Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

Abstract

Rib fractures represent the most common bone fracture, occurring in 10–20% of all blunt trauma patients and leading to concomitant injuries of the inner organs in severe cases. The purpose of this study was to identify specific serial rib fracture patterns after blunt chest trauma. 380 serial rib fracture cases were investigated. Fractures were assigned to five different locations within the transverse plane. Rib level, fracture type, and dislocation grades were recorded and related to the cause of accident. In total, 3735 rib fractures were identified (9.8 per patient). 54% of the rib fractures were detected on the left thorax. Rib fracture distribution exhibited a hotspot at rib levels 4 to 7 in the lateral and posterolateral segments. On average, most rib fractures occurred in crush/burying injuries (15.8, n = 13) and pedestrian accidents (12.8, n = 13), least in car/truck accidents (8.9, n = 75). In the car/truck accident group, 47% of all rib fractures were in the lateral segment, in case of frontal collision (n = 24) even 60%. Fall injuries (n = 141) entailed mostly posterolateral rib fractures (35%). In case of falls >3 m (n = 45), 48% more rib fractures were detected on the left thorax. In cardiopulmonary resuscitation related serial rib fractures (n = 33), 70% of all rib fractures were located anterolaterally. Infractions were the most observed fracture type (44%), followed by oblique (25%) and transverse (18%) fractures, while 46% of all rib fractures were dislocated (15% ≥ rib width). Serial rib fractures showed distinct fracture patterns depending on the cause of accident. When developing a serial rib fracture classification system, data regarding patterns, fracture types, dislocation grades, and associated fractures should be included.

Experimental study exploring the factors that promote rib fragility in the elderly

“…However, the study of Daegling et al solely showed four incomplete fractures in the eight tested ribs, whereas in the present study, 74 of the 89 fracture types were infractions, which might be explained by differences in testing conditions and the use of rehydrated rib specimens, since it was shown that moisture level can affect the fragility of cortical bone 25 . Compared to data of a retrospective clinical study, however, rib fracture locations of the present study showed similar patterns as ribs of cardiopulmonary resuscitated patients 19 , which might be explained by equivalent loading conditions in both cases. Therefore, it can be assumed that pure antero-posterior rib cage compression predominantly results in anterior or antero-lateral rib fractures.…”

“…Of the remaining 29 ribs, 25 showed oblique fractures (19 infractions), whereas only 4 ribs had multifragment fractures (1 infraction). Fracture locations were detected in the antero-lateral section as defined by Liebsch et al 19 in 88 of the 89 investigated ribs, while only one rib fractured in the posterior section.…”

“…A total of 89 human ribs from 13 donors were prepared for experimental testing, while solely ribs from levels 4 to 8 were included since highest fracture rates were detected at these levels in a recent retrospective study 19 . Donor age ranged from 55 to 99 years with a mean of 75 years, including seven male and six female donors and a total of 45 left and 44 right ribs (Table 1 ).…”

Life Across the River: Exploring the Impact of Urbanisation in 18th–19th Century Panevėžys

“…No humeral or femoral fractures were recorded in the sample, although, as seen in many other archaeological sites, broken ribs were more prevalent (25%) than any other type of fracture (Lovell, 1997;Aufderheide and Rodríguez-Martín, 1998;Roberts and Cox, 2003;Brickley, 2006;Kozakaitė and Jakulis, 2017;Kozakaitė, 2018). Even though the reconstruction of an underlying traumatic event is often a challenging task, rib fractures occur no less frequently today than they did in the past (Galloway, 1999;Liebsch et al, 2019). Matos (2009) indicated the great variability in the crude prevalence rates of rib fractures in bioarchaeological studies, which ranges from 5.2% to 31.3%.…”

Análise comparativa do perfil de vítimas de trauma contuso e penetrante atendidas na sala de emergência: estudo longitudinal

“…Na região do tórax, ferimentos penetrantes causam danos com manifestações clínicas importantes, mas que requerem abordagem cirúrgica em menos de 15% dos casos e mortalidade variável de 10% a 50% (1,12,14) . Traumatismos contusos nessa região podem provocar manifestações clínicas importantes decorrentes da desaceleração e impacto dos órgãos internos com a parede torácica, provocando compressão e contusão pulmonar.…”