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Trials Dec 2019An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery. This study explored its effect on lung function and pulmonary complication rates in patients with rib fractures.
METHODS
Between June 2014 and May 2017, 50 adult patients with traumatic rib fractures were prospectively investigated. Patients who were unconscious, had a history of chronic obstructive pulmonary disease or asthma, or an Injury Severity Score (ISS) ≥ 16 were excluded. Patients were randomly divided into a study group (n = 24), who underwent IS therapy, and a control group (n = 26). All patients received the same analgesic protocol. Chest X-rays and pulmonary function tests (PFTs) were performed on the 5th and 7th days after trauma.
RESULTS
The groups were considered demographically homogeneous. The mean age was 55.2 years and 68% were male. Mean pretreatment ISSs and mean number of ribs fractured were not significantly different (8.23 vs. 8.08 and 4 vs. 4, respectively). Of 50 patients, 28 (56%) developed pulmonary complications, which were more prevalent in the control group (80.7% vs. 29.2%; p = 0.001). Altogether, 25 patients had delayed hemothorax, which was more prevalent in the control group (69.2% vs. 29.2%; p = 0.005). Two patients in the control group developed atelectasis, one patient developed pneumothorax, and five patients required thoracostomy. PFT results showed decreased forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV) in the control group. Comparing pre- and posttreatment FVC and FEV, the study group had significantly greater improvements (p < 0.001).
CONCLUSIONS
In conclusion, the use of an IS reduced pulmonary complications and improved PFT results in patients with rib fractures. The IS is a cost-effective device for patients with rib fractures and its use has clinical benefits without harmful effects.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT04006587. Registered on 3 July 2019.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Forced Expiratory Volume; Hemothorax; Humans; Length of Stay; Lung; Male; Middle Aged; Pneumothorax; Prospective Studies; Pulmonary Atelectasis; Rib Fractures; Spirometry; Thoracotomy; Treatment Outcome; Vital Capacity; Young Adult
PubMed: 31888765
DOI: 10.1186/s13063-019-3943-x -
BMC Cancer Apr 2023The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated...
BACKGROUND
The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated with an increased risk of osteoradionecrosis-induced rib fracture. We aimed to (1) evaluate potential clinical, demographic, and procedure-related risk factors for rib fractures and (2) describe the radiographic features of post-SBRT rib fractures.
METHODS
We retrospectively identified 106 patients who received SBRT between 2015 and 2018 for a primary or metastatic lung tumor with at least 12 months of follow up. Exclusion criteria were incomplete records, previous ipsilateral thoracic radiation, or relevant prior trauma. Computed tomography (CT) images were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was employed to determine clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location).
RESULTS
A total of 106 patients with 111 treated tumors met the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total fractured ribs). The highest number of fractured ribs per patient was five. Multivariate regression identified posterolateral tumor location as the only independent risk factor for rib fracture. On CT, fractures showed discontinuity between healing edges in 77% of affected patients.
CONCLUSIONS
Nearly one third of patients receiving SBRT for lung tumors experienced rib fractures, 34% of whom experienced pain. Many patients developed multiple fractures. Post-SBRT fractures demonstrated a unique discontinuity between the healing edges of the rib, a distinct feature of post-SBRT rib fractures. The only independent predictor of rib fracture was tumor location along the posterolateral chest wall. Given its increasing frequency of use, describing the risk profile of SBRT is vital to ensure patient safety and adequately inform patient expectations.
Topics: Humans; Rib Fractures; Radiosurgery; Retrospective Studies; Lung Neoplasms; Thoracic Wall
PubMed: 37046249
DOI: 10.1186/s12885-023-10776-8 -
Fa Yi Xue Za Zhi Aug 2023The artificial intelligence-aided diagnosis model of rib fractures based on YOLOv3 algorithm was established and applied to practical case to explore the application...
OBJECTIVES
The artificial intelligence-aided diagnosis model of rib fractures based on YOLOv3 algorithm was established and applied to practical case to explore the application advantages in rib fracture cases in forensic medicine.
METHODS
DICOM format CT images of 884 cases with rib fractures caused by thoracic trauma were collected, and 801 of them were used as training and validation sets. A rib fracture diagnosis model based on YOLOv3 algorithm and Darknet53 as the backbone network was built. After the model was established, 83 cases were taken as the test set, and the precision rate, recall rate, 1-score and radiology interpretation time were calculated. The model was used to diagnose a practical case and compared with manual diagnosis.
RESULTS
The established model was used to test 83 cases, the fracture precision rate of this model was 90.5%, the recall rate was 75.4%, 1-score was 0.82, the radiology interpretation time was 4.4 images per second and the identification time of each patient's data was 21 s, much faster than manual diagnosis. The recognition results of the model was consistent with that of the manual diagnosis.
CONCLUSIONS
The rib fracture diagnosis model in practical case based on YOLOv3 algorithm can quickly and accurately identify fractures, and the model is easy to operate. It can be used as an auxiliary diagnostic technique in forensic clinical identification.
Topics: Humans; Rib Fractures; Artificial Intelligence; Thoracic Injuries; Algorithms; Radiography; Retrospective Studies
PubMed: 37859472
DOI: 10.12116/j.issn.1004-5619.2023.230308 -
The British Journal of Radiology Jun 2023To evaluate the performance and robustness of a deep learning-based automatic fresh rib fracture detection and positioning system (FRF-DPS).
OBJECTIVE
To evaluate the performance and robustness of a deep learning-based automatic fresh rib fracture detection and positioning system (FRF-DPS).
METHODS
CT scans of 18,172 participants admitted to eight hospitals from June 2009 to March 2019 were retrospectively collected. Patients were divided into development set (14,241), multicenter internal test set (1612), and external test set (2319). In internal test set, sensitivity, false positives (FPs) and specificity were used to assess fresh rib fracture detection performance at the lesion- and examination-levels. In external test set, the performance of detecting fresh rib fractures by radiologist and FRF-DPS were evaluated at lesion, rib, and examination levels. Additionally, the accuracy of FRF-DPS in rib positioning was investigated by the ground-truth labeling.
RESULTS
In multicenter internal test set, FRF-DPS showed excellent performance at the lesion- (sensitivity: 0.933 [95%CI, 0.916-0.949], FPs: 0.50 [95%CI, 0.397-0.583]) and examination-level. In external test set, the sensitivity and FPs at the lesion-level of FRF-DPS (0.909 [95%CI, 0.883-0.926], < 0.001; 0.379 [95%CI, 0.303-0.422], = 0.001) were better than the radiologist (0.789 [95%CI, 0.766-0.807]; 0.496 [95%CI, 0.383-0.571]), so were the rib- and patient-levels. In subgroup analysis of CT parameters, FRF-DPS were robust (0.894-0.927). Finally, FRF-DPS(0.997 [95%CI, 0.992-1.000], < 0.001) is more accurate than radiologist (0.981 [95%CI, 0.969-0.996]) in rib positioning and takes 20 times less time.
CONCLUSION
FRF-DPS achieved high detection rate of fresh rib fractures with low FP values, and precise positioning of ribs, thus can be used in clinical practice to improve the detection rate and work efficiency.
ADVANCES IN KNOWLEDGE
We developed the FRF-DPS system which can detect fresh rib fractures and rib position, and evaluated by a large amount of multicenter data.
Topics: Humans; Rib Fractures; Deep Learning; Retrospective Studies; Sensitivity and Specificity; Ribs
PubMed: 36972072
DOI: 10.1259/bjr.20221006 -
European Journal of Trauma and... Dec 2021Rib fractures (RF) occur in 10% of trauma patients; associated with significant morbidity and mortality. Despite advancing technology of surgical stabilization of rib...
PURPOSE
Rib fractures (RF) occur in 10% of trauma patients; associated with significant morbidity and mortality. Despite advancing technology of surgical stabilization of rib fractures (SSRF), treatment and indications remain controversial. Lack of displacement is often cited as a reason for non-operative management. The purpose was to examine RF patterns hypothesizing RF become more displaced over time.
METHODS
Retrospective review of all RF patients from 2016-2017 at our institution. Patients with initial chest CT (CT1) followed by repeat CT (CT2) within 84 days were included. Basic demographics were obtained. Primary outcomes included RF displacement in millimeters (mm) between CT1 and CT2 in three planes (AP = anterior/posterior, O = overlap/gap, and SI = superior/inferior). Displacement was calculated by subtracting CT1 fracture displacement from CT2 displacement for each rib. Given anatomic and clinical characteristics, ribs were grouped (1-2, 3-6, 7-10, 11-12), averaged, and analyzed for displacement. Secondary outcome included number of missed RF on CT1. Non-parametric sign test and paired t test were used for analysis. Significance was set at p < 0.002.
RESULTS
78 of 477 patients with RF on CT1 had CT2 during the study period: primarily male (76%) and age 55.8 ± 20.1 with blunt mechanism of injury (99%). Median Injury Severity Score was 21 (IQR, 13-27) with Chest Abbreviated Injury Score of 3 (IQR, 3-4). Median time between CT1 and CT2 was 6 days (IQR, 3-12). Missed RF rate for CT1 was 10.1% (p = 0.11). Average fracture displacement was significantly increased for all rib groupings except 11-12 in all planes (p < 0.002).
CONCLUSION
RF become more displaced over time. Pain regimens and SSRF considerations should be adjusted accordingly.
Topics: Adult; Aged; Humans; Injury Severity Score; Male; Middle Aged; Retrospective Studies; Rib Fractures; Ribs; Thoracic Injuries
PubMed: 32219487
DOI: 10.1007/s00068-020-01353-w -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Apr 2022The aim of this study was to determine the effect of the presence of rib fracture on mortality and morbidity in blunt thoracic trauma (BTT).
BACKGROUND
The aim of this study was to determine the effect of the presence of rib fracture on mortality and morbidity in blunt thoracic trauma (BTT).
METHODS
Records of patients aged over 18 and admitted with BTT between January 2017 and October 2019 dates were ret-rospectively evaluated. Only patients with both BTT and rib fracture were included in the study. Age, gender, trauma mechanism, additional organ injuries, and need for intensive care unit of patients were identified. The total length of hospital stay, length of stay in the intensive care unit, treatment modalities, need for mechanical ventilator; blood and blood products, complications, and mortality rates for patients were recorded.
RESULTS
One hundred eighty-six (73.8%) and 66 (26.2%) of 252 included patients were male and female, respectively. The most commonly seen trauma mechanism was motor vehicle accidents (51.4%). The mean age of patients was 52±12 (18-91). We identified that there was a significant association between hemothorax and non-thoracic additional organ injuries (p=0.024). There was no significant association between pneumothorax and additional organ injuries (p=0.067). The number of fractured ribs was significantly different between cases with and without hemothorax (p<0.001). There was also a significant difference between cases with and without pneumothorax in terms of the number of broken ribs (p<0.039). There was a significant difference between cases undergone thoracotomy and cases who did not undergo thoracotomy in terms of mean length of stay in the hospital (p<0.001). There was a positive correlation between the number of broken ribs and length of stay in the hospital (r=320, p<0.001).
CONCLUSION
Increased number of rib fracture in BTTs increases morbidity and length of stay in the hospital.
Topics: Aged; Female; Hemothorax; Humans; Male; Morbidity; Pneumothorax; Rib Fractures; Wounds, Nonpenetrating
PubMed: 35485510
DOI: 10.14744/tjtes.2020.55710 -
Computational and Mathematical Methods... 2022Rib fractures are common injuries caused by chest trauma, which may cause serious consequences. It is essential to diagnose rib fractures accurately. Low-dose thoracic...
Rib fractures are common injuries caused by chest trauma, which may cause serious consequences. It is essential to diagnose rib fractures accurately. Low-dose thoracic computed tomography (CT) is commonly used for rib fracture diagnosis, and convolutional neural network- (CNN-) based methods have assisted doctors in rib fracture diagnosis in recent years. However, due to the lack of rib fracture data and the irregular, various shape of rib fractures, it is difficult for CNN-based methods to extract rib fracture features. As a result, they cannot achieve satisfying results in terms of accuracy and sensitivity in detecting rib fractures. Inspired by the attention mechanism, we proposed the CFSG U-Net for rib fracture detection. The CSFG U-Net uses the U-Net architecture and is enhanced by a dual-attention module, including a channel-wise fusion attention module (CFAM) and a spatial-wise group attention module (SGAM). CFAM uses the channel attention mechanism to reweight the feature map along the channel dimension and refine the U-Net's skip connections. SGAM uses the group technique to generate spatial attention to adjust feature maps in the spatial dimension, which allows the spatial attention module to capture more fine-grained semantic information. To evaluate the effectiveness of our proposed methods, we established a rib fracture dataset in our research. The experimental results on our dataset show that the maximum sensitivity of our proposed method is 89.58%, and the average FROC score is 81.28%, which outperforms the existing rib fracture detection methods and attention modules.
Topics: Humans; Image Processing, Computer-Assisted; Neural Networks, Computer; Rib Fractures; Tomography, X-Ray Computed
PubMed: 36035283
DOI: 10.1155/2022/8945423 -
The British Journal of Radiology Feb 2021To investigate the impact of deep learning (DL) on radiologists' detection accuracy and reading efficiency of rib fractures on CT.
OBJECTIVES
To investigate the impact of deep learning (DL) on radiologists' detection accuracy and reading efficiency of rib fractures on CT.
METHODS
Blunt chest trauma patients ( = 198) undergoing thin-slice CT were enrolled. Images were read by two radiologists (R1, R2) in three sessions: S1, unassisted reading; S2, assisted by DL as the concurrent reader; S3, DL as the second reader. The fractures detected by the readers and total reading time were documented. The reference standard for rib fractures was established by an expert panel. The sensitivity and false-positives per scan were calculated and compared among S1, S2, and S3.
RESULTS
The reference standard identified 865 fractures on 713 ribs (102 patients) The sensitivity of S1, S2, and S3 was 82.8, 88.9, and 88.7% for R1, and 83.9, 88.7, and 88.8% for R2, respectively. The sensitivity of S2 and S3 was significantly higher compared to S1 for both readers (all < 0.05). The sensitivity between S2 and S3 did not differ significantly (both > 0.9). The false-positive per scan had no difference between sessions for R1 ( = 0.24) but was lower for S2 and S3 than S1 for R2 (both < 0.05). Reading time decreased by 36% (R1) and 34% (R2) in S2 compared to S1.
CONCLUSIONS
Using DL as a concurrent reader can improve the detection accuracy and reading efficiency for rib fracture.
ADVANCES IN KNOWLEDGE
DL can be integrated into the radiology workflow to improve the accuracy and reading efficiency of CT rib fracture detection.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Deep Learning; Female; Humans; Male; Middle Aged; Observer Variation; Radiographic Image Interpretation, Computer-Assisted; Reproducibility of Results; Retrospective Studies; Rib Fractures; Ribs; Sensitivity and Specificity; Tomography, X-Ray Computed; Young Adult
PubMed: 33332979
DOI: 10.1259/bjr.20200870 -
Fa Yi Xue Za Zhi Oct 2021
Topics: Humans; Rib Fractures; Thoracic Injuries
PubMed: 35191253
DOI: 10.12116/j.issn.1004-5619.2020.200302 -
Injury Jul 2024Rib fracture non-union is an uncommon complication of traumatic rib fractures. Our objective was to perform a scoping review of the literature for the management of rib... (Review)
Review
OBJECTIVE
Rib fracture non-union is an uncommon complication of traumatic rib fractures. Our objective was to perform a scoping review of the literature for the management of rib fracture non-union. This included analysis of the variations in surgical technique, complications experienced, and reported outcomes.
METHODS
We conducted a scoping review and searched databases (MEDLINE, CINAHL, and Embase). We performed abstract and full-text screening, and abstracted data related to pre-operative assessment, surgical technique, complications, and reported outcome measures.
RESULTS
We included 29 articles of which 19 were case reports and 10 were case series. The data quality was generally heterogeneous. The studies included 229 patients and the commonest symptoms of rib fracture non-union included chest pain, clicking, dyspnea and deformities. The patients underwent surgical management of rib fracture non-union (excluding first rib fractures) using various techniques. The majority used surgical stabilization of rib fracture with or without a graft. The reported outcomes were inconsistent between studies, but showed high rates of union (>94 %), reduction in reported VAS scores, and improved return to work when included. Implant failure occurred in 10 % of the 229 total patients reported in our studies, the re-operation rate was 13 %, and the overall complication rate was 27 %.
CONCLUSION
Surgical management of rib fracture non-union often involving locking plates and screws with or without a graft has been shown in several case reports and series as an effective treatment with acceptable implant failure and complication rates. Surgical management is therefore a viable option for symptomatic patients. Further research is required to determine optimal management strategies that further reduce surgical complications for these patients.
Topics: Humans; Rib Fractures; Fractures, Ununited; Fracture Fixation, Internal; Fracture Healing; Treatment Outcome; Reoperation
PubMed: 38762403
DOI: 10.1016/j.injury.2024.111553