Abstract
Rib fractures represent the most common bone fracture, occurring in 10–20% of all blunt trauma patients and leading to concomitant injuries of the inner organs in severe cases. The purpose of this study was to identify specific serial rib fracture patterns after blunt chest trauma. 380 serial rib fracture cases were investigated. Fractures were assigned to five different locations within the transverse plane. Rib level, fracture type, and dislocation grades were recorded and related to the cause of accident. In total, 3735 rib fractures were identified (9.8 per patient). 54% of the rib fractures were detected on the left thorax. Rib fracture distribution exhibited a hotspot at rib levels 4 to 7 in the lateral and posterolateral segments. On average, most rib fractures occurred in crush/burying injuries (15.8, n = 13) and pedestrian accidents (12.8, n = 13), least in car/truck accidents (8.9, n = 75). In the car/truck accident group, 47% of all rib fractures were in the lateral segment, in case of frontal collision (n = 24) even 60%. Fall injuries (n = 141) entailed mostly posterolateral rib fractures (35%). In case of falls >3 m (n = 45), 48% more rib fractures were detected on the left thorax. In cardiopulmonary resuscitation related serial rib fractures (n = 33), 70% of all rib fractures were located anterolaterally. Infractions were the most observed fracture type (44%), followed by oblique (25%) and transverse (18%) fractures, while 46% of all rib fractures were dislocated (15% ≥ rib width). Serial rib fractures showed distinct fracture patterns depending on the cause of accident. When developing a serial rib fracture classification system, data regarding patterns, fracture types, dislocation grades, and associated fractures should be included.
Highlights
Rib fractures are common injuries after blunt chest trauma, occurring in 60–80% of all cases [1,2]
The rib fracture number increased from rib level 1 to rib level 5 and decreased from level 5 to rib level 12, generally showing a bell-shaped distribution of the fractures between the rib levels 1 and 10 on both sides of the rib cage (Fig 2). 54% of all fractures were found on the left side, 46% on the right side
More than 50% of all rib fractures were between the rib levels 4 and 7 and in the lateral and posterolateral sections, respectively, leading to oblique running hotspot areas from anterolateral-cranial to posterolateral-caudal on both sides of the rib cage
Summary
Rib fractures are common injuries after blunt chest trauma, occurring in 60–80% of all cases [1,2]. Rib fractures represent the most frequent type of bone fractures, being observed in about 10–20% of all trauma patients [3,4,5]. In most cases of thoracic trauma, rib fractures do not arise isolatedly, but entail concomitant injuries [11]. Since rib fractures are often related to specific intrathoracic and intraabdominal traumas, predictions of the probability, progression, and complication rate of the inner organ injuries are possible [12,13,14,15]. Detailed knowledge about the fracture patterns of serial rib fractures is essential to improve the treatment strategy of these types of injury
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