Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures

Abstract

BACKGROUND:Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment. METHODS:Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map. RESULTS:A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6. CONCLUSION:Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures.

Rib Fracture Map in High-Energy Injuries

“…[1][2][3][4][5] In our patient cohort, only 8% of patients presented with flail chest, which is higher than in a general rib fracture population but lower than the reported 12%-56% prevalence of flail chest found in similar patient cohorts with multiple rib fractures. 5,30 Serial rib fractures of 3 or more consecutive ribs broken were found in 52% of our patients, which is consistent with the limited amount of literature that has reported on serial rib fractures. 5,38 However, our result of a 52% prevalence of serial rib fractures was lower than expected considering that our cohort exclusively consisted of patients with 2 or more rib fractures without single rib fractures.…”

“…A separate investigation has been performed to specifically isolate this population of patients with scapula fractures which yields a different mapping paradigm with different implications. 30 Furthermore, although it is difficult to quantify what the exact cutoff between a younger and older patient cohort should be, we included patients within a 30-year time frame to ensure that we were capturing rib fractures that were occurring in young, healthy bone. Geriatric patients were excluded which likely altered the patterns and frequencies seen in this initial mapping study.…”

Mapping of Pelvic Ring Injuries From High-Energy Trauma Using Unfolded CT Image Technology

“…In addition, unfolded chest CT scans have been used with the fracture mapping technique to analyze common rib fracture patterns in patients with operatively treated scapula fractures. 19 To the best of the authors' knowledge, a comprehensive pelvic ring fracture map pertaining to high-energy trauma that uses unfolding technology has not been published. The evaluation of high-energy pelvic ring fracture patterns using a novel 3D CT unfolding process, along with the production of fracture frequency maps using this technology, will allow for improved identification of specific pelvic ring injury patterns, with potential implications for management of pelvic ring fractures.…”

Three-dimensional mapping of sternum fractures from high-energy trauma

“…Variations of this process have already been performed for several anatomical areas, using either 2-dimensional or 3-dimensional imaging, such as the scapula, tibial pilon, coronoid, radial head, femur, pelvis, calcaneus, tibial plateau, distal humerus, and ribs. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] The primary objective of this retrospective study was to use a previously described 3D CT reconstruction mapping process to create high-energy sternum fracture frequency maps for evaluating and analyzing fracture characteristics and distribution. Secondary goals included exploring the presence of recurring injury patterns, assessing the frequency of concomitant injuries while exploring their association with mapped fracture patterns, and determining the 30-day all-cause mortality rate of eligible patients presenting with a high-energy sternum fracture.…”

“…A research technique known as fracture mapping involves superimposing fracture lines or comminution zones from multiple patients with an injury of interest to develop frequency maps, allowing for analysis of fracture patterns and distribution. Variations of this process have already been performed for several anatomical areas, using either 2-dimensional or 3-dimensional imaging, such as the scapula, tibial pilon, coronoid, radial head, femur, pelvis, calcaneus, tibial plateau, distal humerus, and ribs 7–20 …”