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Journal of Thoracic Disease May 2019Geriatric trauma has become an increasingly recognized management concern for trauma centers, and hospitals alike, on a national scale. The population of the United... (Review)
Review
Geriatric trauma has become an increasingly recognized management concern for trauma centers, and hospitals alike, on a national scale. The population of the United States is aging, as life expectancy rates have demonstrated a steady climb to an average of 78.8 years of expected life. With pervasive efforts of medical screening, prevention and chronic medical condition management, more elderly people will lead more active lifestyles and will be more predisposed to injury. As best practice guidelines specific for the geriatric trauma population have yet to be developed, many researchers have identified management strategies that have offset complications and mortality rates inherent to this patient population after injury. The impact of rib fractures in the 65-year and older patient population has been well documented, as have the mortality and pneumonia rates yet, historically, little attention has been directed to curtailing these adverse outcomes with more advanced treatment options. With the advent of rib plating for rib fracture fixation and chest wall stabilization, the practice paradigm for rib fracture management is shifting, as a viable operative intervention now exists. In this review, we focus on the characteristics of the geriatric trauma patient, areas of management where improvement opportunities have been identified, chest wall injury in the elderly patient, rib plating as a treatment option and offer our data to facilitate a better understanding of rib plating's impact in the geriatric trauma patient.
PubMed: 31205759
DOI: 10.21037/jtd.2018.12.16 -
Micromachines Jan 2022This article presents a novel cross-rib micro-channel (MC-CR) heat sink to make fluid self-rotate. For a thermal test chip (TTC) with 100 w/cm, the cross-ribs...
This article presents a novel cross-rib micro-channel (MC-CR) heat sink to make fluid self-rotate. For a thermal test chip (TTC) with 100 w/cm, the cross-ribs micro-channel were compared with the rectangular (MC-R) and horizontal rib micro-channel (MC-HR) heat sinks. The results show that, with the cross-rib micro-channel, the junction temperature of the thermal test chip was 336.49 K, and the pressure drop was 22 kPa. Compared with the rectangular and horizontal ribs heat sink, the cross-rib micro-channel had improvements of 28.6% and 14.3% in cooling capability, but the pressure drop increased by 10.7-fold and 5.5-fold, respectively. Then, the effects of the aspect ratio (λ) of micro-channel in different flow rates were studied. It was found that the aspect ratio and cooling performance were non-linear. To reduce the pressure drop, the inclination (α) and spacing (S) of the cross-ribs were optimized. When α = 30°, S = 0.1 mm, and λ = 4, the pressure drop was reduced from 22 kPa to 4.5 kPa. In addition, the heat dissipation performance of the rectangular, staggered fin (MC-SF), staggered rib (MC-SR) and cross-rib micro-channels were analyzed in the condition of the same pressure drop, MC-CR still has superior heat dissipation performance.
PubMed: 35056296
DOI: 10.3390/mi13010132 -
Journal of Anatomy Aug 2017Elderly populations have a higher risk of rib fractures and other associated thoracic injuries than younger adults, and the changes in body morphology that occur with...
Elderly populations have a higher risk of rib fractures and other associated thoracic injuries than younger adults, and the changes in body morphology that occur with age are a potential cause of this increased risk. Rib centroidal path geometry for 20 627 ribs was extracted from computed tomography (CT) scans of 1042 live adult subjects, then fitted to a six-parameter mathematical model that accurately characterizes rib size and shape, and a three-parameter model of rib orientation within the body. Multivariable regression characterized the independent effect of age, height, weight, and sex on the rib shape and orientation across the adult population, and statistically significant effects were seen from all demographic factors (P < 0.0001). This study reports a novel aging effect whereby both the rib end-to-end separation and rib aspect ratio are seen to increase with age, producing elongated and flatter overall rib shapes in elderly populations, with age alone explaining up to 20% of population variability in the aspect ratio of mid-level ribs. Age was not strongly associated with overall rib arc length, indicating that age effects were related to shape change rather than overall bone length. The rib shape effect was found to be more strongly and directly associated with age than previously documented age-related changes in rib angulation. Other demographic results showed height and sex being most strongly associated with rib size, and weight most strongly associated with rib pump-handle angle. Results from the study provide a statistical model for building rib shapes typical of any given demographic by age, height, weight, and sex, and can be used to help build population-specific computational models of the thoracic rib cage. Furthermore, results also quantify normal population ranges for rib shape parameters which can be used to improve the assessment and treatment of rib skeletal deformity and disease.
Topics: Adult; Aged; Aged, 80 and over; Aging; Female; Humans; Male; Middle Aged; Ribs; Tomography, X-Ray Computed; Young Adult
PubMed: 28612467
DOI: 10.1111/joa.12632 -
European Journal of Trauma and... Aug 2019Rib fixation for flail chest has been shown to improve in-hospital outcome, but little is known about treatment for multiple rib fractures and long-term outcome is...
PURPOSE
Rib fixation for flail chest has been shown to improve in-hospital outcome, but little is known about treatment for multiple rib fractures and long-term outcome is scarce. The aim of this study was to describe the safety, long-term quality of life, and implant-related irritation after rib fixation for flail chest and multiple rib fractures.
METHODS
All adult patients with blunt thoracic trauma who underwent rib fixation for flail chest or multiple rib fractures between January 2010 and December 2016 in our level 1 trauma facility were retrospectively included. In-hospital characteristics and implant removal were obtained via medical records and long-term quality of life was assessed over the telephone.
RESULTS
Of the 864 patients admitted with ≥ 3 rib fractures, 166 (19%) underwent rib fixation; 66 flail chest patients and 99 multiple rib fracture patients with an ISS of 24 (IQR 18-34) and 21 (IQR 16-29), respectively. Overall, the most common complication was pneumonia (n = 58, 35%). Six (9%) patients with a flail chest and three (3%) with multiple rib fractures died, only one because of injuries related to the thorax. On average at 3.9 years, follow-up was obtained from 103 patients (62%); 40 with flail chest and 63 with multiple rib fractures reported an EQ-5D index of 0.85 (IQR 0.62-1) and 0.79 (0.62-0.91), respectively. Forty-eight (48%) patients had implant-related irritation and nine (9%) had implant removal.
CONCLUSIONS
We show that rib fixation is a safe procedure and that patients reported a relative good quality of life. Patients should be counseled that after rib fixation approximately half of the patients will experience implant-related irritation and about one in ten patients requires implant material removal.
Topics: Aged; Conservative Treatment; Female; Flail Chest; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Multiple; Hospitalization; Humans; Male; Middle Aged; Netherlands; Retrospective Studies; Rib Fractures
PubMed: 30229337
DOI: 10.1007/s00068-018-1009-5 -
Frontiers in Bioengineering and... 2023Human body models (HBMs) play a key role in improving modern vehicle safety systems to protect broad populations. However, their geometry is commonly derived from...
Human body models (HBMs) play a key role in improving modern vehicle safety systems to protect broad populations. However, their geometry is commonly derived from single individuals chosen to meet global anthropometric targets, thus their internal anatomy may not fully represent the HBM's target demographic. Past studies show sixth rib cross-sectional geometry differences between HBM ribs and population-derived ribs, and corrections to HBM ribs based on these data have improved HBM's abilities to predict rib fracture locations. We measure and report average and standard deviations (SDs) in rib cross-sectional geometric properties derived from live subject CT scans of 240 adults aged 18-90. Male and female results are given as functions of rib number and rib lengthwise position for ribs 2 through 11. Population means/SDs are reported for measures of rib total area, rib cortical bone area, and rib endosteal area, as well as inertial moment properties of these rib sections. These population corridors are compared between males and females, and against the baseline rib geometries defined in six current HBMs. Total cross-sectional area results found average males ribs to be larger than those of females by between approximately 1-2 SDs depending on rib number and position, and larger in cortical bone cross-sectional area by between 0-1 SDs. Inertial moment ratios showed female ribs being between approximately 0-1 SDs more elongated than male ribs, dependent again on rib number and position. Rib cross-sectional areas from 5 of the 6 HBMs were found to be overly large along substantial portions of most ribs when compared to average population corridors. Similarly, rib aspect ratios in HBMs deviated from average population data by up to 3 SDs in regions towards sternal rib ends. Overall, while most HBMs capture overall trends such as reductions in cross-section along shaft lengths, many also exhibit local variation that deviates from population trends. This study's results provide the first reference values for assessing the cross-sectional geometry of human ribs across a wide range of rib levels. Results also further provide clear guidelines to improve rib geometry definitions present in current HBMs in order to better represent their target demographic.
PubMed: 37284235
DOI: 10.3389/fbioe.2023.1158242 -
European Journal of Radiology Sep 2022The purpose of this study was to evaluate the performance of a deep learning system for the automatic diagnosis and classification of rib fractures.
PURPOSE
The purpose of this study was to evaluate the performance of a deep learning system for the automatic diagnosis and classification of rib fractures.
METHODS
This retrospective study analyzed computed tomography (CT) data of patients diagnosed with a rib fracture between 1 January 2019 and 23 July 2020 in two hospitals, including 591 patients from Suzhou TCM hospital and 75 patients from Jintan TCM hospital. A deep learning system (Dr.Wise@ChestFracture v1.0) based on a convolutional neural network framework was used as a diagnostic tool, and a human-model comparison experiment was designed to compare the diagnostic efficiencies of the deep learning system and radiologists. Furthermore, a secondary classification model was established to distinguish the different types of fracture. First, a classification model to differentiate between fresh and old fractures was developed. Second, a submodel to determine any misalignment in fresh fractures was established.
RESULTS
For all fracture types, the detection efficiency (recall) of the system was statistically significantly better than that of radiologists with different levels of experience (all p < 0.0167 except for senior radiologists). The F1-score of the system for diagnosing rib fractures was similar to that of the radiologists. The system was much faster than the radiologists in assessing rib fractures (all p < 0.0167). The two classification models can distinguish between fresh and old fractures (accuracy = 87.63%) and determine whether there is any misalignment in fresh fractures (accuracy = 95.22%) or not.
CONCLUSION
The use of a deep learning system can accurately, automatically, and rapidly diagnose and classify rib fractures, helping doctors improve the diagnostic efficiency and reducing their workload. The classification models can distinguish different types of rib fracture well.
Topics: Deep Learning; Humans; Neural Networks, Computer; Retrospective Studies; Rib Fractures; Tomography, X-Ray Computed
PubMed: 35797792
DOI: 10.1016/j.ejrad.2022.110434 -
Frontiers in Bioengineering and... 2020The effects of segmental length as well as anterior rib cage and costovertebral joint integrity on thoracic spinal stability have not been extensively investigated, but...
The effects of segmental length as well as anterior rib cage and costovertebral joint integrity on thoracic spinal stability have not been extensively investigated, but are essential for the calibration and validation of numerical models of the thoracic spine and rib cage. The aim of the study was to quantify these effects by experiments. Eight human thoracic spine specimens (C7-L1) including the rib cage were loaded with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation while tracking the motions of all functional spinal units. Specimens were tested stepwise in four different conditions: (1) In the intact condition, (2) after cutting all anterior rib-to-rib connections, (3) after partitioning the polysegmental specimens into monosegmental specimens, and (4) after removing the ribs in the monosegmental condition. Significant increases of the range of motion ( < 0.05) were especially found at the segmental levels of the upper half of the thoracic spine in all motion planes and for all resection steps, particularly in axial rotation, while the stabilizing effects of the structures decreased in inferior direction. Partitioning of polysegmental specimens into monosegmental specimens primarily affected the stability in lateral bending, while the effects of resection were generally lowest in flexion/extension. Presence of the ribs, anterior rib cage integrity, and segmental length all affect the thoracic spinal stability and have therefore to be considered in the calibration process of numerical models of the thoracic spine and rib cage.
PubMed: 32117927
DOI: 10.3389/fbioe.2020.00046 -
Journal of Thoracic Disease Apr 2017Rib fractures are a common and highly morbid finding in patients with blunt chest trauma. Over the past decade, a renewed interest in (and instrumentation for) rib... (Review)
Review
Rib fractures are a common and highly morbid finding in patients with blunt chest trauma. Over the past decade, a renewed interest in (and instrumentation for) rib fixation in this cohort has occurred. Stabilization of the chest wall in this setting, particularly when a flail segment is present, is associated with significant reductions in the rates of respiratory failure, pneumonia, ICU stay, and mortality. Thoracic surgeons should remain actively involved in this evolving area of our specialty to further optimize patient outcomes.
PubMed: 28446987
DOI: 10.21037/jtd.2017.04.05 -
The Journal of Manual & Manipulative... Jun 2021First rib dysfunction is a possible cause of symptoms in patients with neck and/or shoulder pain.
BACKGROUND
First rib dysfunction is a possible cause of symptoms in patients with neck and/or shoulder pain.
OBJECTIVES
To explore therapists' perceptions of useful diagnostic criteria to identify first rib dysfunction.
METHODS
A Delphi survey over four rounds involving international manual therapy experts who were asked to agree on which items were most useful in identifying first rib dysfunction.
RESULTS
Consensus (>70% agreement) was reached on key aspects of first rib dysfunction being first rib mobility restriction, upper limb symptom distribution, and a subclassification into two subgroups was suggested. The main clinical findings suggested were: painful and restricted neck movements and shoulder girdle loading activities; positive Upper Limb Neural Test 1; direct palpation of first rib, neural structures, and scalene muscles; pain and hypomobility of first rib accessory movements with improvement after mobilization. The cervical rotation lateral-flexion test was considered a useful, although not widely used test among the experts. Its diagnostic accuracy and interpretation in isolation was questioned.
CONCLUSIONS
This Delphi study produced a cluster of clinical tests aimed to identify first rib dysfunction in patients with neck and/or shoulder conditions. However, these need to be tested out in further research to establish reliability and validity.
Topics: Humans; Neck; Range of Motion, Articular; Reproducibility of Results; Ribs; Shoulder Pain
PubMed: 32956019
DOI: 10.1080/10669817.2020.1824470 -
Chinese Journal of Traumatology =... Aug 2017Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical... (Comparative Study)
Comparative Study
PURPOSE
Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography (USG) has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography.
METHODS
In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior (PA) chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared.
RESULTS
Sixty-one suspected patients were assessed. The male to female ratio was 2.4:1 (43 men and 18 women) with a mean ± SD age of (44.3 ± 19.7) years. There were totally 59 rib fractures in 38 (62.3%) patients based on radiography and USG, while 23 (37.7%) patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 (54.1%) of 61 suspected patients and radiographs revealed 32 rib fractures in 20 (32.8%) of 61 patients. A total of 58 (98.3%) rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 (45.8%) and 24 (40.7%) rib fractures, respectively. The average duration of USG was (12 ± 3) min (range 7-17 min), whereas the duration of radiography was (27 ± 6) min (range 15-37 min). The kappa coefficient showed a low level of agreement between both USG and PA chest radiography (kappa coefficient = 0.28), and between USG and oblique rib view (kappa coefficient = 0.32).
CONCLUSION
USG discloses more fractures than radiography in most patients presenting with suspected rib fractures. Moreover USG requires significantly less time than radiography.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Rib Fractures; Ultrasonography; Young Adult
PubMed: 28687342
DOI: 10.1016/j.cjtee.2016.04.010