Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma

Abstract

Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. RSNA, 2017.

Widening of sternoclavicular joint distances in blunt chest trauma

“…Fractures involving 9 th to 12 th ribs may be accompanied by upper abdominal organ injury. 6,7 We detected fractures of 9 th to 12 th ribs at the right side in 11 patients with blunt chest trauma and at the left side in 22 patients, and 5% of patients also had hepatic or splenic laceration.…”

“…We revealed a costal cartilage fracture prevalence of 3.03% among 1415 trauma patients. Nummela et al reported a costal cartilage fracture prevalence of 7.8% in 1461 patients presenting with trauma 7 . We believe that the lower prevalence in our study likely resulted from a more common use of CT for trauma victims at the emergency departments in our country.…”

“…The incidence of hemothorax and pneumothorax rises with increasing number of fractured ribs 6 . The incidence of costal cartilage fracture has been reported 19.9% 7 . Costal cartilage fractures, together with rib fractures, may cause chest wall instability.…”

The Value of 99mTc-Methylene Diphosphonate Single-Photon Emission Computed Tomography/Computed Tomography in Detecting Atraumatic Costal Cartilage Fracture in Malignant Tumor Patients

“…Computed tomography is a common imaging examination for the detection of CCF in clinical practice, which can reveal the fracture line and dislocation (4,6). Insufficiency fracture of the costal cartilage without a trauma history can be easily misdiagnosed by CT because of mild abnormalities, such as swelling, irregular calcification, and malformation, without typical fracture line or dislocation.…”

Evaluation of Nexus X-ray Rules in Blunt Thorax Trauma

“…Inclusion criteria were: 1) Patients over 18 years of age, (2) patients who applied to the emergency department within 24 hours after blunt trauma (3) were asked to perform thorax imaging. The exclusion criteria were: (1) Patients under the age of 18 (2) who did not want to take part in this study (3) who applied to the emergency department due to penetrating injury mechanism (4) who applied to our emergency department more than 24 hours after trauma (5) X-ray untreated or unreached patients.…”