Taxonomy of multiple rib fractures: Results of the chest wall injury society international consensus survey

Edwards, John; Clarke, Peter; Pieracci, Fredric M.; Bemelman, Mike; Black, Elizabeth; Doben, Andrew R.; Gasparri, Mario; Gross, R; Wu, Jun; Long, William B.; Lottenberg, Lawrence; Majercik, Sarah; Marasco, Silvana; Mayberry, John C.; Sarani, Babak; Schulz-Drost, Stefan; Boerum, Don Van; Whitbeck, SarahAnn; White, Thomas W.

doi:10.1097/ta.0000000000002282

Cited by 65 publications

(69 citation statements)

References 14 publications

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“…11 With the recognition of a costal cartilage section in rib fracture localisation, the possible favourable effect of SSRF in this type of injury can be studied. 1 While reporting successful surgical management of costal cartilage fractures, one case report has stressed the technical difficulty of this procedure as the location of this injury often makes the advised bilateral attachment of hardware to bone impracticable. 12 Another case series of surgically treated patients for sternocostal dislocation after pectus excavatum repair showed no hardware complications and good patient satisfaction at 1 year after treatment.…”

Section: Discussionmentioning

confidence: 99%

“…A recent consensus statement of the Chest Wall Injury Society advocated the addition of a costal cartilage sector to the existing anterior, lateral and dorsal sectors to record rib fractures in this anatomic region. 1 The costal cartilage sector is a biomechanically demanding region due to the symmetrical and asymmetrical tractive, compressive and shearing forces, which can result in sternocostal dislocation and has previously been described after pectus excavatum repair. 2 Whereas Schulz-Drost has presented satisfactory results after surgical stabilisation of sternocostal dislocation, this operative treatment has, to the best of our knowledge, not been described in the literature for patients with traumatic sternocostal or costochondral dislocation.…”

Section: Introductionmentioning

confidence: 99%

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Operative treatment of multiple costochondral dislocations in a patient with severe rib fractures and a flail chest following trauma

Prins

Wijffels

2021

BMJ Case Rep

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A 73-year-old male patient underwent operative treatment for dislocation of multiple costochondral junctions alongside multiple bony rib fractures and a flail chest following high-energy trauma. During the operative fixation of the flail chest, the costochondral lesions were surgically stabilised with plates and screws, which were fixated on the osseous anterior rib, sternum or the rib cartilage. The patient experienced no pulmonary complications during the primary admission. At 7 months after the trauma, the chest CT scan showed full consolidation of all fixated rib fractures, including the costochondral lesions, without hardware dislocation or complications. The patient did not require any pain medication and had no pain during daily activities, at rest or at night. Although being a biomechanically demanding region, which is often not defined in current rib fracture classification, operative treatment of costochondral lesions is feasible with outcome similar to the treatment of bony rib fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Operative treatment of multiple costochondral dislocations in a patient with severe rib fractures and a flail chest following trauma

Prins

Wijffels

2021

BMJ Case Rep

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“…Fractures were further defined in terms of three anatomic sectors as recommended by the Chest Wall Injury Society. 9 As previously described by Chapman et al, 10 fractures were described as anterior from the insertion of the serratus anterior to the distal rib, lateral from the serratus anterior to the costal angle, and posterior from the proximal rib to the costal angle. Respiratory morbidity potentially secondary to rib fractures, including unplanned intubation, failure of extubation, need for tracheostomy, pneumonia, or mortality, were all identified and included.…”

Section: Methodsmentioning

confidence: 99%

Use of continuous intercostal nerve blockade is associated with improved outcomes in patients with multiple rib fractures

Uhlich

Kerby

Bosarge

et al. 2021

Trauma Surg Acute Care Open

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BackgroundRib fractures are common among trauma patients and may result in significant morbidity and mortality. There are numerous treatment options, but ideal management is unclear. Delivery of local anesthetic via an analgesia catheter for continuous intercostal nerve blockade offers an attractive potential option for management of patients with rib fractures.MethodsWe performed a single-center, retrospective case–control analysis of trauma patients with multiple rib fractures from 2016 to 2018, comparing patients managed with continuous intercostal nerve blockade with standard care. Matching was performed in a 2:1 ratio by Injury Severity Score, age, and gender. Respiratory morbidity potentially secondary to rib fractures, including unplanned intubation, failure of extubation, need for tracheostomy, pneumonia, or mortality, were all identified and included. Potential complications due to catheter insertion were identified to be recorded. The primary outcome of interest was 30-day hospital-free days.ResultsNine hundred and thirty-three patients were eligible for analysis, with 48 managed using intercostal blockade compared with 96 matching controls. No complications of intercostal blockade were identified during the study period. Controls demonstrated fewer rib fractures (6.60±4.11 vs. 9.3±3.73, p=0.001) and fewer flail segments (0.8±1.76 vs. 2.0±2.94, p=0.02). Those managed with intercostal blockade demonstrated significantly more 30-day hospital-free days (15.9±6.43 vs. 13.2±9.94, p=0.048), less incidence of pneumonia (4.2% vs. 16.7%, p=0.03), and lower hospital mortality (2.1% vs. 13.5%, p=0.03). When adjusting for number of rib fractures and number of flail segments, use of continuous intercostal nerve blockade was significantly associated with lower hospital mortality (OR 0.10; 95% CI 0.01 to 0.91), pneumonia (OR 0.15; 95% CI 0.03 to 0.76), or need for tracheostomy (OR 0.23; 95% CI 0.06 to 0.83).DiscussionThe addition of continuous intercostal nerve blockade may help to improve outcomes in patients with multiple rib fractures compared with standard care alone.Level of evidenceTherapeutic/care management; level IV.

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“…Rib fracture patterns were characterized according to Chest Wall Injury Society (CWIS) taxonomy. 4 Open access degree (undisplaced, offset (<90% cortical contact), displaced (no cortical contact)), fracture type (simple, wedge, complex), neighboring rib fractures (series, not series), and chest wall location (anterior, lateral, posterior, costal). In addition to rib fractures, we also noted radiographic lung injury (chest wall soft tissue emphysema, pulmonary laceration or contusion, pneumothorax).…”

Section: Detailed Characterization Of Rib Fracturesmentioning

confidence: 99%

Complication to consider: delayed traumatic hemothorax in older adults

Choi

Anand

Sborov

et al. 2021

Trauma Surg Acute Care Open

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BackgroundEmerging evidence suggests older adults may experience subtle hemothoraces that progress over several days. Delayed progression and delayed development of traumatic hemothorax (dHTX) have not been well characterized. We hypothesized dHTX would be infrequent but associated with factors that may aid prediction.MethodsWe retrospectively reviewed adults aged ≥50 years diagnosed with dHTX after rib fractures at two level 1 trauma centers (March 2018 to September 2019). dHTX was defined as HTX discovered ≥48 hours after admission chest CT showed either no or ‘minimal/trace’ HTX. Two blinded, board-certified radiologists reviewed inpatient chest imaging and classified injury patterns according to Chest Wall Injury Society (CWIS) taxonomy. Descriptive analysis was performed for demographic and hospitalization characteristics.ResultsWe identified 14 patients with pooled dHTX rate of 1.3%. After initial chest CT negative for concerning hemothoraces, the patients did not undergo follow-up imaging until new symptoms (shortness of breath, chest pain) developed: eight (57%) were not diagnosed until after discharge from initial hospitalization (mean (range): 9 (2–20) days after discharge). Aspirin and/or anticoagulants were involved in fewer than half of cases (43%). According to CWIS taxonomy, all patients had a series of posterolateral fractures with at least one offset or displaced fracture, and an average of six consecutive rib fractures. All patients underwent tube thoracostomy and six patients (42%)—all aged <65—underwent operative interventions.DiscussionPreliminary data suggest older adults with rib fractures may be at risk of experiencing delayed progression of trace hemothoraces or a delayed presentation of hemothoraces. Asymptomatic progression or readmission to other services/hospitals likely occurs and true dHTX rates are likely higher. Our preliminary findings suggest a possible anatomic explanation for severe chest wall injury patterns’ association with dHTX. Further characterization and capturing the true incidence of dHTX first requires wider recognition of this complication.

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Taxonomy of multiple rib fractures: Results of the chest wall injury society international consensus survey

Cited by 65 publications

References 14 publications

Operative treatment of multiple costochondral dislocations in a patient with severe rib fractures and a flail chest following trauma

Operative treatment of multiple costochondral dislocations in a patient with severe rib fractures and a flail chest following trauma

Use of continuous intercostal nerve blockade is associated with improved outcomes in patients with multiple rib fractures

Complication to consider: delayed traumatic hemothorax in older adults

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