[Isolated fracture of the first rib].
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Fractures, Bone↗
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[Isolated traumatic fracture of the first rib].
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Fractures, Bone↗
Fracture of the first rib as a complication of midline sternotomy.
Fracture of the first rib occurred in six patients after cardiac surgery through a midline sternotomy. Two of the fractures could not be seen on the chest films and were demonstrated only on oblique radiographs of the cervical spine. Symptoms simulating myocardial infarction and/or pulmonary embolism were present in three of the six cases. In a review of 50 randomly selected cases of midline sternotomy, first-rib fractures were found in 3(6%).
Adult↗
[Spontaneous fracture of the first rib].
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Disease↗
[THE FRACTURE OF THE 1ST RIB].
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Fractures, Bone↗
Follow-up skeletal surveys in suspected child abuse.
OBJECTIVE: The purpose of this study was to assess the additional yield of a repeat skeletal survey in identifying and dating skeletal injury for cases in which child abuse was strongly suspected. MATERIALS AND METHODS: Twenty-three infants and toddlers strongly suspected of being physically abused on the basis of findings on the initial skeletal survey, other imaging studies, history, or physical examination underwent a follow-up examination approximately 2 weeks after the initial examination. The high-detail imaging system included a single-emulsion, single-screen combination with a low-absorption carbon-fiber cassette. The skeletal survey protocol entailed tightly collimated anteroposterior views of the appendicular skeleton and anteroposterior and lateral views of the axial skeleton. Between the two studies, all children were in Department of Social Services custody or living in a safe home. RESULTS: The follow-up skeletal survey yielded additional information regarding skeletal injury in 14 (61%) of 23 cases. Follow-up study increased the number of definite fractures detected from 70 to 89 (27%) (p = .005). Most of these additional injuries were classic metaphyseal lesions or rib fractures. In 13 of the 70 fractures previously detected, the follow-up skeletal survey also provided important information about the age of those injuries. CONCLUSION: When child abuse is strongly suspected on the basis of the findings on the initial skeletal survey, other imaging studies, history, or physical examination, a follow-up skeletal survey is recommended to provide a through and accurate assessment of osseous injuries.
Bone and Bones↗
[Correlation in imaging techniques for the early detection of bone metastases in a case of breast cancer].
The presented case is part of a pilot study performed in the Biophysics and Nuclear Medicine Service from the Tenon Hospital (Paris), chief Department Prof. J.N. Talbot. A 46 years patient, with mastectomy for a left breast cancer in 1999, followed by radiotherapy, is detected, in January 2004, through CT scan, with a tumoral mass at the left thoracic base. To confirm the rib osteolysis hypothesis a standard Rx was done; the result was the detection of a pathologic IX left rib fracture and a lacuna site on the L1 vertebra. The following bone scintigraphy make evidence of two hot spots (rib and vertebra) and also of a new pathologic site on the sternum. An 18FFDG PET image detects, despite the three known sites, another one on the left iliac bone crest. In conclusion, an extensive scintigraphic examination, including PET, is necessary to optimize the osteofil cancer metastases detection.
Bone Neoplasms↗
[Stress fracture of the ribs in amateur golfers diagnosed by Tc-99m MDP scintigraphy].
Golf has become a popular sport in Taiwan recently. Some amateur golfers suffer from back or chest pain, and a few of them have stress fractures of the ribs. Six amateur golfers suffering from back pain or chest pain, all male and right-handed players, aged from 28 to 39, were included in our study. The initial chest roentgenograms, including special views focusing on ribs, were all negative. Tc-99m MDP bone scan confirmed the diagnosis of stress fractures of the ribs. The intervals between playing golf and time of diagnosis were from 1 month to 5 months. In five cases, fracture sites in the left side were prominently located in the posterior aspect, a condition which may result from traction of the serratus anterior. Three cases with fracture sites in the right side had fractures prominently located in the lateral aspect, which may result from the repercussive force produced by the clubhead hitting the ground. Tc-99m MDP bone scan, with its high sensitivity, is useful in establishing the diagnosis of stress fracture.
Adult↗
Vertical trauma: injuries to patients who fall and land on their feet.
We reviewed the patterns of injuries sustained by 12 consecutive fallers and jumpers in whom primary impact was onto the feet. The fall heights ranged from 20 to 100 ft. The 12 patients sustained 49 significant injuries. Skeletal injuries were most frequent and included 15 lower extremity fractures, four pelvic fractures, and nine spinal fractures. In two patients, paraplegia resulted. Genitourinary tract injuries included bladder hematoma, renal artery transection, and renal contusion. Thoracic injuries included rib fractures, pneumothorax, and hemothorax. Secondary impact resulted in several craniofacial and upper extremity injuries. Chronic neurologic disability and prolonged morbidity were common. One patient died; the patient who fell 100 ft survived. After initial stabilization, survival is possible after falls or jumps from heights as great as 100 feet It is important to recognize the skeletal and internal organs at risk from high-magnitude vertical forces.
Accidental Falls↗
Warfarin use and fracture risk.
Two recent studies examined the association between chronic use of warfarin, a vitamin K antagonist, and fracture rate among older women. Whereas one study reported no association, the other reported a significantly higher risk for vertebral and rib fractures among warfarin users compared with nonusers. The effect of vitamin K antagonists on age-related bone loss continues to be controversial.
Animals↗
[Traumatic complications of indirect cardiac massage].
The author analyzed injuries in 238 subjects where before death indirect cardiac massage was applied by skilled health workers. The ribs were fractures in 27.7% and the sternum in 16% of the deceased, injuries of other organs were detected 13 times (5.5%). In women injuries were more frequent and fractures of the sternum markedly more frequent than in men. While in men rib fractures on the left side were more frequent than on the rights side, in women this difference was not observed. Rib fractures were mostly in the medioclavicular line at the level of the 3rd-5th rib. The fractures of the sternum were also most frequently at the level between the 3rd and 5th rib. No fractures of the 10th-12th rib were found. The author observed an age-depunende cy of rib fractures in men and women, while fractures of the sternum were age-dependent only in men. There was no relationship with age as regards injuries of other organs. Only in two deceased subjects the injury which developed during indirect cardiac massage was the immediate cause of death. Once it was rupture of the interval mammary vein with haemorrhage into the mediastinum and haemorrhage into the chest, in the other case rupture of the right ventricle with cardiac tamponade.
Female↗
[Elastic, stable intramedullary nailing in midclavicular fractures--a change in treatment strategies?].
Midshaft fractures of the clavicle are mostly treated conservatively. For the few cases in which stabilisation is needed, open reduction and plate fixation is the standard procedure. We report a minimally invasive technique of intramedullary stabilisation using a titanium nail carried out in 35 markedly displaced midclavicular fractures. Twelve fractures were simple and 23 consisted of more than two fragments. A total of 62.9% (22/35) of the patients presented additional injuries; 37.1% (13/35) with additional fractures. There were four ipsilateral scapular neck fractures. In 74.3% (26/35) of patients closed reduction was possible, whereas nine fractures required open reduction before the nail inserted from the sternal end of the clavicle could be introduced into the peripheral fragment. All fractures healed clinically and radiologically within 6 weeks. In contrast to conservatively treated fractures, length discrepancies of 1 cm or more, mainly shortening, could be avoided. Using a visual analog scale, significant pain relief (8.4-2.4 points) was already recorded on the first day after surgery. Patients with an isolated fracture of the clavicle showed a nearly normal range of motion only 1 week after surgery, whereas patients with associated scapular or rib fractures needed up to 3 weeks to reach normal shoulder function. No patient complications requiring interventional procedures occurred. Minimally invasive, elastic, stable intramedullary nailing of midshaft fractures of the clavicle should be recommended as an alternative to conservative treatment because of early pain relief, associated rapid functional recovery and anatomical restoration of the clavicle.
Adult↗
[3 Cases of blunt chest trauma].
3 Cases of blunt chest trauma were reported, including aortic isthmus rupture, diaphragmatic injury and right main bronchial rupture. All cases were injured by traffic accidents. The first case was a 21-year-old man complicated with aortic injury and femoral bone fracture and died of intrapleural rupture before thoracotomy. The second case was a 49-year-old man who had right 11th rib fracture and he received emergent thoracotomy due to hemorrhagic shock. We found accidentally arterial massive bleeding by the diaphragmatic injury at thoracotomy and ligated directly. The third case was a 19-year-old man and he was unconscious on admission and rupture of the right main bronchus was found by bronchofiberscope and performed pneumectomy. One patient died and other two patients have survived. Blunt chest trauma sometimes lead to fatal damage of vital organs. So it is necessary to make early diagnosis and perform the emergent operations for life salvage.
Accidents, Traffic↗
Reversal of anticoagulation in trauma: a North-American survey on clinical practices among trauma surgeons.
BACKGROUND: Recent studies addressing reversal of anticoagulation in trauma have reported conflicting results. We hypothesized that current clinical practice is variable throughout North America. METHODS: We surveyed 100 trauma surgeons to obtain information regarding variability in current clinical practice. RESULTS: Seventy-five of 100 trauma surgeons surveyed responded, and the majority (98.7%) agreed that preinjury anticoagulation poses problems in trauma management that include bleeding, increased complications, and mortality. Nine participants (12.2%) had a protocol addressing reversal of anticoagulation in their institution. Most use fresh frozen plasma based on the type and location of injury, initial international normalized ratio (INR), and targeted INR value. Fresh frozen plasma was consistently used in patients with positive head computed tomographic scans, hemothorax, nonoperative solid organ injury management, pelvic and long bone fractures, and any operative intervention. Practice inconsistencies were found in patients with loss of consciousness and normal head computed tomographic scan, facial and rib fractures, and pulmonary contusion. Significant variability was found in the reversal INR target. One third of participants agreed that anticoagulation could be restarted 5 to 7 days after craniotomy; one sixth would do so within 72 hours and one third would wait 10 or more days. Most agreed that anticoagulation could be restarted 3 days after chest, abdominal, and orthopedic operations. Significant inconsistencies were also observed regarding when to restart anticoagulation in closed head injury patients treated nonoperatively. CONCLUSION: On the basis of the discrepancies observed in this survey, a clinical trial addressing specific injury location and patterns, INR thresholds, and type of strategy to achieve reversal is warranted, and most would agree to participate.
Abdominal Injuries↗
The significance of scapular fractures.
Scapular fractures in the multiply injured patient have received little attention. Fifty-six patients with 58 scapular fractures secondary to blunt trauma were reviewed. The patients averaged 3.9 major injuries excluding their scapular fractures. The injury pattern associated with blunt scapular fracture is unique. Patients with scapular fracture have a high incidence of injury to the ipsilateral lung and chest wall and to the ipsilateral shoulder girdle and its contained structures: rib fractures, 53.6%; pulmonary contusions, 53.6%; clavicular fracture, 26.8%; brachial plexus injury, 12.5%; subclavian, brachial, or axillary artery injury, 10.7%. Eight patients died (14.3%). Although no patient died from the scapular fracture, half of the deaths in this series were the result of pulmonary sepsis arising in an associated ipsilateral pulmonary contusion. Scapular fractures provide the trauma surgeon with a reliable clinical clue that the patient is at inordinate risk to have associated injuries of major consequence to the ipsilateral lung and chest wall, the ipsilateral shoulder girdle, and the ipsilateral subclavian, axillary, or brachial artery.
Adolescent↗
[Fractures of the first rib].
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Fractures, Bone↗
Unclassified sclerosing bone dysplasia with osteopathia striata, cranial sclerosis, metaphyseal undermodeling, and bone fragility.
Sclerosing bone dysplasias are diagnosed on the basis of a characteristic pattern of osteosclerosis and clinical manifestations; in many of them, cause and pathogenesis are still unknown. A 33-year-old man had five fractures of the humerus, tibiae, and femur as a result of mild traumatic incidents that occurred between the ages of 18 and 33 years as well as a remnant of rib fractures without apparent trauma on radiographs. His height was 158 cm (-2.2 SD). Radiographic evaluation showed cranial sclerosis, longitudinal striations in the metaphyses of the femur and tibia, fan-like striation in the ilium, metaphyseal widening in the femur and tibia, and sclerosis of the ribs. The blood chemistry findings, including serum calcium, phosphorus, and alkaline phosphatase, were normal. Biopsy from the ilium showed thick trabeculae composed of woven bone. The coexistence of osteopathia striata, cranial sclerosis, metaphyseal undermodeling, and bone fragility has not been recognized previously. Our case appears to represent a new form of sclerosing bone dysplasia.
Abnormalities, Multiple↗
[The role of cTnI levels in the detection of etiological factors for cardiac contusion].
BACKGROUND: Cardiac contusion, associated with on blunt chest trauma, was investigated according to changes of CPK, CKMB, ECG and especially cTnI levels. METHODS: In this study, 88 cases with blunt traumas were evaluated prospectively. 61 cases with thoracic trauma and 27 cases without thoracic trauma as the control group were studied. RESULTS: In 12 of 61 cases with thoracic trauma cTnI was elevated. cTnI showed no increase in cases without thoracic trauma. CKMB level was high in both thoracic trauma and control groups. 11 of 12 cases with elevated cTnI were traffic accidents. cTnI did not increase in 6 cases with sternum fractures. CONCLUSIONS: We consider that decceleration wounds are the main cause of cardiac contusions. Although thoracic trauma is essential in the pathogenesis of cardiac contusion, rib fracture is not a rule. Cardiac contusion is not related directly with degrees of body and thoracic trauma. However it is more related with the degree of cardiac trauma.
Case-Control Studies↗