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A case of Pierre Robin-Syndrome with associated rib gap defects is reported. Rib defects are described still now only in childs with micrognathia. Respiratory embrassement may be caused.
The reported patient was a 37-year-old male, who got a blunt chest trauma by a motor vehicle accident. Chest X-ray and computed tomography of the chest revealed bilateral multiple rib-fractures, pneumo-hemothorax, lung contusions, but no evidence of mediastinal hematoma. Since respiratory distress with a flail chest was observed, the patient was placed on an artificial ventilation, and thoracocentesis were also done on both sides, while the hemodynamics was fairly maintained with blood transfusion. On the 10th hospital day, however, he suddenly fell into a deep shock with the left hemothorax by changing the body position. Emergency thoracotomy demonstrated the laceration of the descending aorta, that was considered to be made by the sharp edge of the fractured left 8th rib, which correspondingly protruded into the thoracic cavity toward the aorta. The repair of the aortic injury and the resection of the rib edges were performed. He was discharged on the 45th hospital day. In cases with a blunt chest trauma, the majority of the causes of the traumatic aortic injury are reported to be "deceleration injury". Although the considered mechanism of the traumatic rupture of the thoracic aorta in this case is extremely rare, it should be taken into a consideration for treatment of the cases with a blunt chest trauma and multiple rib-fractures.
A 66-year-old woman with multiple rib fractures was successfully treated with the use of Rib Staplers (Judet's struts made of titanium). Rib Staplers are effective for the stabilization of fractured ribs even if fracture lines are oblique.
For an assessment of the late lesions after rib fractures 108 patients having had an accident between 1968 and 1973 were followed up. As to the individual signs observed, the patients were very heterogeneous. Radiodiagnostic, spirometric and scintigraphic data were compiled in order to characterize the late morphologic and functional lesions. By means of correlation and discrimination analyses as well as tests of significance we found that the extension of the late lesions depends either on the age of the patient nor on the number of fractured ribs but, instead, on concomitant intrathoracic lesions. The late morphologic lesions such as deformedly healed rib fractures and pleural thickening were the substrate for the ventilative and circulatory disturbances of the lung.
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.
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.
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.
This report describes 2 patients in whom focal areas of decreased 99mTc sulfur colloid marrow activity were associated with callus formation and healing rib fractures in one case and rib fractures with bony bridging in the second. Since bone marrow scans are occasionally used to select appropriate sites for marrow biopsy in patients with suspected metastatic disease, radiographic correlation of "cold" lesions on marrow scans is recommended prior to biopsy to exclude fracture with callus formation as a benign cause of the abnormality.
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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.
In a retrospective study we evaluated the data regarding 126 patients (96 male/30 female) hospitalized with rib fractures between 1986 and 1989. Fifty percent of the subjects had been in a traffic accident. Eighty-five percent of the patients had 2-7 broken ribs. Sixty-two patients suffered from multiple injuries, 40% were men aged less than 40 years. Fifty-six patients were treated by pleural drainage either for hemato- and/or pneumothorax or to prevent intrapleural tension during surgical intervention under endotracheal anesthesia. Thirty-two patients underwent mechanical ventilation for between 1 and 52 days (mean 10 days). In five cases a flail chest was stabilized by ribosteosynthesis to avoid prolonged artificial ventilation. Pain relief by continuous peridural Carbostesin (bupivacaine) administration was given to 31 patients. There was a positive correlation between the incidence of pneumo- and hematothorax and the number of broken ribs. A significant association was found between multiple-injured patients died in hospital; six of them had multiple injuries. The recovery of 44 patients was interrupted by complications, predominantly of pulmonary origin (68%). The pattern and severity of concomitant injuries and interference of complications influenced the length of the hospital stay; pulmonary complications doubled it.
On consulting our archives in order to give a casuistic contribution to the scar-cancer theory, we have met with a new datum: in 60 patients affected with a lung carcinoma, 13 of these, i.e. 21.6%, had suffered with a previous thoracic trauma with or without rib fractures.
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