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At least 19 recordsLinked to original sources
PubMed1984

Child abuse, cardiopulmonary resuscitation, and rib fractures.

Rib fractures have occasionally been described in children receiving cardiopulmonary resuscitation (CPR). Because child abuse is sometimes suspected in these cases, it is both medically and legally important to establish whether the rib fractures are secondary to abuse or CPR. One hundred thirteen children, including 41 victims of child abuse, 50 patients who had CPR, and 22 patients who had rib fractures, were studied. Twenty-nine patients had rib fractures; 14/29 (48%) were abusive. Other causes of fracture were: motor vehicle accidents (four), rickets/osteoporosis (five), surgery (five), and osteogenesis imperfecta (one). In spite of prolonged resuscitation performed with variable degrees of skill, no fractures could be attributed to CPR. On the other hand, rib fractures occurred frequently in abused children (6/41 or 15%). Abusive fractures were often multiple, of different ages, and affected multiple adjacent ribs. Patients with abusive rib fracture also had other physical and radiologic signs of abuse or neglect.

Adult↗
PubMed1984

Thoracic epidural analgesia in the treatment of rib fractures.

Rib fractures and flail chest could be fatal if gas exchange is impaired. Efficient pain relief with continuous thoracic epidural analgesia allows a good physiotherapy management without central sedation and impairment of cough reflex, this prevents pulmonary atelectasis and infection. Eighteen patients/19 were treated with success in spite of flail chest, chronic obstructive pulmonary disease and minor pulmonary contusion. Intermittent positive pressure ventilation must be reserved to severe pulmonary contusion and other crushing injuries of the chest as bronchial or great vessels ruptures.

Adult↗
PubMed2003

Acute pain management of patients with multiple fractured ribs.

BACKGROUND: Multiple rib fracture causes severe pain that can seriously compromise respiratory mechanics and exacerbate underlying lung injury and pre-existing respiratory disease, predisposing to respiratory failure. The cornerstone of management is early institution of effective pain relief, the subject of this review. METHODS: A MEDLINE search was conducted for the years 1966 through and up to December 2002 for human studies written in English using the keywords "rib fractures", "analgesia", "blunt chest trauma", "thoracic injury", and "nerve block". The reference list of key articles was also searched for relevant articles. The various analgesic techniques used in patients with multiple fractured ribs were summarized. RESULTS: Analgesia could be provided using systemic opioids, transcutaneous electrical nerve stimulation or non steroidal anti-inflammatory drugs. Alternatively, regional analgesic techniques such as intercostal nerve block, epidural analgesia, intrathecal opioids, interpleural analgesia and thoracic paravertebral block have been used effectively. Although invasive, in general, regional blocks tend to be more effective than systemic opioids, and produce less systemic side effects. CONCLUSION: Based on current evidence it is difficult to recommend a single method that can be safely and effectively used for analgesia in all circumstances in patients with multiple fractured ribs. By understanding the strengths and weaknesses of each analgesic technique, the clinician can weigh the risks and benefits and individualize pain management based on the clinical setting and the extent of trauma.

Analgesia↗
PubMedDate not supplied

[The basic patterns of the change in the morphological properties of rib fractures with the breathing preserved].

The author analyzes the kinematics of fractured rib fragment movements from the thoracic excursion position and in relation to orthogonal coordinates. A scheme of stages in changes of fractured rib morphology in a biotribologic system at intact respiration has been developed. Staged pattern and order of changes of the initial morphologic characteristics of fractured ribs and acquisition of new properties by them is demonstrated which may be regarded as expert diagnostic criteria to assess their life-time or postmortem appearance.

Biomechanical Phenomena↗
PubMed1992

[A sharp edge of the fractured ribs caused the aortic injury at body-position change: a case report].

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.

Adult↗
PubMed2004

Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results.

REASONS FOR PERFORMING STUDY: Fractured ribs are encountered quite frequently in newborn Thoroughbred foals, often with fatal outcome. Surgical repair of fractures therefore requires consideration as a means of reducing mortality. OBJECTIVES: To evaluate the repair of rib fractures using internal fixation techniques in foals at 2 different equine hospitals following similar diagnostics and case selection. METHODS: The records of 14 foals that underwent internal fixation of fracture ribs were reviewed. Subject details, clinical presentation, diagnosis, surgical technique, post operative care and complications were recorded. Follow-up information was obtained in 7 foals. RESULTS: The fractured ribs were reduced and stabilised using reconstruction plate(s), self-tapping cortical screws and cerclage wire in 12 cases, Steinmann pins and cerclage wires in 1 case and both techniques in 1 case. Not every rib was reduced on each case. Surgical reduction was performed on an average of 2 ribs, range 1-3 ribs in each foal. At the time of writing, 4 foals had been sold, one age 2 years was in training and 2 others died from unrelated causes. CONCLUSIONS: Our data support the use of surgical stabilisation utilising reconstruction plates, self-tapping cortical screws and cerclage wire for selected cases of thoracic trauma in neonatal foals. The use of Steinmann pins may be suboptimal due to cyclic failure, implant migration and the potential for iatrogenic internal thoracic trauma. POTENTIAL RELEVANCE: Foals with existing extensive internal thoracic trauma resulting from rib fracture(s), or the potential for such trauma, previously considered to have a guarded to poor prognosis for survival, may be successfully managed with internal fixation of selected fracture sites.

Animals↗
PubMedDate not supplied

Management and treatment of patients with fractured ribs.

Rib fractures are a common injury to the chest. The mainstay of treatment is adequate analgesia coupled with meticulous respiratory care in order to prevent complications. Treatment can be as an outpatient, but patients with more severe fractures may be admitted to hospital for oxygen therapy, ventilation, aggressive analgesic techniques and physiotherapy. Significant morbidity and mortality rates have been reported with rib fractures. To avoid complications, accurate diagnosis, adequate analgesia and effective physiotherapy are essential.

Analgesics↗
PubMed1986

Delayed life-threatening hemothorax associated with rib fractures.

We present two cases of delayed, massive, life-threatening hemothorax due to intercostal hemorrhage in association with fractured ribs and severe blunt chest trauma (SBCT), a combination we have not seen described in the literature. Blunt chest trauma is not benign. Significant intrathoracic injuries are frequent although usually not life threatening. However, associated extrathoracic injuries are also common and much more lethal. Most cases of hemo- and pneumothorax associated with SBCT can be treated without thoracotomy. However, rapid blood loss requires immediate open thoracotomy and surgical attention. Several days of observation in hospital may be required for patients with SBCT and fractured ribs even without any other obvious intra- or extra-thoracic injuries. Vigorous activity or chest physical therapy may be dangerous during the first several days after the injury.

Accidents, Occupational↗
PubMed1998

Cough stress rib fractures in two obstetric patients: case report and pathophysiology.

The clinical presentation of fractured ribs and physiology of cough in two obstetric patients are described to explain why a rib fracture, not a pneumothorax, occurred on coughing in these patients. At total lung capacity the outward expansion of the lower thorax (flare) during a cough is limited. The costal angles are widened at term pregnancy, and flare may then be almost impossible at total lung capacity. The insertional action of the diaphragm is virtually nil. A direct expiratory action of abdominal muscles predominates over their indirect inspiratory action. The lower ribs are pulled down by the cough and may even fracture from the enormous intrapleural cough pressures which are generated before the glottis opens.

Journal Article↗
PubMed2004

Epidural analgesia improves outcome after multiple rib fractures.

BACKGROUND: Rib fractures are common and associated with significant pulmonary morbidity. We hypothesized that epidural analgesia would provide superior pain relief, and reduce the risk of subsequent pneumonia. METHODS: A prospective, randomized trial of epidural analgesia versus IV opioids for the management of chest wall pain after rib fractures was carried out. Entry criteria included patients older than 18 years with more than 3 rib fractures and no contraindications to epidural catheter placement. RESULTS: From March 2000 to December 2003, 408 patients were admitted with more than 3 rib fractures; 282 met exclusion criteria, 80 could not be consented, and 46 were enrolled (epidural n = 22, opioids n = 24). The groups were comparable for mean age, injury severity score, gender, chest Abbreviated Injury Scale, and mean number of rib fractures. The epidural group tended to have more flail segments (38% vs 21%, P = .20) and pulmonary contusions (59% vs 38%, P = .14), and required more chest tubes (95% vs 71%, P = .03) Despite the greater direct pulmonary injury in the epidural group, their rate of pneumonia was 18% versus 38% for the intravenous opioid group. When adjusted for direct pulmonary injury, there was a greater risk of pneumonia in the opioid group: OR, 6.0; 95% CI, 1.0-35; P = .05. When stratified for the presence of pulmonary contusion there was a 2.0-fold increase in the number of ventilator days for the opioid group: incident rate ratio, 2.0; 95% CI, 1.6-2.6; P < .001. CONCLUSIONS: The use of epidural analgesia is limited in the trauma population due to numerous exclusion criteria. However, when feasible, epidural analgesia is associated with a decrease in the rate of nosocomial pneumonia and a shorter duration of mechanical ventilation after rib fractures.

Adult↗
PubMed1990

Subpleural block in patients with multiple rib fractures.

Multiple rib fractures result in agonizing pain as well as impaired pulmonary functions. Mechanical ventilations are frequently indicated for those with poor respiratory reserves. Regional anesthesia has been advocated for easing pain and discomfort. We evaluate the efficacy of subpleural block in the treatment of multiple rib fractures. Ten patients who sustained multiple rib fractures were observed on the arrival of emergent service. One sustained flailed chest with respiratory distress which necessitated mechanical ventilation in intensive care unit. Subpleural block with 20 ml 0.5% bupivacaine was done to each patient. The location of catheter was identified by the injection of contrast medium. Serial visual analogue pain scale, arterial blood gas, and pulmonary function test were taken before and after subpleural block. Pulmonary function test significantly improved after subpleural block. Pain relief was immediate and desirable. The case in ICU weaned from ventilator 3 days later. There were no major complications after subpleural block. Inadvertent epidural spread and recurrent laryngeal nerve blocks were detected both clinically and radiologically without sequela noted. Subpleural block is effective both in pain relief and in improving pulmonary functions. Image intensifier is essential to subpleural block in order to prevent the misplacement of catheter. We recommend subpleural block to be an alternative approach of regional anesthesia in patients with multiple rib fractures.

Adult↗
PubMed1990

Pediatric first rib fractures.

First rib fractures are associated with a high incidence of thoracic, vascular, abdominal, and central nervous system injuries. Usually reported in the adult population, first rib fractures are infrequently described in the pediatric population. We take this opportunity to describe six pediatric patients who sustained traumatic first rib fractures. Overall, five patients required operative intervention. Two patients sustained major vascular injuries which were detected on physical examination and confirmed by arch aortography. In view of the high percentage of patients with vascular injury, first rib fracture in a pediatric patient should prompt a search for major vascular injury.

Adolescent↗
PubMed2001

Management of patients with multiple rib fractures.

Multiple rib fractures in trauma patients are associated with significant morbidity and mortality. Delayed morbidity for patients with rib fractures is often a result of hypoventilation leading to atelectasis, pneumonia, and respiratory failure. Pain management was first recognized as an important factor in preventing complications in these patients. Later, management of the respiratory system became more widely recognized as a major factor in patients' care. It is now known that patients with multiple rib fractures benefit most from adequate pain control, rapid mobilization, and meticulous respiratory care to prevent complications. A protocol based on a synthesis of the existing literature is developed. Development of such a protocol for decisions about rapid mobilization, respiratory support, and pain management is the first step in testing the hypothesis that these interventions will decrease the length of patients' stay in intensive care units.

Age Factors↗
PubMed1997

The fractured rib in chest wall trauma.

Chest wall trauma and rib fractures are significant sources of morbidity and mortality in countries in which motor vehicle accidents are prevalent. Physicians who care for injured patients should realize that patients with thoracic trauma are at significant risk for mortality, deterioration, and associated injuries. Care must be taken to avoid underestimation of the effect of the injury on subsequent respiratory mechanics. Armed with an understanding of chest injury epidemiology, biomechanics, and pain control, physicians can better serve these high-risk patients.

Adult↗
PubMed1953

FRACTURED ribs.

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Fractures, Bone↗