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PubMed2004

Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future.

We determined the current trends in the number and incidence of hospital-treated minimal-trauma rib fractures (low- to moderate-energy traumas typically caused by a fall from standing height or less) in Finnish elderly people by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to hospitals in 1970-2001 for primary treatment of such fractures. The number and incidence (per 100,000 persons) of these fractures clearly increased from 268 (number) and 41 (incidence) in 1970 to 737 and 70 in 2001, while in younger patients (aged 20-49 years) the trend was decreasing, the corresponding numbers being 194 and 10 in 1970, and 153 and 7 in 2001. In the elderly Finns, also the age-adjusted incidence of these hospital-admitted rib fractures showed an increase, from 37 (1970) to 51 (2001) in women, and from 63 to 77 in men. In women aged 80 years and over, the age-specific incidence of fracture increased from 88 to 186, while in the other age groups only slight secular changes were found. If the above-described trends continue, the number of elderly Finns admitted to a hospital due to a rib fracture will more than double in next three decades.

Accidental Falls↗
PubMed1994

Rib fractures in children--resuscitation or child abuse?

The autopsy reports of 233 babies and children aged between 5 days and 7 years, including 190 cases of non-traumatic and 43 cases of traumatic death, were reviewed. In 94 out of 190 cases of death due to natural causes, attempted resuscitation (closed-chest massage) was performed and only in 2 cases could fractures of the ribs localized on both sides in the midclavicular line be observed. In 15 of the 43 cases of death due to traumatic events, fractures mainly of the posterior ends of the ribs occurred. These observations support the published findings of other authors which indicate that fractures of ventral parts of the thorax can occur during resuscitation. Fractures localized in particular in dorsal parts of the chest wall of infants without metabolic bone diseases, however, must be interpreted as a strong indication of physical child abuse. It was observed that relevant injuries due to resuscitation are caused much more frequently or almost exclusively by physicians than by non-medical persons. This finding refutes any possible claims that rib fractures were caused by inexpert resuscitation in a panic-like reaction.

Cause of Death↗
PubMedDate not supplied

Nonunion of a first rib fracture in a gymnast.

Isolated fracture of the first rib is uncommon, but has been reported to occur in sports such as basketball, baseball, and dancing. It has not been reported to occur in gymnasts. Usually, these fractures heal with an adequate period of rest. Rarely do first rib fractures become nonunions. They have been felt to be asymptomatic and are usually found incidentally on routine chest roentgenograms. Symptomatic nonunion of a first rib fracture has not been reported previously. Our patient did not respond to nonoperative treatment and required surgical intervention to alleviate her symptoms. We agree that most fractures of this type heal without complications. However, if a persistently symptomatic nonunion ensues, we suggest transaxillary resection of 90% or more of the first rib.

Child↗
PubMed2005

Horner syndrome due to first rib fracture after major thoracic trauma.

A case of Horner syndrome diagnosed during the follow-up after major thoracic trauma is presented in this report. A 10-year-old boy was admitted to the emergency service with severe thoracic trauma with left clavicular and first rib fracture after a traffic accident. During the follow-up, myosis and ptosis were recognized in his left eye. Cranial tomography and neurological examination were all normal. The symptoms were thought to be caused by compression of the local hematoma to the cervical ganglia. After 30 days of conservative treatment with tube thoracostomies, he was discharged with his Horner syndrome. After 6 months of follow-up, the findings of Horner syndrome were found to be partially resolved. First rib fracture associated with Horner syndrome is very rarely seen in children, and only 2 cases were found in English-language literature. Our case seems to be the third reported case. Horner syndrome should be kept in mind in cases of first rib fractures. When head trauma is considered, as it can be mistaken with anisocoria, this knowledge may help the surgeon in differential diagnosis.

Child↗
PubMed1978

A rationale for epidural analgesia in the treatment of multiple rib fractures.

Thoracic epidural analgesia (EA) is described as an alternative to controlled ventilation in patients presenting with multiple rib fractures. Lung mechanics were especially studied in 6 patients selected from a total of 49. The average ICU stay for this group was 4.5 days (2-11) and the mean age 55.7 years. The EA group was compared with 51 patients primarily ventilated who had an average stay in the ICU of 9.8 days and a mean age of 44.7 years. Mean number of rib fractures of the ventilated group at 6.5 was almost equal to the mean of 6.8 in the EA group. There was a difference in the number of associated fractures, 98 in the ventilated group compared to 35 in the EA group. Severe pulmonary and cerebral contusion were the two most important factors in enforcing the need to ventilate. The success of the method is evidenced by the increase in functional residual capacity (FRC), dynamic lung compliance (Cdyn), vital capacity (VC), the decrease of airway resistance (R) and a significantly increase of PaO2 (p less than 0,001) for the EA group with a balanced fluid therapy. All this accounts for the clinical observation of diminishing paradoxical movement of the flail segment.

Adult↗
PubMed2004

Histochemical evidence of the initial chondrogenesis and osteogenesis in the periosteum of a rib fractured model: implications of osteocyte involvement in periosteal chondrogenesis.

We have examined cellular events at the early stages of periosteal chondrogenesis and osteogenesis induced by bone fracture, using a well-standardized rib fracture model of the mouse. The initial cellular event was recognized as considerable proliferation in the deeper layer referred to as the "cambium layer" of the periosteum, as evidenced by numerous proliferating cell nuclear antigen-positive cells. The periosteal cartilage and bone were then regenerated directly from the region of the most-differentiated cell, i.e., mature osteoblasts of the cambium layer both close to and distant from the fracture site. Therefore, periosteal osteoblasts appeared to have the potential to differentiate into chondrogenic and osteoblastic lineages. CD31-positive blood vessels were uniformly localized along the periosteum that was regenerating cartilage and bone, being therefore indicative of less influence on the initiation of osteochondrogenesis. In contrast, however, the regenerated periosteal cartilage or bone extended from the cortical bones included dead or living osteocytes, respectively. Empty lacunae and lacunae embedded with amorphous materials were found close to the regenerated cartilage, while intact osteocytes persisted adjacent to the regenerated bone. The embedded lacunae with amorphous materials would render the tissue fluid, nutrients, oxygen, and several secretory factors such as dentin matrix protein-1 impossible to be delivered to the periosteal osteoblasts that interconnect osteocytes via gap junctions. Our study thus provides two major clues on initial cellular events in response to bone fracture: the potentiality of periosteal osteoblastic differentiation into a chondrogenic lineage, and a putative involvement of osteocytes in periosteal cartilage and bone regeneration.

Animals↗
PubMed1985

Surfer's rib: isolated first rib fracture secondary to indirect trauma.

A case of anterolateral first rib fracture produced by indirect trauma in a surfer is presented. A 17-year-old man was seen in the emergency department with the complaint of left shoulder pain that developed while he performed a so-called lay back maneuver on a surfboard. No history of direct trauma was elicited. After physical examination revealed point tenderness high in the left axilla, radiographic evaluation of the chest showed an isolated fracture of the anterolateral aspect of the left first rib. No morbidity was associated with this fracture which, when produced by other forces, can have serious sequelae.

Adolescent↗
PubMed2006

Acquiring non-censored rib fracture data during dynamic belt loading.

The purpose of this paper is to present a method to determine the exact timing of all rib fractures during dynamic belt loading tests on the thorax of human cadavers. In order to generate non-censored rib fracture data, a total of 47 strain gages were placed throughout the thorax of two human cadavers (1 male, 1 female). In order to simulate thoracic loading from a severe car crash, a table-top belt loading device was developed that utilizes a servo-hydraulic test machine to apply a dynamic input. The belt load pulse was configured to result in 40% chest compression through a 150 ms load and unload cycle. Potentiometers and accelerometers measured the chest compression and acceleration at three locations, load cells in line with the belt provided belt loads, and load cells on the posterior side of the thorax measured the reaction loads. The time histories of each strain gage were analyzed to determine the time of fracture which could then be compared directly to the reaction loads and chest displacements at that exact time, thereby creating a non-censored data set. In both cadavers, all fractures (20 for female and 12 for male) occurred within the first 35% compression of the thorax. By utilizing this technique, the exact timing of an injury level can be characterized relative to the mechanical parameters.

Acceleration↗
PubMedDate not supplied

[The mechanisms and sequence of the changes in the morphological properties of rib fractures with time].

The authors describe the biotribological process, disclose mechanisms and time course of morphological changes in fractured bones as exemplified by interactions between the ends of fragments in an extension fracture of a rib. These changes result from contacts between fragments due to persistent respiration and parallel processes closely connected, friction and repair regeneration. The data on mechanisms and time course of morphological changes in a fractured bone may prove useful not only for forensic medicine specialists, but for traumatologists as well.

Friction↗
PubMed1986

[Long-term regional anesthesia in closed chest injuries complicated by rib fracture].

Prolonged regional anesthesia used for relieving pain was given to 65 patients with closed traumas of the chest complicated by fractures of the ribs. The method was shown to be effective, simple and safe. It may be used both at the hospital and at prehospital stage. The prolonged regional anesthesia allowed reducing the amount of pulmonary complications from 4.5% to 1.7%.

Anesthesia, Conduction↗
PubMed2002

Detection of rib fractures in an abused infant using digital radiography: a laboratory study.

PURPOSE: To assess the diagnostic performance of digital radiography using charge-coupled device (CCD) technology in the detection of rib fracture in infant abuse. MATERIALS AND METHODS: Four fractured posterior rib arcs and eight normal ribs removed at autopsy from a 10-month-old abused infant were radiographed using a CCD prototype, four clinical film-screen systems, and direct-exposure film. Each rib was viewed with these six systems in nine different projections. The resultant 648 images were assessed for probability of fracture (0-100%) by four pediatric radiologists. The calculated area under the resultant ROC curves (A(z)) for the CCD was compared with those obtained with direct-exposure, high-detail, medium and fast film-screen radiographic systems. RESULTS: The mean A(z) for the CCD (0.937) fell within the range of the high-detail systems (0.934-0.940) and was significantly higher (p < 0.05) than the medium and fast system (0.861 and 0.858, respectively). Despite a lower spatial resolution than direct-exposure film (7 line pairs per millimeter vs. > 20 line pairs per millimeter) the CCD performance was comparable (A(z) = 0.944 vs. 0.937). The similar performance can be explained by the higher contrast resolution of the digital technology. CONCLUSION: This study indicates that in the ex vivo setting, digital radiology can perform comparably to high-detail film-screen imaging. The findings suggest that digital radiography has the potential to replace film-screen imaging in the evaluation of inflicted skeletal injury in infants.

Autopsy↗
PubMed2004

Effect of intercostal nerve block with 0.5% bupivacaine on peak expiratory flow rate and arterial oxygen saturation in rib fractures.

BACKGROUND: This prospective study was undertaken to evaluate the efficiency of intercostal nerve block (ICNB) with 0.5% bupivacaine (Marcaine) for pain relief in patients with rib fractures and to correlate the degree of pain relief with changes in the peak expiratory flow rate (PEFR) and oxygen saturation (Sao2). METHODS: Twenty-one consecutive adult patients admitted with rib fractures associated with severe pain formed the basis of the study. Chest pain was scored on a four-point scale before ICNB, 1 hour after ICNB, and 24 hours after ICNB. Sao2 was measured before and immediately after ICNB. PEFR was measured before and immediately after ICNB. RESULTS: Pain score and PEFR before and after ICNB showed statistically significant differences (p = 0.0000, df = 20). There was a significant difference between Sao2 before and after ICNB. CONCLUSION: Significant increases in Sao2 and PEFR occur after ICNB with 0.5% bupivacaine, which also provides sustained analgesia, leading to improvement in respiratory mechanics.

Adolescent↗
PubMed1982

Radiographic evaluation of rib fractures.

A prospective study of 100 radiographs performed for possible rib fracture due to blunt trauma was conducted to determine if some of the films routinely obtained should be eliminated for medical or economic reasons. Of the 100 patients evaluated for fracture, 29 fractures were detected radiographically. The physical findings of fracture are seen to be nonspecific, and the clinical impression of the likelihood of fracture is unreliable. Therapy is symptomatic, aimed at relief of pain, and except for the complications of fractures, therapy does not differ significantly in patients with and without fractures. The complications of fractures that may influence therapy were seen in 13 of the 29 patients with fractures. All 13 complications were detected by the posteroanterior chest film while only three were seen on the rib films. Radiographs obtained solely to detect fractures are not warranted, but a posteroanterior chest film is necessary to assess pleural or pulmonary complication of chest trauma.

Costs and Cost Analysis↗