Perils of Rib Fractures

2008 ◽  
Vol 74 (4) ◽  
pp. 310-314 ◽  
Author(s):  
Om P. Sharma ◽  
Michael F. Oswanski ◽  
Shashank Jolly ◽  
Sherry K. Lauer ◽  
Rhonda Dressel ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Close Observation ◽  
Motorcycle Crashes ◽  
Level 1 Trauma Center

Rib fractures (RF) are noted in 4 to 12 per cent of trauma admissions. To define RF risks at a Level 1 trauma center, investigators conducted a 10-year (1995–2004) retrospective analysis of all trauma patients. Blunt chest trauma was seen in 13 per cent (1,475/11,533) of patients and RF in 808 patients (55% blunt chest trauma, 7% blunt trauma). RF were observed in 26 per cent of children (<18 years), 56 per cent of adults (18–64 years), and 65 per cent of elderly patients (≥65 years). RF were caused by motorcycle crashes (16%, 57/347), motor vehicle crashes (12%, 411/3493), pedestrian-auto collisions (8%, 31/404), and falls (5%, 227/5018). Mortality was 12 per cent (97/808; children 17%, 8/46; adults 9%, 46/522; elderly 18%, 43/240) and was linearly associated with a higher number of RF (5% 1–2 RF, 15% 3–5 RF, 34% ≥6 RF). Elderly patients had the highest mortality in each RF category. Patients with an injury severity score ≥15 had 20 per cent mortality versus 2.7 per cent with ISS <15 ( P < 0.0001). Increasing age and number of RF were inversely related to the percentage of patients discharged home. ISS, age, number of RF, and injury mechanism determine patients’ course and outcome. Patients with associated injuries, extremes of age, and ≥3 RF should be admitted for close observation.

Delayed Respiratory Failure After Blunt Chest Trauma

2020 ◽  
pp. 000313482096627
Author(s):  
Christina S. Martin ◽  
Ning Lu ◽  
David S. Inouye ◽  
Kazuma Nakagawa ◽  
Karen Ng ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Rib Fractures ◽  
P Value ◽  
Clinical Predictors ◽  
Chi Square ◽  
Risk Patients ◽  
Student’S T

Background Patient factors associated with delayed respiratory failure (DRF) after blunt chest trauma are not well documented. Earlier identification and closer monitoring may improve outcomes for these patients. The purpose of this study was to identify the prevalence and clinical predictors of DRF in patients after blunt chest trauma. Materials and Methods A retrospective review of adult patients admitted to a Level 1 trauma center after blunt chest trauma between January 1, 2009 and December 31, 2013, was conducted. Patients with early respiratory failure were compared to patients with DRF using Fisher’s exact tests, chi square, and Student’s t-tests. A P-value of <.05 was considered significant. Results 1299 patients had blunt chest trauma and at least 1 rib fracture, of which 830 met inclusion criteria. 5.8% of patients progressed to respiratory failure. Respiratory failure was delayed in 25% of these patients. DRF patients had significantly lower ISS (16.5 vs. 22.7, P = .04), more bilateral rib fractures (66.7% vs. 28.7%, P = .02) and fewer pulmonary contusions (16.7% vs. 50.0%, P = .04). Discussion Injury patterns, including bilateral rib fractures without pulmonary contusions and low but severe Injury Severity Score burden, may help identify high-risk patients who may benefit from closer monitoring and more aggressive therapy.

scholarly journals Epidemiology of combined clavicle and rib fractures: a systematic review

2021 ◽  
Author(s):  
Arthur A. R. Sweet ◽  
Reinier B. Beks ◽  
Frank F. A. IJpma ◽  
Mirjam B. de Jong ◽  
Frank J. P. Beeres ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Multiple Rib Fractures ◽  
Polytrauma Patients ◽  
Clavicle Fractures

Abstract Purpose The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. Methods A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14th of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant–Murley score, union and complications. Results Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56–60.6% versus 29% in patients without clavicle fractures. Vice versa, 14–18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days). Conclusion Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury.

Breast Hematoma: An Under-Recognized and Under-Reported Female-Specific Traumatic Injury and Its Clinical Significance

2020 ◽  
pp. 000313482094356
Author(s):  
Danielle LaSalle Hashmi ◽  
Adrian W. Ong ◽  
Alison Muller ◽  
MariaLisa Itzoe ◽  
Anthony Martin ◽  
...  
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Univariate Analysis ◽  
Traumatic Injury ◽  
Antithrombotic Agent ◽  
Female Patients ◽  
Severity Scores ◽  
Female Specific

Female-specific traumatic injury patterns have not been well researched and are potentially not well documented. Our aim was to examine the prevalence of breast hematomas (BHs) after blunt chest trauma, and to evaluate if there were risk factors associated with BH requiring intervention. A retrospective review from 2013 to 2018 was performed, identifying female patients ≥18 years sustaining blunt chest trauma. BH was defined as the presence of a collection of blood within the breast parenchyma, and clinically significant breast hematoma (CSBH) as BH requiring blood transfusion, surgical, or interventional radiology intervention. Univariate analysis was performed comparing CSBH with BH in terms of demographics, injury severity, antithrombotic agent use, and body mass index (BMI). Of 871 female patients meeting criteria, 59 (7%) had BH. Of these, 10 (17%) had CSBH (transfusion only, n = 3; angioembolization, n = 4; operation, n = 3). Compared to BH not requiring intervention, CSBH patients were older (mean age, 80 vs 69, P = .006), but had similar rates of motor vehicle crashes (90% vs 78%), seatbelt use (70% vs 71%), antiplatelet use (10% vs 12%), and anticoagulant use (10% vs 6%). Median Injury Severity Scores and median BMI (34 vs 34) were similar between the groups.

scholarly journals Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review

CJEM ◽  
2018 ◽  
Vol 20 (4) ◽  
pp. 614-622 ◽  
Author(s):  
Jake Sawa ◽  
Robert S. Green ◽  
Brent Thoma ◽  
Mete Erdogan ◽  
Philip J. Davis
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Prognostic Factors ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Adverse Outcomes ◽  
Rib Fractures ◽  
Factors Associated ◽  
Chest Wall Trauma

ABSTRACTObjectivesThe objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma.MethodsEMBASE and MEDLINE were searched from inception until March 2017 for prognostic factors associated with adverse outcomes in older adults sustaining blunt chest trauma using a pre-specified search strategy. References were independently screened for inclusion by two reviewers. Study quality was assessed using the Quality in Prognostic Studies tool. Where appropriate, descriptive statistics were used to evaluate study characteristics and predictors of adverse outcomes.ResultsThirteen cohort studies representing 79,313 patients satisfied our selection criteria. Overall, 26 prognostic factors were examined across studies and were reported for morbidity (8 studies), length of stay (7 studies), mortality (6 studies), and loss of independence (1 study). No studies examined patient quality of life or emergency department recidivism. Prognostic factors associated with morbidity and mortality included age, number of rib fractures, and injury severity score. Although age and rib fractures were found to be associated with adverse outcomes in more than 3 studies, meta-analysis was not performed due to heterogeneity amongst included studies in how these variables were measured.ConclusionsWhile blunt chest wall trauma in older adults is relatively common, the literature on prognostic factors for adverse outcomes in this patient population remains inadequate due to a paucity of high quality studies and lack of consistent reporting standards.

Lung ultrasound in blunt chest trauma: A clinical review

Ultrasound ◽  
2021 ◽  
pp. 1742271X2199460
Author(s):  
Serena Rovida ◽  
Daniele Orso ◽  
Salman Naeem ◽  
Luigi Vetrugno ◽  
Giovanni Volpicelli
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Lung Ultrasound ◽  
Lung Parenchyma ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Major Life ◽  
Diagnostic Modality ◽  
Life Threatening ◽  
Sternal Fractures

Introduction Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. Topic Description We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms ‘trauma’, ‘lung contusion’, ‘pneumothorax’, ‘hemothorax’ and ‘lung ultrasound’. The latest articles were reviewed and this article was written using the most current and validated information. Discussion Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. Conclusion Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.

scholarly journals Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel H. Wolbrom ◽  
Aleef Rahman ◽  
Cory M. Tschabrunn
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Motor Vehicle ◽  
Structural Heart Disease ◽  
Chest Injury ◽  
Chronic Stage ◽  
Chest Wall Injury

Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis) and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

Decreased Incidence of Rib Fractures in Pregnant Patients After Motor Vehicle Collisions

2021 ◽  
Vol 30 (5) ◽  
pp. 385-390
Author(s):  
Marissa Di Napoli ◽  
William B. DeVoe ◽  
Stuart Leon ◽  
Bruce Crookes ◽  
Alicia Privette ◽  
...  
Keyword(s):  
Chest Wall ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Rib Fractures ◽  
Hormonal Changes ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Vehicle Collision ◽  
Chest Wall Injury ◽  
Wall Injury

Background Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood. Objectives To compare the incidences of chest wall injury following blunt thoracic trauma between pregnant and nonpregnant women. Methods The authors conducted a retrospective review of female patients seen at a level I trauma center from 2009 to 2017 after a motor vehicle collision. Patient characteristics were compared to determine if pregnancy affected the incidence of chest wall injury. Statistics were calculated with SPSS version 24 and are presented as mean (SD) or median (interquartile range). Results In total, 1618 patients were identified. The incidence of rib/sternal fracture was significantly lower in pregnant patients (7.9% vs 15.2%, P = .047), but the incidence of intrathoracic injury was similar between the groups. Pregnant and nonpregnant patients with rib/sternal fractures had similar Injury Severity Score results (21 [13-27] vs 17 [11-22], P = .36), but pregnant patients without fractures had significantly lower scores (1 [0-5] vs 4 [1-9], P &lt; .001). Conclusions Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.

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