Fractures de côtes non traumatiques

Abstract

Non-traumatic rib fractures are probably greatly undercounted, although they are the second more frequent peripheral fractures in osteoporotic patients. They can be ascribed to 5 categories: 1) osteoporotic either primary, or, mostly, secondary (especially to corticosteroid intake, hyperparathyroidism, or anorexia nervosa in youngest): those osteoporotic rib fractures are five times less costly than hip fractures; 2) stress fractures, which occur mostly in addicts of rowing, golf and throwing sports; 3) pathological fractures (tumours); 4) osteomalacia, whose diagnosis can already be highly suspected on imaging; 5) rib fractures following forgotten or undisclosed traumatisms, like in alcoholism, chronic coughing, or in Silverman’ syndrome in abused children. In this last context, differential diagnosis with osteogenesis imperfecta is complicated, but rib fractures very rarely herald osteogenesis imperfecta, while they are the more frequent fractures observed in Silverman's syndrome. X-rays can fail to show rib fractures, even when using rib series, so that CT-scan is the mainstay of imaging in difficult cases. However, ultrasound seems also very efficient when performed by trained operators. No specific complications have been reported following non-traumatic and non-tumoral rib fractures. Treatment relies on analgesia, but proposed techniques have yet to be validated.