-
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 -
International Journal of Medical... 2021Intrathoracic ribs are very rare congenital anomalies, and often discovered incidentally on chest X-ray. Since its first description by Lutz in 1947, approximately 50... (Review)
Review
Intrathoracic ribs are very rare congenital anomalies, and often discovered incidentally on chest X-ray. Since its first description by Lutz in 1947, approximately 50 cases have been reported in the literature till date. The aim is to review the all reported intrathoracic ribs, summarize their clinical features, and propose a potential classification. All relevant literatures were searched and reviewed. The terms include intrathoracic rib, intrathoracic bifid rib, trans-thoracic rib and intrathoracic rib anomaly. We have summarized the first finding events, origination, distribution, related anomalies and imaging features of intrathoracic rib, and propose an updated classification. The patients' age at initial finding was from six weeks to 79 years old. Of all, sixty percent was less than 30 years old. There was no difference in gender. Most of them were reported by authors in western countries (85.3%, 58/68), and incidental findings by radiologist and respiratory physician. The intrathoracic rib occurs more frequently on the right side, and is usually single and unilateral. According to the new classification, type I and II was account for 45.6% and 35.3%, respectively. Intrathoracic rib is rare findings in clinical practice. It is useful that radiologists or clinician are familiarized with the imaging appearances of these malformations. These anomalies reflect some disturbances during the embryo development, leading us to propose a potential classification that could contribute to a better understanding of this rib anomaly.
Topics: Adolescent; Adult; Aged; Bone Diseases, Developmental; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Rare Diseases; Rib Cage; Ribs; Young Adult
PubMed: 34790056
DOI: 10.7150/ijms.63828 -
European Journal of Trauma and... Oct 2022The 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. (Review)
Review
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 14 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.
Topics: Clavicle; Humans; Length of Stay; Multiple Trauma; Retrospective Studies; Rib Fractures; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 34075434
DOI: 10.1007/s00068-021-01701-4 -
Journal of Thoracic Disease May 2019As a means of treating rib fractures, surgical stabilization of rib fractures (SSRF) has been carried out sporadically for nearly 100 years. However, with the recent... (Review)
Review
As a means of treating rib fractures, surgical stabilization of rib fractures (SSRF) has been carried out sporadically for nearly 100 years. However, with the recent advent of new materials and technologies suitable for SSRF, the developmental rate and data concerning SSRF have increased greatly. The main manifestations of these advancements include the improvement of the preoperative localization method by combining CT scanning with three-dimensional reconstruction technology and ultrasound application to accurately locate fractures. The bone fracture plate is specifically used for rib fixation, and the intramedullary fixation devices and special SSRF tools make SSRF relatively simple. The application of 3D printing technology can accurately reproduce the anatomical shape of the fracture site under conditions before operation and combine with the internal fixation of chest wall, especially the thoracoscopy-assisted internal fixation of the chest wall, to achieve the minimally invasive internal fixation of the rib fracture. Absorbable internal fixation materials and thoracoscopic SSRF are considered the primary future research directions.
PubMed: 31205764
DOI: 10.21037/jtd.2019.04.99 -
Pain Physician Jan 2021Twelfth rib syndrome, or slipping of the 12th rib, is an often overlooked cause for chronic chest, back, flank, and abdominal pain from irritation of the 12th... (Review)
Review
BACKGROUND
Twelfth rib syndrome, or slipping of the 12th rib, is an often overlooked cause for chronic chest, back, flank, and abdominal pain from irritation of the 12th intercostal nerve. Diagnosis is clinical and follows the exclusion of other causes of pain. This syndrome is usually accompanied by long-suffering, consequent psychiatric comorbidities, and increased health care costs, which are secondary to the delayed diagnosis.
OBJECTIVES
This manuscript is a review of twelfth rib syndrome and its management options. The review provides etiology, pathophysiology, and epidemiology of twelfth rib syndrome. Additionally, diagnosis and current options for treatment and management are presented.
STUDY DESIGN
This is a narrative review of twelfth rib syndrome.
SETTING
A database review.
METHODS
A PubMed search was conducted to ascertain seminal literature regarding twelfth rib syndrome.
RESULTS
Conservative treatment is usually the first line, including local heat or ice packs, rest, and oral over-the-counter analgesics. Transcutaneous stimulation and 12th intercostal nerve cryotherapy have also been described with some success. Nerve blocks can additionally be tried and are usually effective in the immediate term; there is a paucity of evidence to suggest long-term efficacy. Surgical removal of all or part of the 12th rib and possibly the 11th rib, as well as the next line of therapy, may provide long-lasting relief of pain.
LIMITATIONS
Further large scale clinical studies are needed to assess the most effective management of twelfth rib syndrome.
CONCLUSIONS
Twelfth rib syndrome is usually diagnosed late and causes significant morbidity and suffering. The actual epidemiology is unclear given the difficulty of diagnosis. Nerve blocks and surgical rib resection appear to be effective in treating this syndrome, however, further evidence is required to properly evaluate them. Familiarity with this syndrome is crucial in reaching a prompter diagnosis.
Topics: Chronic Pain; Humans; Intercostal Nerves; Male; Nerve Block; Neuralgia; Pain Management; Ribs; Syndrome
PubMed: 33400437
DOI: No ID Found -
Journal of Thoracic Disease Apr 2019Rib fractures in the setting of trauma carries a high morbidity and mortality. Forty-three percent of patients presenting with trauma will have rib fractures. Fifty-five... (Review)
Review
Rib fractures in the setting of trauma carries a high morbidity and mortality. Forty-three percent of patients presenting with trauma will have rib fractures. Fifty-five percent of patients, greater than 60 years of age, who die following chest trauma, have isolated rib fractures. Mortality associated with rib fractures starts to increase from the age of 45. Rib fixation is being utilised more for the management of rib fractures. Following the review of literature, we propose a pathway for the management of both simple rib fractures and flail segments. Furthermore, we review the various methods of rib fixation, discussing the advantages and disadvantages of each.
PubMed: 31179112
DOI: 10.21037/jtd.2019.03.54 -
Journal of Anatomy Jan 2022The morphology of the rib cage affects both the biomechanics of the upper body's musculoskeletal structure and the respiratory mechanics. This becomes particularly...
The morphology of the rib cage affects both the biomechanics of the upper body's musculoskeletal structure and the respiratory mechanics. This becomes particularly important when evaluating skeletal deformities, as in adolescent idiopathic scoliosis (AIS). The aim of this study was to identify morphological characteristics of the rib cage in relation to the lung in patients with non-deformed and scoliotic spines. Computed tomography data of 40 patients without any visible spinal abnormalities (healthy group) and 21 patients with AIS were obtained retrospectively. All bony structures as well as the right and left lung were reconstructed using image segmentation. Morphological parameters were calculated based on the distances between characteristic morphological landmarks. These parameters included the rib position, length, and area, the rib cage depth and width, and the rib inclination angle on either side, as well as the spinal height and length. Furthermore, we determined the left and right lung volumes, and the area of contact between the rib cage and lung. Differences between healthy and scoliotic spines were statistically analysed using the t-test for unpaired data. The rib cage of the AIS group was significantly deformed in the dorso-ventral and medio-lateral directions. The anatomical proximity of the lung to the ribs was nearly symmetrical in the healthy group. By contrast, within the AIS group, the lung covered a significantly greater area on the left side of the rib cage at large thoracic deformities. Within the levels T1-T6, no significant difference in the rib length, depth to width relationship, or area was observed between the healthy and AIS groups. Inferior to the lung (T7-T12), these parameters exhibited greater variability. The ratio between the width of the rib cage at T6 and the thoracic spinal height (T1-T12) was significantly increased within the thoracic AIS group (1.1 ± 0.08) compared with the healthy group (1.0 ± 0.05). No statistical differences were found between the lung volumes among all the groups. While the rib cage was frequently strongly deformed in the AIS group, the lung and its surrounding ribs appeared to be normally developed. The observed rib hump in AIS appeared to be formed particularly by a more ventral position of the ribs on the concave side. Furthermore, the rib cage width to spinal height ratio suggested that the spinal height of the thoracic AIS-spine is reduced. This indicates that the spine would gain its growth-related height after correcting the spinal deformity. These are the important aspects to consider in the aetiology research and orthopaedic treatment of AIS.
Topics: Adolescent; Humans; Kyphosis; Lung; Retrospective Studies; Rib Cage; Scoliosis; Thoracic Vertebrae
PubMed: 34346505
DOI: 10.1111/joa.13528 -
Journal of Thoracic Disease May 2019The clinical treatment choices for multiple rib fractures and flail chest are controversial. For example, among conservative treatment and surgical treatment, different... (Review)
Review
The clinical treatment choices for multiple rib fractures and flail chest are controversial. For example, among conservative treatment and surgical treatment, different studies have different conclusions and recommendations. Furthermore, early clinical research was mainly focused on the treatment of flail chest due to its severity. Nowadays, the treatment for multiple rib fractures patients without a flail chest is drawing an increased clinical interest. However, we are facing many challenges for the treatment of rib fractures, such as insufficient understanding of the available treatment options, lack of clinical research, lack of the internationally recognized clinical indication for the surgical stabilization of rib fractures (SSRF), and the constant controversies and debates in terms of treatment options, surgery timing, and surgical techniques. All these challenges make it difficult to select the most appropriated clinical decisions for the proper treatment of a rib fracture, resulting in a seriously hindered development of novel rib fractures treatment choices. The concepts and ideas for traditional rib fractures treatment are relatively old, and even have some misunderstandings or errors. With the emergence of more and more research, the understandings of the rib fractures treatment has gradually improved; for example, the benefits provided to patients under the open reductions and internal fixation of fractures treatment. In this article, we outlined the new concepts in rib fractures treatment, which mainly included four parts, damage control, pain management, fixation selection, and quality of life. We hope these concepts help practitioners better manage rib fracture patients.
PubMed: 31205765
DOI: 10.21037/jtd.2019.04.109 -
Journal of Personalized Medicine Feb 2022This study aimed to investigate the effects of tumor-rib distance and dose-dependent rib volume on radiation-induced rib fractures (RIRFs) in patients with breast...
This study aimed to investigate the effects of tumor-rib distance and dose-dependent rib volume on radiation-induced rib fractures (RIRFs) in patients with breast cancer. We retrospectively included 510 women with breast cancer who underwent surgical resection with adjuvant radiotherapy. The tumor-rib distance was measured using preoperative computed tomography (CT) images. Postoperative chest wall thickness and dose-dependent rib volumes, which are absolute rib volumes receiving >20 Gy (V20), 30 Gy (V30), 40 Gy (V40), 45 Gy (V45), and 50 Gy (V50), were measured from the stimulation CT images for radiation treatment planning. We assessed the relationship of RIRF with tumor-rib distance, postoperative chest wall thickness, and dose-dependent rib volumes. Patients with high values of tumor-rib distance and postoperative chest wall thickness had significantly lower risks of RIRF than those with low values. Patients with high values of V20, V30, V40, V45, and V50 had significantly higher risks of RIRF than those with low values. In a multivariate analysis, tumor-rib distance and all five dose-dependent rib volumes, as well as osteoporosis and radiation field, were independent risk factors for RIRF. Tumor-rib distance and dose-dependent rib volume were independent risk factors for RIRF in patients with breast cancer.
PubMed: 35207728
DOI: 10.3390/jpm12020240