Bone Marrow Aspirate for Delayed Union due to Severe Thoracic Rib Trauma

In this peculiar setting, the infiltrations with BMA proved to be an efficient alternative tool for the treatment of severe thoracic rib trauma and delayed union. The patient returned with no complaints and CT evidence indicated that all of the fractured ribs had complete consolidation. Pain and functional outcome of the chest wall in terms of stability improved with the help of this orthobiologic alternative.

Novel chest wall blocks for severe chest wall injuries in older persons: A case series

Patients over the age of 65 years admitted to hospital with more than six rib fractures have a mortality rate as high as 38%. Of the survivors, 34% are likely to be admitted to an aged care facility. High-quality analgesia is paramount to the mitigation of rib fracture–associated morbidity and mortality. We report a series of ten consecutive patients over the age of 65 years with more than eight fractured ribs. All patients were managed with a novel chest wall block. There were no deaths, and only one patient was discharged into an aged care facility.

Preliminary study of the characteristics of rib fractures and their impact on pulmonary ventilatory function

Background This study aimed to investigate the pulmonary ventilation function (PVF) according to different types of rib fractures and pain levels. Methods This was a retrospective study of patients with thoracic trauma admitted to our ward from May 1, 2015, to February 1, 2017. Vital capacity (VC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were measured on admission. A numerical rating scale (NRS) was used for pain assessment. Results A total of 118 (85 males and 33 females) were included. The location of rib fractures did not affect the PVF. When the number of rib fractures was ≥5, the PVF was lower than in those with ≤4 fractures (VC: 0.40 vs. 0.47, P = 0.009; FEV1: 0.37 vs. 0.44, P = 0.012; PEF: 0.17 vs. 0.20, P = 0.031). There were no difference in PVF values between rib fractures with multiple locations and those with non-multiple locations (VC: 0.41 vs. 0.43, P = 0.202; FEV1: 0.37 vs. 0.39, P = 0.692; PEF: 0.18 vs. 0.18, P = 0.684). When there were ≥ 5 breakpoints, the PVF parameters were lower than those with ≤4 breakpoints (VC: 0.40 vs. 0.50, P = 0.030; FEV1: 0.37 vs. 0.45, P = 0.022; PEF: 0.18 vs. 0.20, P = 0.013). When the NRS ≥ 7, the PVF values were lower than for those with NRS ≤ 6 (VC: 0.41 vs. 0.50, P = 0.003; FEV1: 0.37 vs. 0.47, P = 0.040; PEF: 0.18 vs. 0.20, P = 0.027). Conclusions When the total number of fractured ribs is ≥5, there are ≥5 breakpoints, or NRS is ≥7, the VC, FEV1, and PEF are more affected. Trial registration The trial was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and individual consent for this retrospectively registered analysis was waived.

Five autopsy reports of rib fractures in the mental hospital of Reggio Emilia (1874–5): pathogenesis proposal in defence of the ‘non-restraint’ system

At the end of the nineteenth century, recurrent cases of rib fractures were recorded in psychiatric asylums, opening a long chapter of discussions about the application of the ‘non-restraint’ system. Here we present a brief discussion of an article written by Enrico Morselli about five cases of rib fractures in the mental asylum of Reggio Emilia, in 1874–5. Morselli, a supporter of the ideas of ‘non-restraint’, suggested a common pathological cause. His analysis proposed the osteomalacic condition as the possible cause of fractured ribs, rejecting the accusations of violence by asylum attendants. The discussion also examines similar cases of the same period, making rib fractures the means through which the issue of management of the insane was addressed.

Triage of Patients With Rib Fractures

Background Most triage guidelines for blunt chest wall trauma focus on advanced age and multiple fractured ribs to indicate a high-risk patient population that should be admitted to an intensive care unit (ICU). Overly sensitive ICU admission criteria, however, may result in overutilization of resources. We revised our rib fracture triage guideline to de-emphasize age and number of rib fractures, hypothesizing that we could lower ICU admission rates without compromising outcomes. Methods Patients admitted to our level 1 trauma center over 9 months after the institution of the revised guideline (N = 248) were compared with those admitted over 6 months following the original guideline (N = 207) using Fisher’s exact and Wilcoxon-Mann-Whitney tests, as appropriate. Univariate followed by multivariate analyses were performed to determine risk factors for complications. Results The ICU admission rate significantly decreased from 73% to 63% ( P = .02) after the institution of the revised guideline, despite an increase in the patient’s age and injury acuity of the cohort. There was no significant difference in respiratory complications, unplanned ICU admission rates, and overall mortality. Poor incentive spirometer effort (750 mL or less) and dyspnea in the trauma bay were the strongest predictors of an adverse composite outcome and prolonged hospital length of stay. Discussion A revised rib fracture triage guideline with less emphasis on the patient’s age and the number of fractured ribs safely lowered ICU admission rates. Poor functional status rather than age and anatomy was the strongest predictor of complications and prolonged hospital stay.

Rib Fracture Fixation, a new Era in Treatment of Chest Trauma in Albania

Rib fractures are a consequence of the forces of various arthritis that the chest wall and the thoracic cage itself undergo, and are most often due to closed injuries (eg, motor vehicle collision, falls from height, and Hits with strong objects ..), but penetrating injuries (eg, wounds with sharp tools, gunshot injuries ...) can also result in rib fractures. Non-operative treatment is based on pain control and pulmonary support, which mainly aim to avoid the need for intubation, which is associated with increased levels of pulmonary disorders until death. For patients who continue to have acute pain or instability of the chest wall (eg, flail chest), each of which impedes pulmonary function despite maximal medical therapy, or those with non-consolidating rib fractures and causing pain in the persistence and impairment of pulmonary function, surgicaly stabilization of fractured ribs, also known as osteosynthesis, are now well-known procedures that improve the quality of treatment of the traumatized patient. The thoracic wall injury association has been established to better study all aspects related to the consequences, diagnosis and treatment of thoracic wall injuries [1]. Indications for osteosynthesis, patient preparation, operative technique for stabilizing fractured ribs and the results are quite significant.

The Effectiveness of Kinesiotaping for Patients with Fractured Ribs: A Single-subject Experimental Design

Purpose: Kinesiotape is an elastic, adhesive tape applied to the skin that has been used extensively to reduce pain associated with various musculoskeletal conditions. Its use in the setting of fractured ribs is less clear. The aim of this preliminary study was to investigate the effect of kinesiotaping for patients with rib fracture(s) on pain levels, pulmonary function, and mobility. Method: We prospectively evaluated five patients admitted with fractured ribs using a single-subject experimental ABAB design. Each phase lasted 24 hours with kinesiotape applied during B phases. All participants received usual medical, nursing, and allied health care. Outcome measures included pain levels (participant-rated), pulmonary function, and maximum mobility. The occurrence of skin irritation was tracked. Results: Considerable variability was seen between- and within-participants for pain levels. There was some evidence, albeit inconsistent, that pain levels were lower when the kinesiotape was in situ compared to when it was not. Pulmonary function and mobility levels showed no consistent pattern between intervention phases. Skin irritation occurred in one participant and another required escalation of medical therapy for pneumonia. Conclusions: Kinesiotaping may reduce pain for patients with fractured ribs but further research, preferably randomized controlled trials with homogenous samples and standardized medication regimens, is required to confirm its effectiveness in the acute care setting.

Management of Chest Trauma in Bangladesh Perspective: Experience of a Decade

Background: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 10-year experience in the management and clinical outcome of 437 chest trauma cases as a result of blunt and penetrating injuries in two medical college hospitals of Bangladesh. Methods: We reviewed 437 cases of chest trauma between January 2006 and December 2015.The mean age of our patients was 33 ± 15 years mostly males with blunt injuries. Patients were evaluated and compared according to age, sex, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results: The leading cause of the trauma was road traffic accident (61%) followed by violence (23%). Hemothorax (62%), Pneumothorax (51%), rib fractures (38%), and lung contusion (35%) were the most common types of injury. Associated injuries were documented in 35% of patients (extremities 18%, abdomen 12%, head 5%). Minority of the patients required thoracotomy (6%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital stay was 5.5 ± 4.8 days. The overall mortality rate was 3.6%. Conclusion: Road traffic accident was the most common cause of chest trauma rather than violence in this series, this necessitates epidemiologic or multi-institutional studies to know what are the causes of RTA contributes to chest trauma in Bangladesh. The number of fractured ribs can be used as simple indicator of the severity of trauma. Cardiovasc. j. 2019; 12(1): 3-8