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Journal of Orthopaedic Surgery and... Feb 2024This study aimed to determine the incidence and influencing factors of venous thromboembolism (VTE) in patients with traumatic rib fractures.
BACKGROUND
This study aimed to determine the incidence and influencing factors of venous thromboembolism (VTE) in patients with traumatic rib fractures.
METHODS
The retrospective study analyzed medical records of patients with traumatic rib fractures from 33 hospitals.
RESULTS
The overall incidence of VTE in hospitalized patients with traumatic rib fractures was 8.1%. Patients with isolated traumatic rib fractures had a significantly lower incidence of VTE (4.4%) compared to patients with rib fractures combined with other injuries (12.0%). Multivariate analysis identified the number of rib fractures as an independent risk factor for thrombosis. Surgical stabilization of isolated rib fractures involving three or more ribs was associated with a lower VTE incidence compared to conservative treatment.
CONCLUSIONS
Patients with rib fractures have a higher incidence of VTE, positively correlated with the number of rib fractures. However, the occurrence of thrombosis is relatively low in isolated rib fractures. Targeted thromboprophylaxis strategies should be implemented for these patients, and surgical stabilization of rib fractures may be beneficial in reducing the risk of VTE.
Topics: Humans; Venous Thromboembolism; Rib Fractures; Anticoagulants; Incidence; Retrospective Studies; Risk Factors; Ribs; Thrombosis
PubMed: 38395963
DOI: 10.1186/s13018-024-04622-1 -
Injury May 2024Rib fracture nonunion is a probable cause of chronic pain following chest trauma, although its prevalence remains unknown. The aims of this study were to determine rib...
Radiographic rib fracture nonunion and association with fracture classification in adults with multiple rib fractures without flail segment: A multicenter prospective cohort study.
BACKGROUND
Rib fracture nonunion is a probable cause of chronic pain following chest trauma, although its prevalence remains unknown. The aims of this study were to determine rib fracture nonunion prevalence following nonoperative management and to determine if presence of nonunion was associated with the number of rib fractures, or the rib fracture classification of anatomical location, type, and displacement.
METHODS
This multicenter prospective cohort study included trauma patients with three or more fractured ribs but without a flail segment, who participated in the nonoperative management group of the FixCon trial between January 2019 and June 2022. The number and classification of rib fractures were assessed on trauma chest CT. Chest CTs conducted six months post-trauma were evaluated for the presence of nonunion. Radiological characteristics of nonunions were compared with normally healed rib fractures using the Mann-Whitney U, χ test, and Fisher's exact test as appropriate. A generalized linear model adjusted for multiple observations per patient when assessing the associations between nonunion and fracture characteristics.
RESULTS
A total of 68 patients were included with 561 post-traumatic fractures in 429 ribs. Chest CT after six months revealed nonunions in 67 (12 %) rib fractures in 29 (43 %) patients with a median of 2 (P-P 1-3) nonunions per patient. Nonunion was most commonly observed in ribs seven to 10 (20-23 %, p < 0.001, adjusted p = 0.006). Nonunion occurred in 14 (5 %) undisplaced, 22 (19 %) offset, and 20 (23 %) displaced rib fractures (p < 0.001). No statistically significant association between rib fracture type and nonunion was found.
CONCLUSIONS
Forty-three percent of patients with multiple rib fractures had radiographic nonunion six months after trauma. Fractures in ribs seven to 10 and dislocated fractures had an increased risk of rib fracture nonunion.
Topics: Adult; Humans; Rib Fractures; Prospective Studies; Flail Chest; Thoracic Injuries; Fractures, Ununited; Ribs; Retrospective Studies; Fracture Fixation, Internal
PubMed: 38290909
DOI: 10.1016/j.injury.2024.111335 -
Clinical Radiology Apr 2022To evaluate the value and limitations of computed tomography (CT) diagnosis of rib fractures, and to discuss the characteristics of missed rib fractures.
Diagnostic value and limitations of CT in detecting rib fractures and analysis of missed rib fractures: a study based on early CT and follow-up CT as the reference standard.
AIM
To evaluate the value and limitations of computed tomography (CT) diagnosis of rib fractures, and to discuss the characteristics of missed rib fractures.
MATERIALS AND METHODS
One hundred and sixty chest trauma patients who underwent both early CT (within 48 h) and follow-up CT (14 days later) were enrolled. For early CT examinations, the diagnosis of rib fractures was divided into routine assessment and verification assessment. The detection rates of rib fractures in both patterns were calculated, and the characteristics of missed rib fractures were analysed, based on the imaging results of the twice CT examinations as the reference standard.
RESULTS
A total of 584 fracture sites were confirmed. The overall detection rate of rib fractures in the routine assessment method was 72.4%. In the verification assessment, the detection rates of rib fractures of four observation strategies (axial images, multiplanar reconstruction [MPR], axial images + volume reconstruction [VR] and MPR + VR) were 76.2%, 79.1%, 78.6%, 80.8%, respectively. The incidence of occult fractures was 19.2% (112/584). In both assessment methods, the detection rates of rib fractures at the costochondral junction were the lowest (60%, 65%, respectively); the detection rates ranged from 63.6% to 74.7% for non-displaced rib fractures, but 100% for displaced rib fractures. Most (78.9%) missed rib fractures were accompanied by visible fractures on the same or adjacent first to second rib.
CONCLUSIONS
Most missed rib fractures are occult on early CT, which is attributable to the limitations of the CT technique. The number of displaced rib fractures on early CT is a more stable and reliable clinical indicator.
Topics: Follow-Up Studies; Humans; Reference Standards; Rib Fractures; Ribs; Tomography, X-Ray Computed
PubMed: 35164929
DOI: 10.1016/j.crad.2022.01.035 -
Korean Journal of Radiology Jul 2020To evaluate the performance of a convolutional neural network (CNN) model that can automatically detect and classify rib fractures, and output structured reports from...
OBJECTIVE
To evaluate the performance of a convolutional neural network (CNN) model that can automatically detect and classify rib fractures, and output structured reports from computed tomography (CT) images.
MATERIALS AND METHODS
This study included 1079 patients (median age, 55 years; men, 718) from three hospitals, between January 2011 and January 2019, who were divided into a monocentric training set (n = 876; median age, 55 years; men, 582), five multicenter/multiparameter validation sets (n = 173; median age, 59 years; men, 118) with different slice thicknesses and image pixels, and a normal control set (n = 30; median age, 53 years; men, 18). Three classifications (fresh, healing, and old fracture) combined with fracture location (corresponding CT layers) were detected automatically and delivered in a structured report. Precision, recall, and F1-score were selected as metrics to measure the optimum CNN model. Detection/diagnosis time, precision, and sensitivity were employed to compare the diagnostic efficiency of the structured report and that of experienced radiologists.
RESULTS
A total of 25054 annotations (fresh fracture, 10089; healing fracture, 10922; old fracture, 4043) were labelled for training (18584) and validation (6470). The detection efficiency was higher for fresh fractures and healing fractures than for old fractures (F1-scores, 0.849, 0.856, 0.770, respectively, = 0.023 for each), and the robustness of the model was good in the five multicenter/multiparameter validation sets (all mean F1-scores > 0.8 except validation set 5 [512 × 512 pixels; F1-score = 0.757]). The precision of the five radiologists improved from 80.3% to 91.1%, and the sensitivity increased from 62.4% to 86.3% with artificial intelligence-assisted diagnosis. On average, the diagnosis time of the radiologists was reduced by 73.9 seconds.
CONCLUSION
Our CNN model for automatic rib fracture detection could assist radiologists in improving diagnostic efficiency, reducing diagnosis time and radiologists' workload.
Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Feasibility Studies; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Neural Networks, Computer; ROC Curve; Rib Fractures; Thorax; Tomography, X-Ray Computed; Young Adult
PubMed: 32524787
DOI: 10.3348/kjr.2019.0651 -
Scientific Reports May 2022Artificial intelligence algorithms utilizing deep learning are helpful tools for diagnostic imaging. A deep learning-based automatic detection algorithm was developed...
Artificial intelligence algorithms utilizing deep learning are helpful tools for diagnostic imaging. A deep learning-based automatic detection algorithm was developed for rib fractures on computed tomography (CT) images of high-energy trauma patients. In this study, the clinical effectiveness of this algorithm was evaluated. A total of 56 cases were retrospectively examined, including 46 rib fractures and 10 control cases from our hospital, between January and June 2019. Two radiologists annotated the fracture lesions (complete or incomplete) for each CT image, which is considered the "ground truth." Thereafter, the algorithm's diagnostic results for all cases were compared with the ground truth, and the sensitivity and number of false positive (FP) results per case were assessed. The radiologists identified 199 images with a fracture. The sensitivity of the algorithm was 89.8%, and the number of FPs per case was 2.5. After additional learning, the sensitivity increased to 93.5%, and the number of FPs was 1.9 per case. FP results were found in the trabecular bone with the appearance of fracture, vascular grooves, and artifacts. The sensitivity of the algorithm used in this study was sufficient to aid the rapid detection of rib fractures within the evaluated validation set of CT images.
Topics: Algorithms; Artificial Intelligence; Humans; Retrospective Studies; Rib Fractures; Technology; Tomography, X-Ray Computed
PubMed: 35589847
DOI: 10.1038/s41598-022-12453-5 -
Journal of the Mechanical Behavior of... Jun 2020To enable analysis of the risk of occupants sustaining rib fractures in a crash, generic finite element models of human ribs, one through twelve, were developed. The...
Generic finite element models of human ribs, developed and validated for stiffness and strain prediction - To be used in rib fracture risk evaluation for the human population in vehicle crashes.
To enable analysis of the risk of occupants sustaining rib fractures in a crash, generic finite element models of human ribs, one through twelve, were developed. The generic ribs representing an average sized male, were created based on data from several sources and publications. The generic ribs were validated for stiffness and strain predictions in anterior-posterior bending. Essentially, both predicted rib stiffness and rib strain, measured at six locations, were within one standard deviation of the average result in the physical tests. These generic finite elements ribs are suitable for strain-based rib fracture risk predictions, when loaded in anterior-posterior bending. To ensure that human variability is accounted for in future studies, a rib parametric study was conducted. This study shows that the rib cross-sectional height, i.e., the smallest of the cross-sectional dimensions, accounted for most of the strain variance during anterior-posterior loading of the ribs. Therefore, for future rib fracture risk predictions with morphed models of the human thorax, it is important to accurately address rib cross-sectional height.
Topics: Accidents, Traffic; Biomechanical Phenomena; Cross-Sectional Studies; Finite Element Analysis; Humans; Male; Rib Fractures; Ribs; Risk Assessment
PubMed: 32250953
DOI: 10.1016/j.jmbbm.2020.103742 -
Annals of the Royal College of Surgeons... Mar 1974
Topics: Accidents, Traffic; Cough; Cyanosis; Diaphragm; Emphysema; Hemothorax; Humans; Lung Diseases; Methods; Pneumothorax; Radiography; Rib Fractures; Thoracic Injuries; Unconsciousness
PubMed: 4817125
DOI: No ID Found -
British Medical Journal Dec 1951
Topics: Cough; Humans; Pleurisy; Respiration Disorders; Rib Fractures; Ribs
PubMed: 14886632
DOI: 10.1136/bmj.2.4746.1492 -
The Journal of Surgical Research Dec 2021Previous studies suggest that patients with multiple rib fractures have poor outcomes, but it is unknown how isolated single rib fractures (SRF) are associated with...
PURPOSE
Previous studies suggest that patients with multiple rib fractures have poor outcomes, but it is unknown how isolated single rib fractures (SRF) are associated with morbidity or mortality. We hypothesized that patients with poor outcomes after SRF can be identified by demographics and comorbidities. The purpose of this study was to model adverse outcome after single rib fractures.
MATERIALS AND METHODS
We used the 2016 National Inpatient Sample to identify patients with SRF associated with blunt trauma using ICD-10 coding. Comorbidities and abbreviated injury score (AIS) were also extracted. Patients with non-chest trauma were excluded. The primary outcome was an adverse composite outcome of death, pneumonia, tracheostomy, or hospitalization longer than twelve days. One-third of the cohort was reserved for validation. Backward selection multivariable modeling identified factors associated with adverse composite outcome. The model was used to create a nomogram to predict adverse composite outcome. The nomogram was then tested using the validation cohort.
RESULTS
2,398 patients with isolated SRF were divided into training (n = 1,598) and validation sets (n = 800). The average age was 69 and the majority were male (66%) and received care at academic institutions (61.6%). The adverse composite outcome occurred in 20.8%: 61 deaths (2.5%), 67 tracheostomies (2.8%), 319 pneumonias (13.3%), and 165 patients with hospital length of stay greater than twelve days (6.9%). Results of stepwise multivariable modeling had a C-statistic of 0.700. The multivariable model was used to create a nomogram which had a c-statistic of 0.672 in the validation cohort.
CONCLUSION
20% of isolated SRF patients had an adverse outcome. Demographics and comorbidities can be used to identify and triage high-risk patients for specialized care and proper counseling.
Topics: Aged; Female; Humans; Injury Severity Score; Length of Stay; Male; Morbidity; Retrospective Studies; Rib Fractures; Wounds, Nonpenetrating
PubMed: 34329822
DOI: 10.1016/j.jss.2021.06.048 -
BMC Emergency Medicine Mar 2023The disadvantages and complications of computed tomography (CT) can be minimized if CT is performed in rib fracture patients with high probability of intra-thoracic and... (Observational Study)
Observational Study
BACKGROUND
The disadvantages and complications of computed tomography (CT) can be minimized if CT is performed in rib fracture patients with high probability of intra-thoracic and intra-abdominal injuries and CT is omitted in rib fracture patients with low probability of intra-thoracic and intra-abdominal injuries. This study aimed to evaluate the factors that can identify patients with rib fractures with intra-thoracic and intra-abdominal injuries in the emergency department among patients with rib fracture.
METHODS
This retrospective observational study included adult patients (age ≥ 18 years) diagnosed with rib fracture on chest radiography prior to chest CT due to blunt chest trauma in the emergency department who underwent chest CT from January 2016 to February 2021. The primary outcomes were intra-thoracic and intra-abdominal injuries that could be identified on a chest CT. Multivariate logistic regression analysis was performed.
RESULTS
Among the characteristics of rib fractures, the number of rib fractures was greater (5.0 [3.0-7.0] vs. 2.0 [1.0-3.0], p < 0.001), bilateral rib fractures were frequent (56 [20.1%] vs. 12 [9.8%], p = 0.018), and lateral and posterior rib fracture was more frequent (lateral rib fracture: 160 [57.3%] vs. 25 [20.5%], p < 0.001; posterior rib fracture: 129 [46.2%] vs. 21 [17.2%], p < 0.001), and displacement was more frequent (99 [35.5%] vs. 6 [6.6%], p < 0.001) in the group with intra-thoracic and intra-abdominal injuries than in the group with no injury. The number of rib fractures (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.16-1.78; p = 0.001), lateral rib fracture (aOR, 2.80; 95% CI, 1.32-5.95; p = 0.008), and posterior rib fracture (aOR, 3.18; 95% CI, 1.45-6.94; p = 0.004) were independently associated with intra-thoracic and intra-abdominal injuries. The optimal cut-off for the number of rib fractures on the outcome was three. The number of rib fractures ≥ 3 (aOR, 3.01; 95% CI, 1.35-6.71; p = 0.007) was independently associated with intra-thoracic and intra-abdominal injuries.
CONCLUSION
In patients with rib fractures due to blunt trauma, those with lateral or posterior rib fractures, those with ≥ 3 rib fractures, and those requiring O supplementation require chest CT to identify significant intra-thoracic and intra-abdominal injuries in the emergency department.
Topics: Adult; Humans; Adolescent; Rib Fractures; Thoracic Injuries; Wounds, Nonpenetrating; Tomography, X-Ray Computed; Retrospective Studies; Emergency Service, Hospital; Abdominal Injuries
PubMed: 36949390
DOI: 10.1186/s12873-023-00807-9