A prospective randomized trial on trauma thoracic cage with rib fracture especially first rib fracture and associated complications

Abstract

Background: Thoracic cage is an osseocartilaginous cavity which not only protects and supports vital organs but also has dynamic role in mechanism of respiration. The aim was to study the mechanism of first rib fracture, incidence and complications of first rib and other ribs' fracture and their sequelae. Methods: A prospective randomized trial was conducted on 300 patients of trauma thoracic cage having rib fracture with or without associated injuries at NIMS Medical College and Hospital, Jaipur, Rajasthan, India from April 2013 to March 2016. All patients were examined on a fixed protocol (age, sex, mode of injury, vital status, number and site of rib fracture) with associated injury and complications. Results: Maximum patients (including males and females both) with first and other rib fractures were in the age group of 11-30 years. The most common mode of trauma was roads traffic accident (RTA). First rib fractured at shaft by indirect trauma mostly. Commonly reported chest, abdomen and associated injury complications were haemothorax, haemoperitoneum and head injury respectively. Most of the patients were treated conservatively except 1% patients who required thoracotomy. Conclusions: Most common cause of chest trauma with rib fracture was RTA and first rib fracture was indirect trauma. The most common cause of mortality was an associated head injury. Kochar MP et al. Int Surg J. 2016 Aug;3(3):1278-1282 International Surgery Journal | July-September 2016 | Vol 3 | Issue 3 Page 1279 contraction of scalene and sternocleidomastoid muscle, thus fracture of first rib. Most commonly fractured ribs are 4 th -9 th , generally at the weakest area (posterior angle). Flail/stove in chest lead to paradoxical respiratory movements. Lower ribs fracture is usually associated with injury to diaphragm and abdominal organs (fracture of left lower ribs-spleen, right lower ribs-liver, floating ribs-renal injuries). Chest injuries are usually life threatening, either on their own or in conjunction with other system injuries. Ribs fracture may compromise ventilation, pain can cause respiratory splinting and fragments of fractured ribs can act as penetrating objects. Threats to life are; Keywords ImmediatePneumothorax, haemothorax, flail/ stove in chest, airway injuries, pericardial tamponade. PotentialPulmonary contusion, oesophageal/ aortic/ tracheobronchial/ myocardial injuries, rupture of diaphragm.The aim was to study rib fractures' mechanism, incidence and complications especially the first rib and their sequelae. METHODSThe study was conducted on 300 patients at NIMS Medical College and Hospital, Jaipur, Rajasthan, India, during the period April 2013 to March 2016, admitted in various departments mainly department of orthopaedics and neurosurgery having rib fracture with or without associated injuries. All patients were examined on a fixed protocol (age, sex, mode of injury, vital status, number and site of rib fracture) with associated injury and their complications were recorded. All patients underwent routine...

First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

“…The common mode of trauma was RTA, accounting for 92.5% of traumas, followed by falls from a heightin7.5% of the cases studied, which is nearly similar to that in a study by Kochar et al, where in RTA was found to account for70% of traumas, whereas falls from a height accounted for15% of trauma cases. 11 In this study, of the 53 cases with first-rib fracture, 19 (35.8%) were bilateral, whereas the study by Ismail et al concluded that bilateral first-rib fracture was a rare entity. 6 In our study, 28.3% of cases were right-side unilateral side and 35.8% were left-side unilateral.…”