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The Journal of Surgical Research Aug 2022Multiple rib fractures and flail chest are common in trauma patients and may result in significant morbidity and mortality. While rib fractures have historically been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multiple rib fractures and flail chest are common in trauma patients and may result in significant morbidity and mortality. While rib fractures have historically been treated conservatively, there is increasing interest in the benefits of surgical fixation. However, strong evidence that supports surgical rib fixation and identifies the most appropriate patients for its application is currently sparse.
METHODS
A systematic review and meta-analysis following PRISMA guidelines was performed to identify all peer-reviewed papers that examined surgical compared to conservative management of rib fractures. We undertook a subgroup analysis to determine the specific effects of rib fracture type, age, the timing of fixation and study design on outcomes. The primary outcomes were the length of hospital and ICU stay, and secondary outcomes included mechanical ventilation time, rates of pneumonia, and mortality.
RESULTS
Our search identified 45 papers in the systematic review, and 40 were included in the meta-analysis. There was a statistical benefit of surgical fixation compared to conservative management of rib fractures for length of ICU stay, mechanical ventilation, mortality, pneumonia, and tracheostomy. The subgroup analysis identified surgical fixation was most favorable for patients with flail chest and those who underwent surgical fixation within 72 h. Patients over 60 y had a statistical benefit of conservative management on length of hospital stay and mechanical ventilation.
CONCLUSIONS
Surgical fixation of flail and multiple rib fractures is associated with a reduction in morbidity and mortality outcomes compared to conservative management. However, careful selection of patients is required for the appropriate application of surgical rib fixation.
Topics: Flail Chest; Fracture Fixation, Internal; Humans; Length of Stay; Pneumonia; Retrospective Studies; Rib Fractures; Ribs; Spinal Fractures
PubMed: 35390577
DOI: 10.1016/j.jss.2022.02.055 -
Radiographics : a Review Publication of... 2017The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not... (Review)
Review
The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. RSNA, 2017.
Topics: Bone Diseases; Diagnosis, Differential; Emergency Service, Hospital; Humans; Rib Fractures; Ribs
PubMed: 28186860
DOI: 10.1148/rg.2017160100 -
Injury Jun 2019Rib fractures are common injuries associated with significant morbidity and mortality, largely due to pulmonary complications. Despite equivocal effectiveness data,... (Review)
Review
Rib fractures are common injuries associated with significant morbidity and mortality, largely due to pulmonary complications. Despite equivocal effectiveness data, incentive spirometers are widely utilized to reduce pulmonary complications in the postoperative setting. Few studies have evaluated the effectiveness of incentive spirometry after rib fracture. Multiple investigations have demonstrated incentive spirometry to be an important screening tool to identify high-risk rib fracture patients who could benefit from aggressive, multidisciplinary pulmonary complication prevention strategies. This review evaluates the epidemiology of rib fractures, their associated pulmonary complications, along with the evidence for optimizing their clinical management through the use of incentive spirometry, multimodal analgesia, and surgical fixation.
Topics: Fracture Fixation; Humans; Injury Severity Score; Randomized Controlled Trials as Topic; Respiratory Insufficiency; Rib Fractures; Spirometry; Thoracic Injuries; United States
PubMed: 31047683
DOI: 10.1016/j.injury.2019.04.020 -
Thoracic Surgery Clinics May 2017Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant... (Review)
Review
Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management.
Topics: Combined Modality Therapy; Flail Chest; Fracture Fixation; Humans; Pain Management; Radiography; Respiration, Artificial; Rib Fractures; Sternum; Thoracic Wall
PubMed: 28363365
DOI: 10.1016/j.thorsurg.2017.01.004 -
Scoliosis 2014This article analyzes the double rib contour sign (DRCS) and the rib index (RI). The analyzed topics are 1. the history of presentations - publication of DRCS-RI, 2. the...
This article analyzes the double rib contour sign (DRCS) and the rib index (RI). The analyzed topics are 1. the history of presentations - publication of DRCS-RI, 2. the study source origin: school screening for idiopathic scoliosis (IS), 3. what the DRCS and the RI are- Description, 4. the quantification of the DRCS - RI, 5. a reliability study for RI 6. how much the rib index is affected by the distance between the radiation source and the irradiated individual, 7. the implications on IS aetiology, 8. the applications of Rib index for a. documentation of the deformity, b. assessment of physiotherapy, c. assessment of brace treatment and d. pre- and post-operative assessment; assessment of the rib-cage deformity correction on the transverse plane, 9. the use of RI and implications for screening policies 10. the reference of the RI method in spinal textbooks and finally 11. the citations in Google Scholar.
PubMed: 25635184
DOI: 10.1186/s13013-014-0020-9 -
European Journal of Radiology Jan 2019Rib fractures are the most common form of blunt thoracic injury. Multiple rib fractures are an important indicator of trauma severity, with increased morbidity and... (Review)
Review
Rib fractures are the most common form of blunt thoracic injury. Multiple rib fractures are an important indicator of trauma severity, with increased morbidity and mortality occurring with increasing numbers of rib fractures, especially in the elderly. Thoracic cage injuries may be associated with concomitant and potentially life-threating injuries. In the acute setting, correct recognition of the pattern, extent and severity of thoracic cage injuries, may aid in more accurate delineation of concomitant injuries.
Topics: Adult; Aged; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Radiography; Rib Cage; Rib Fractures; Thoracic Injuries; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 30599865
DOI: 10.1016/j.ejrad.2018.12.003 -
The Surgical Clinics of North America Apr 2024Common mechanisms of blunt thoracic injury include motor vehicle collisions and falls. Chest wall injuries include rib fractures and sternal fractures; treatment... (Review)
Review
Common mechanisms of blunt thoracic injury include motor vehicle collisions and falls. Chest wall injuries include rib fractures and sternal fractures; treatment involves supportive care, multimodal analgesia, and pulmonary toilet. Pneumothorax, hemothorax, and pulmonary contusions are also common and may be managed expectantly or with tube thoracostomy as indicated. Surgical treatment may be considered in select cases. Less common injury patterns include blunt trauma to the tracheobronchial tree, esophagus, diaphragm, heart, or aorta. Operative intervention is more often required to address these injuries.
Topics: Humans; Thoracic Injuries; Wounds, Nonpenetrating; Rib Fractures; Pneumothorax; Thoracotomy
PubMed: 38453306
DOI: 10.1016/j.suc.2023.09.007 -
Asian Cardiovascular & Thoracic Annals Oct 2015Occasionally, patients who complain of chest pain after the onset of coughing are diagnosed with rib fractures. We investigated the characteristics of cough-induced rib... (Observational Study)
Observational Study
BACKGROUND
Occasionally, patients who complain of chest pain after the onset of coughing are diagnosed with rib fractures. We investigated the characteristics of cough-induced rib fractures.
METHODS
Between April 2008 and December 2013, 17 patients were referred to our hospital with chest pain after the onset of coughing. Rib radiography was performed, focusing on the location of the chest pain. When the patient had other signs and symptoms such as fever or persistent cough, computed tomography of the chest was carried out. We analyzed the data retrospectively.
RESULTS
Rib fractures were found in 14 of the 17 patients. The age of the patients ranged from 14 to 86 years (median 39.5 years). Ten patients were female and 4 were male. Three patients had chronic lung disease. There was a single rib fracture in 9 patients, and 5 had two or more fractures. The middle and lower ribs were the most commonly involved; the 10th rib was fractured most frequently.
CONCLUSIONS
Cough-induced rib fractures occur in every age group regardless of the presence or absence of underlying disease. Since rib fractures often occur in the lower and middle ribs, rib radiography is useful for diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chest Pain; Cough; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Rib Fractures; Risk Factors; Tomography, X-Ray Computed; Young Adult
PubMed: 26207003
DOI: 10.1177/0218492315596893 -
JAMA May 2019
Topics: Breathing Exercises; Diagnosis, Differential; Humans; Rib Fractures
PubMed: 31087024
DOI: 10.1001/jama.2019.2313