder of the RCR (P < 0.05). Animal-to-animal variation in shear force was 36% greater than rib-to-rib variation in shear force; thus, statistically significant differences in tenderness among rib locations may be undetectable by consumers. Steaks (n = 330) were offered for sale at a retail supermarket and case time was monitored on each steak to determine consumer purchase preference. Steaks from the 2nd through 4th rib locations required more time to sell (P < 0.01) than steaks from the 5th through 12th rib locations. Two alternative locations for the rib/chuck separation point could be between the 6th and 7th ribs, yielding a ribeye subprimal useful in marketing a "premium quality" product, or between the 4th and 5th ribs, which would yield four more 2.5-cm ribeye steaks per carcass.

Animals↗
PubMed2005

Half-a-dozen ribs: the breakpoint for mortality.

BACKGROUND: We hypothesized that the number of rib fractures independently impacted patient pulmonary morbidity and mortality. METHODS: The National Trauma Data Bank (NTDB, v. 3.0 American College of Surgeons, Chicago, IL) was queried for patients sustaining 1 or more rib fractures. Data abstracted included the number of rib fractures by International Classification of Diseases-9 code, Injury Severity Score, the occurrence of pneumonia, acute respiratory distress syndrome, pulmonary embolus, pneumothorax, aspiration pneumonia, empyema, and associated injuries by abbreviated injury score, the need for mechanical ventilation, number of ventilator days, intensive care unit (ICU) length of stay (LOS), hospital LOS, mortality, and use of epidural analgesia. Statistical analysis was performed using the Student t test and linear regression analysis. Statistical significance was defined as a P value of less than .05. RESULTS: The NTDB included 731,823 patients. Of these, 64,750 (9%) had a diagnosis of 1 or more fractured ribs. Thirteen percent (n = 8,473) of those with rib fractures developed 13,086 complications, of which 6,292 (48%) were related to a chest-wall injury. Mechanical ventilation was required in 60% of patients for an average of 13 days. Hospital LOS averaged 7 days and ICU LOS averaged 4 days. The overall mortality rate for patients with rib fractures was 10%. The mortality rate increased (P < .02) for each additional rib fracture. The same pattern was seen for the following morbidities: pneumonia (P < .01), acute respiratory distress syndrome (P < .01), pneumothorax (P < .01), aspiration pneumonia (P < .01), empyema (P < .04), ICU LOS (P < .01), and hospital LOS for up to 7 rib fractures (P < .01). An association between increasing hospital LOS and number of rib fractures was not shown (P = .19). Pulmonary embolism also was not related to the number of rib fractures (P = .06). Epidural analgesia was used in 2.2% (n = 1,295) of patients with rib fractures. A reduction in mortality with epidural analgesia was shown at 2, 4, and 6 through 8 rib fractures. The use of epidural analgesia had no impact on the frequency of pulmonary complications. When stratifying data by Injury Severity Score and the presence or absence of rib fractures the mortality rates were similar. CONCLUSIONS: Increasing the number of rib fractures correlated directly with increasing pulmonary morbidity and mortality. Patients sustaining fractures of 6 or more ribs are at significant risk for death from causes unrelated to the rib fractures. Epidural analgesia was associated with a reduction in mortality for all patients sustaining rib fractures, particularly those with more than 4 fractures, but this modality of treatment appears to be underused.

Anesthesia, Epidural↗
PubMed2003

The myth of dorsal ribs in gnathostome vertebrates.

Traditionally, two types of rib are distinguished in gnathostomes: dorsal (upper) and ventral (lower, pleural) ribs. They are defined according to their position in the connective tissue system of the body: dorsal ribs develop at the intersection of the serially arranged myosepta with the horizontal septum that separates epaxial from hypaxial musculature, whereas ventral ribs develop at the intersection of myosepta with the peritoneum and usually encircle the body cavity. Distribution of rib types among gnathostomes has traditionally been reported as follows: elasmobranchs have dorsal ribs; all Actinopterygii have only ventral ribs with the exception of polypterids, and two subgroups of teleosts, which supposedly also have dorsal ribs; within Sarcopterygii tetrapods have dorsal ribs, whereas dipnoans have ventral ribs. Here, we report the development of ribs in polypterids, a taxon playing a crucial role in discussions on rib homology. We demonstrate that putative dorsal ribs of polypterids have a unique ontogeny and represent an autapomorphy of this taxon. We discuss previous hypotheses of rib homology and offer a more plausible (i.e. more parsimonious) alternative to the conventional interpretation. We conclude that dorsal ribs do not exist and that ribs of gnathostomes are ventral ribs.

Animals↗
PubMed2006

Geometry of human ribs pertinent to orthopedic chest-wall reconstruction.

Orthopedic reconstruction of blunt chest trauma can aid restoration of pulmonary function to reduce the mortality associated with serial rib fractures and flail chest injuries. Contemporary chest wall reconstruction requires contouring of generic plates to the complex surface geometry of ribs. This study established a biometric foundation to generate specialized, anatomically contoured osteosynthesis hardware for rib fracture fixation. On human cadaveric ribs three through nine, the surface geometry pertinent to anatomically conforming osteosynthesis plates was characterized by quantifying the apparent rib curvature C(A), the longitudinal twist alpha(LT) along the diaphysis, and the unrolled curvature C(U). In addition, the rib cross-sectional geometry pertinent to intramedullary fixation strategies was characterized in terms of cross-section height, width, area, and cortex thickness. The rib surface exhibited a curvature C(A) ranging from 3.8 m(-1) in the anteromedial section of rib seven to 17.3 m(-1) in the posterior section of rib three. All ribs had in common a longitudinal twist alpha(LT), ranging from 41-60 degrees. The unrolled curvature C(U) decreased gradually from ribs three to five, and increased gradually with reversed orientation from rib six to nine. The cross-sectional area remained constant along the rib diaphysis. However, the medullary canal increased in size from 29.9 mm(2) posteriorly to 41.2 mm(2) in anterior rib segments. Results of this biometric rib characterization describe a novel strategy for intraoperative plate contouring and provide a foundation for the development of specialized rib osteosynthesis strategies.

Bone Plates↗
PubMed2002

Rib cage surgery for the treatment of scoliosis: a biomechanical study of correction mechanisms.

Rib shortening or lengthening are surgical options that are used to address the cosmetic rib cage deformity in scoliosis, but can also alter the equilibrium of forces acting on the spine, thus possibly counteracting in a mechanical way the scoliotic process and correcting the spinal deformities. Although rib surgeries have been successful in animal models, they have not gained wide clinical acceptance for mechanical correction of scoliosis due to the lack of understanding of the complex mechanisms of action involved during and after the operation. The objective of this study was to assess the biomechanical action of different surgical approaches on the rib cage for the treatment of scoliosis using a patient-specific finite element model of the spine and rib cage. Several unilateral and bilateral rib shortening/lengthening procedures were tested at different locations on the ribs (convex/concave side of the thoracic curvature; at the costo-transverse/costo-chondral joint; 20 and 40 mm adjustments). A biomechanical analysis was performed to assess the resulting geometry and load patterns in ribs, costo-vertebral articulations and vertebrae. Only slight immediate geometric variations were obtained. However, concave side rib shortening and convex side rib lengthening induced important loads on vertebral endplates that may lead to possible scoliotic spine correction depending on the remaining growth potential. Convex side rib shortening and concave side rib lengthening produced mostly cosmetic rib cage correction, but generated inappropriate loads on the vertebral endplates that could aggravate vertebral wedging. This study supports the concept of using concave side rib shortening or convex side rib lengthening as useful means to induce correction of the spinal scoliotic deformity during growth, though the effects of growth modulation from induced loads must be addressed in more detail to prove the usefulness of rib shortening/lengthening techniques.

Biomechanical Phenomena↗
PubMed1984

Occult rib fractures and brachial plexus injury following median sternotomy for open-heart operations.

The incidence and the sites of rib fractures during open-heart operations through a median sternotomy incision were studied in 36 consecutive patients divided into two groups. In Group 1 (24 patients), a conventional Ankeney retractor was used to expose the heart, and in Group 2 (12 patients), a similar retractor was used but with its uppermost pair of blades removed. Thorough physical examinations and preoperative and postoperative chest roentgenograms were obtained, and postoperative bone scans were done in all patients. No rib fractures were detected on the routine chest roentgenograms in patients in either group. Bone scans, however, showed 44 rib fractures (15 of the first rib, 13 of the second rib, 4 of the third rib, 6 of the fourth rib, 3 of the fifth rib, and 3 of the sixth rib) in 16 patients in Group 1. Six patients in Group 2 had 9 rib fractures (2 of the first rib, 4 of the second rib, and 1 each of the third, fifth, and sixth ribs). None of the patients in Group 2 had brachial plexus injury and neither of the first rib fractures in this group were located posteriorly, whereas 3 patients in Group 1 had both brachial plexus injury and posterior first rib fractures.

Brachial Plexus↗
PubMed2003

Clinical significance and outcome of one or two rib lesions on bone scans in breast cancer patients without known metastases.

The presence of one or two rib lesions on bone scans of post-treatment breast cancer patients without known metastases often makes clinical decision making problematic. The aim of this study was to identify skeletal metastasis predictors that might help the management of these patients. We recruited post-treatment breast cancer patients without overt metastases whose bone scans showed (1) one or two rib hot spots, or (2) one rib lesion and a concurrent bone abnormality. Their clinical and serial scintigraphic data were collected, reviewed and evaluated for correlations. After their first abnormal bone scans, 23 patients (11 of the 77 patients initially with one rib lesion (incidence, 14.3%), three of the 27 patients with two rib lesions (incidence, 11.1%), and nine of the 11 patients with one rib lesion plus a concurrent bone abnormality (incidence, 81.8%)) developed multiple bone metastases within 2 years of the initial rib lesions in all but one case. Univariate analyses revealed that a concurrent bone lesion other than the rib, direct tumour invasion to the chest wall or skin, and 10 or more lymph nodes involved were associated with increased risks of bone metastases whereas longer persistence of the rib lesions was associated with a lower risk. Multivariate proportional hazard analyses indicated that patients with a concurrent bone lesion other than the rib (relative risk (RR)=39.65; 95% confidence interval (CI)=8.13-193.28), 10 or more lymph nodes involved (RR=13.49; 95% CI=2.09-86.91), and no radiotherapy (RR=7.59; 95% CI=2.11-27.39) were more likely to have bone metastases, while those with longer persistence of the rib lesions (RR=0.92; 95% CI=0.84-0.98) and longer time interval between surgery and the rib lesion detection (RR=0.96; 95% CI=0.94-0.99) were less likely. We have identified clinical features applicable to risk stratification. High incidence of bone metastases was noted in patients with one rib lesion and a concurrent bone abnormality. Regular follow-up for 2 years after detection of rib lesions is recommended, especially for those with risk factors.

Adult↗