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Results for “RIB FRACTURES”

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PubMed1989

[Successful surgical treatment of a patient with tension pneumopericardium and left hemothorax caused by multiple rib fractures].

A 62-year-old man underwent operation for tension pneumopericardium and left hemothorax caused by multiple rib fractures. He sustained other multiple injuries, such as acute subdural hematoma, compound fractures of the left leg. At left thoracotomy, massive hemorrhage from the left apical lung disrupted by the first and second fractured ribs was encountered and pericardium was seen to be bulging and tensely inflated. Incision of the pericardial sac resulted in expulsion of air with a subsequent fall in central venous pressure and heart rate. And after repair of the tear of the laceration of the left lung, the chest was closed with underwater seal drainages of the left pleural cavity. He was successfully weaned off the ventilator after 12 days. After extubation, repeated bronchoscopy was done, but the tracheobronchial injury was not able to be found out.

Hemothorax↗
PubMed2002

Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures.

OBJECTIVE: Few non-surgical conditions are more painful than rib fractures. There are a few methods for pain relief in patients with minor rib fractures. METHODS: We used a non-steroidal anti-inflammatory drug (NSAID, Naproxen sodium) and transcutaneous electrical nerve stimulator (TENS) to control pain of the patients with uncomplicated minor rib fractures. One hundred consecutive patients admitted to Kartal Education and Research Hospital Emergency Service, were randomized into four groups. The patients were assigned to one of the following pain treatments: NSAID, TENS, NSAID plus inactive TENS or placebo. The patients used NSAIDs and placebo four times a day and TENS twice a day for 3 days. All patients were asked to assess their pain level with a scoring system on days 0, 1 and 3. RESULTS: The most effective treatment was TENS on days 1 and 3 (P<0.05). Although NSAID and NSAID plus inactive TENS controlled pain better than placebo on day 1 (P<0.05), this superiority did not continue to day 3 (P>0.05). There was no difference between NSAID and NSAID plus inactive TENS in controlling pain on either days 1 or 3. CONCLUSION: We conclude that TENS was more effective than NSAID or placebo in patients with uncomplicated minor rib fractures, because of its prominent and admirable efficacy in reduction of pain.

Adolescent↗
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↗
PubMed2006

Rib fractures: relationship with pneumonia and mortality.

OBJECTIVE: In single-institution studies, age is a risk factor for mortality after rib fracture. Sample size has limited the assessment of other risk factors. We used a national database to analyze suspected risk factors contributing to pneumonia and mortality in patients sustaining rib fractures. DESIGN: : Database analysis. PATIENTS: All patients with rib fractures discharged from hospitals submitting information to the Nationwide Inpatient Sample database. INTERVENTIONS: The 1999 Nationwide Inpatient Sample was queried for all patients with rib fracture. Age, gender, number of rib fractures, Injury Severity Score, comorbidities, pneumonia, and mortality were abstracted from the database. Comorbidities were scored according to Elixhauser. Multivariate analysis identified independent risk factors for mortality and pneumonia. MEASUREMENTS AND MAIN RESULTS: We identified 23,426 patients; 17,308 patients had a primary diagnosis of trauma and were included in the analysis. Mean age was 56. Mean Injury Severity Score was 13.1. The number of comorbidities ranged from 0 to 9. Overall mortality was 4%. Six percent of patients had pneumonia. In a multivariate model, age and Injury Severity Score were significantly associated with both mortality and pneumonia. Comorbidity score was associated with pneumonia and mortality only in patients with isolated thoracic trauma. Pneumonia was associated with mortality only in patients with isolated thoracic trauma. CONCLUSIONS: In a model controlling for multiple known risk factors, age and Injury Severity Score were the only important predictors of mortality in patients with rib fractures and multiple-system injury. Pneumonia was significantly associated with mortality only in patients with isolated thoracic trauma.

Adolescent↗
PubMed2003

Rib fracture pain and disability: can we do better?

OBJECTIVE: The purpose of this study was to determine the magnitude and duration of pain and disability in patients with rib fractures treated using current standard therapy. This was a prospective case series. METHODS: Injured patients with a chest radiographic diagnosis of one or more rib fractures between June 1, 2001, and October 31, 2001, were asked to participate. Pain levels were assessed at days 1, 5, 30, and 120 after injury using a visual pain scale (0-10). Disability at 30 days was assessed using the SF-36 Health Status Survey, and the total number of days lost from work/usual activity was recorded at day 120. The setting was a university-based Level I trauma center. RESULTS: Forty patients with a mean of 2.7 +/- 1.6 rib fractures were enrolled. Twenty-three patients had isolated rib fractures and 17 patients had associated extrathoracic injuries. Mean rib fracture pain was 3.5 +/- 2.1 at 30 days and 1.0 +/- 1.4 at 120 days. For patients with associated extrathoracic injuries, rib pain was equivalent to pain in the rest of the body at all intervals. When compared with the chronically ill reference population of the RAND Medical Outcomes Study, our patients as a group were more disabled at 30 days (p < 0.001) in all categories except emotional stability, where they showed equivalent disability, and in their perception of general health, where they were significantly less disabled (p < 0.001). The total mean days lost from work/usual activity was 70 +/- 41. Patients with isolated rib fractures went back to work/usual activity at a mean of 51 +/- 39 days compared with 91 +/- 33 days in patients with associated extrathoracic injuries (p < 0.01). CONCLUSION: Rib fractures are a significant cause of pain and disability in patients with isolated thoracic injury and in patients with associated extrathoracic injuries. Developing new therapies to accelerate pain relief and healing would substantially improve the outcome of patients with rib fractures.

Activities of Daily Living↗
PubMed1999

Sonography compared with radiography in revealing acute rib fracture.

OBJECTIVE: This study was undertaken to compare the sensitivities of sonography and radiography for revealing acute rib fracture. SUBJECTS AND METHODS: Chest radiography and rib sonography were performed on 50 patients with suspected rib fractures. Sonography was performed with a 9- or 12-MHz linear transducer. Fractures were identified by a disruption of the anterior margin of the rib, costochondral junction, or costal cartilage. The incidence, location, and degree of displacement of fractures revealed by radiography and sonography were compared. Sonography was performed again after 3 weeks in 37 subjects. RESULTS: At presentation, radiographs revealed eight rib fractures in six (12%) of 50 patients and sonography revealed 83 rib fractures in 39 (78%) of 50 patients. Seventy-four (89%) of the 83 sonographically detected fractures were located in the rib, four (5%) were located at the costochondral junction, and five (6%) in the costal cartilage. Repeated sonography after 3 weeks showed evidence of healing in all reexamined fractures. Combining sonography at presentation and after 3 weeks, 88% of subjects had sustained a fracture. CONCLUSION: Sonography reveals more fractures than does radiography and will reveal fractures in most patients presenting with suspected rib fracture. Further scientific studies are needed to clarify the appropriate role for sonography in rib fracture detection.

Adult↗
PubMed1985

Rib fractures in children.

We reviewed the charts of 21 children admitted to the hospital with rib fractures to determine the cause of trauma, the relationship of the number and location of rib fractures to other injuries, the course of flail chest in children, and the frequency and characteristics of injuries caused by child abuse. Sixteen (76%) of 21 children were injured by accidental causes, most commonly by motor vehicles. However, five (24%) children were victims of child abuse. Nineteen children fractured an average of 3.5 ribs (range 1 to 8), while two other children fractured 22 and 23 ribs. Neither an increased number of fractures, nor first or second rib fractures were associated with more severe intrathoracic injuries. Two children with flail chest required intubation but recovered without further complications. The five children with nonaccidental rib fractures were young, had an unexplained history, and a paucity of multiple trauma. These characteristics should alert the physician to the possibility of child abuse in the patient with rib fractures.

Accidents, Traffic↗
PubMed2004

Is ultrasound really helpful in the detection of rib fractures?

OBJECTIVE: To determine the usefulness of ultrasound in the detection of rib fractures. PATIENTS AND METHODS: A prospective study was performed over a 3-month period. Patients presenting with a high clinical suspicion of rib fracture(s) to the Accident and Emergency Department were referred for radiological work-up with a PA chest radiograph, an oblique rib view and a chest ultrasound. Associated lesions, e.g. pleural effusion, splenic laceration and pneumothorax were recorded. RESULTS: Fourteen patients were radiologically assessed. The mean patient age was 31 years (range 16-55 years) and the M:F ratio 3.7:1 (11 men and 3 women). Ten patients displayed a total of 15 broken ribs. Chest radiography detected 11, oblique rib views 13 and ultrasound 14 broken ribs. Ultrasound findings included discontinuity of cortical alignment in 12 fractures, an acoustic linear edge shadow in nine and a reverberation artifact in six. Concordance with plain film findings, and especially oblique rib views, was good, though better when the rib fractures fragments were markedly displaced. One splenic laceration was detected with an associated small pleural effusion. There were no pneumothoraces. The average time of ultrasound examination was 13 min. CONCLUSION: Ultrasound does not significantly increase the detection rate of rib fractures, may be uncomfortable for the patient and is too time-consuming to justify its routine use to detect rib fractures.

Adolescent↗
PubMed2000

Rib fractures in the elderly.

BACKGROUND: We sought to ascertain the extent to which advanced age influences the morbidity and mortality after rib fractures (fxs), to define the relationship between number of rib fractures and morbidity and mortality, and to evaluate the influence of analgesic technique on outcome. METHODS: A retrospective cohort study involving all 277 patients > or = 65 years old with rib fxs admitted to a Level I trauma center over 10 years was undertaken. The control group consisted of 187 randomly selected patients, 18 to 64 years old, with rib fxs admitted over the same time period. Outcomes included pulmonary complications, number of ventilator days, length of intensive care unit and hospital stay (LOS), disposition, and mortality. The specific analgesic technique used was also examined. RESULTS: The two groups had similar mean number of rib fxs (3.6 elderly vs. 4.0 young), mean chest Abbreviated Injury Scores (3.0 vs. 3.0), and mean Injury Severity Score (20.7 vs. 21.4). However, mean number of ventilator days (4.3 vs. 3.1), intensive care unit days (6.1 vs. 4.0), and LOS (15.4 vs. 10.7 days) were longer for the elderly patients. Pneumonia occurred in 31% of elderly versus 17% of young (p < 0.01) and mortality was 22% for the elderly versus 10% for the young (p < 0.01). Mortality and pneumonia rates increased as the number of rib fxs increased with and odds ratio for death of 1.19 and for pneumonia of 1.16 per each additional rib fracture (p < 0.001). The use of epidural analgesia in the elderly (LOS >2 days) was associated with a 10% mortality versus 16% without the use of an epidural (p = 0.28). In the younger group (LOS >2 days), mortality with and without the use of an epidural was 0% and 5%, respectively. CONCLUSION: Elderly patients who sustain blunt chest trauma with rib fxs have twice the mortality and thoracic morbidity of younger patients with similar injuries. For each additional rib fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27%. As the number of rib fractures increases, there is a significant increase in morbidity and mortality in both groups, but with different patterns for each group. Further prospective study is needed to determine the utility of epidural analgesia in this population.

Abbreviated Injury Scale↗
PubMed2005

Epidural versus intravenous pain control in elderly patients with rib fractures.

BACKGROUND: Epidural catheters are used in older patients with rib fractures to improve outcome. We reviewed the efficacy of epidural analgesia (EA) compared with intravenous narcotics (IVN) in this population. METHODS: Rib fracture patients >55 years old admitted to our level I trauma center from 1999 through 2002 were reviewed for demographics, Injury Severity Score (ISS), Abbreviated Injury Score for chest, length of stay, cardiopulmonary comorbidities, complications, and type of analgesia. RESULTS: There were 187 patients: 72 men and 115 women. The mean age was 77 years. For ISS <9, length of stay for EA patients was 12 +/- 5 days versus 5 +/- 4 days for IVN patients (P < 0.001). Complications occurred in 9 of 10 EA patients versus 21 of 52 IVN patients (P < 0.001). No difference was noted in length of stay for patients with ISS > or =9. Complications in the high ISS group occurred in 29 of 43 EA patients versus 37 of 82 IVN patients (P <0.05). Stratification of patients based on low versus high Abbreviated Injury Score for chest yielded similar results. CONCLUSIONS: EA is associated with prolonged length of stay and increased complications in elderly patients, particularly those with less significant injuries, regardless of cardiopulmonary comorbidities. EA for elderly patients with rib fractures should be prospectively re-evaluated.

Aged↗
PubMed1994

Effect of noise on the detection of rib fractures by residents.

RATIONALE AND OBJECTIVES: The authors assessed the effect of noise on the detectability of rib fractures by residents. METHODS: Eight radiology residents read chest posterior-anterior radiographs of 92 subjects with rib fracture(s) and 28 normal subjects to detect rib fracture(s) according to a five-point scale of confidence, under quiet and "noisy" conditions. Each individual's attitude toward noise was measured by a multiple-choice questionnaire. RESULTS: The readers were divided into two groups depending on the questionnaire result: group A readers were accustomed to a quiet environment, and group B readers were accustomed to noisy environments or were unaffected by noise. Group A's performance, measured by the area (Az) under the receiver operating characteristic (ROC) curve, was better in quiet conditions when compared with their performance in noisy conditions; however, the opposite tendency was observed for group B. There was a significant individual difference of performance in response to noise. CONCLUSION: Effect of noise on the detection of rib fractures depends on an individual's attitude toward sound and noise.

Attitude of Health Personnel↗
PubMed1986

Rib fractures as a cause of immediate neonatal tachypnoea.

Two macroscopic term neonates are described who presented with uncomplicated tachypnoea immediately following vaginal delivery. The tachypnoea was not associated with lung injury, metabolic, endocrine or cardio-respiratory disease but with multiple unilateral posterior rib fractures. The neonatologist should be aware that neonatal tachypnoea immediately after vaginal term delivery, especially in macrosomic infants, may be caused by the pain of fractured ribs. The diagnosis can be made only by careful inspection of the ribs on chest X-ray.

Female↗
PubMed1975

[Fenestrated rib fracture, a disease entity?].

The problems of the paradoxical respiration - observed in the case of fenestrated rib fracture - are discussed by the authors. On the basis of the data of the literature and of 348 own cases with covered rib fracture, as well as on the basis of the course and the clinical analysis of the lesion the authors refuse to admit the role of the "pendelluft" and of the mediastinal flutter in the development of circulatory and respiratory disorders occurring in the case of fenestrated rib fractures. In the authors' opinion, there are only quantitative differences between the consequences of the various rib fractures. The thoracal lesion is considered by the authors as functional unity. The treatment is always prescribed according to the degree of the functional disorder and also the classification of the injured patients is to be made on this basis.

Cardiovascular Diseases↗
PubMed1992

Impact of a primary reader's opinion on the detection of rib fractures.

RATIONALE AND OBJECTIVES: The authors assessed the influence of a prior reader's opinion on the detectability of rib fractures. METHODS: Six pairs of observers read the chest PA radiographs of 92 subjects with rib fracture(s) and 28 normal subjects to detect rib fracture(s) according to a five-point rating of confidence with three methods. In method A, each reader read films as a primary reader. In method B, each reader read films after knowing his or her partner's opinion. In method C, each reader initially observed films and then made the final decision after knowing his or her partner's opinion. RESULTS: Methods B and C were superior to method A in sensitivity. There was no difference in performance between methods B and C. Method C required a significantly longer time than the other methods. CONCLUSION: Detection of rib fractures is improved by seeking the opinion of other observers.

Fractures, Bone↗
PubMed1975

First rib fracture: a hallmark of severe trauma.

First rib fractures occurred in 55 patients. This injury is a harbinger of major trauma with 35 patients suffering a major chest injury, and abdominal and cardiac injuries occurring in 18 and eight patients respectively. The mortality associated with this injury was high (36.3%). Neurologic lesions accounted for the majority of deaths, however, unrecognized abdominal injuries and pulmonary complications were significant causes of mortality. Brachial plexus injury (5) and Horner's syndrome (3) occurred in survivors. Three patients had an associated injury of the subclavian artery, and the importance of this association is stressed. One late-developing post-traumatic thoracic outlet syndrome occurred. A fracture of the first rib is a hallmark of severe trauma; its presence should alert the clinician to: 1) generalized massive trauma with abdominal, chest, and cardiac injuries; 2) local injury to the subclavian artery and brachial plexus and; 3) necessity of long-term followup for late-developing sequelae.

Abdominal Injuries↗