Bilateral Rib Research Articles

Bilateral First Rib Fractures in Blunt Trauma Patients: A Retrospective Study

Abstract Introduction: Unilateral fracture of the first rib frequently led to severe complications such as brachial plexus or major vascular injury. Bilateral first rib fracture (BFRF) is very rare. We aimed to study the incidence, mechanism of injury, management, and outcome of BFRF in blunt trauma patients in a community-based hospital. Methods: Data of all blunt trauma patients who were admitted to our institution with (BFRF from December 2014 through January 2017) were retrospectively collected. Data included demography, mechanism of injury, severity of the injury, associated injuries, management, and outcome. Results: During the study period, 4779 patients with blunt trauma were included in the trauma registry and 12 (0.25%) patients had BFRF. The mean age of standard deviation (SD) was 29 (8.3) years. Seven (58.3%) patients were involved in road traffic collisions and 5 (41.7%) patients fell from more than 3 m height. The most commonly associated thoracic injury was lung contusions in 8 (66.7%) patients. The median (range) Glasgow Coma Score on admission was 15 (14–15) and Injury Severity Score (SD) was 19 (10.5). Length of hospital stay mean (SD) was 6.8 (6.4) days. No patients died in the study. Conclusions: BFRF is a rare entity in blunt trauma patients caused by high-energy trauma. Major vascular or brachial plexus injuries in patients with BFRF are much less than those reported in the medical literature on unilateral first rib fractures. Associated injuries are the main cause of trauma-related morbidity rather than the direct effect of BFRF.

Bilateral multiple ribs and sternum fracture causing central flail chest with respiratory failure

Bilateral thoracic blunt injuries in a patient may present with central Flail chest, and acute respiratory failure which is one of the life-threatening complications. We present a case of central flail chest caused by blunt trauma, successfully managed with operative rib and sternum fixation. A 35-year male with a central flail chest with acute respiratory failure caused by road-traffic accident who was managed initially with bilateral intercostal chest-tube drainage for significant bilateral hemopneumothorax and lung contusions. The patient was intubated and connected to mechanical ventilatory support with positive pressure ventilation for the internal pneumatic stabilization. There were multiple rib fractures anteriorly (first to seventh rib bilaterally) and fracture of the sternum - the flail chest, for which he underwent bilateral rib fixation and fixation of sternum with titanium reconstruction plate and screws on the 9th postinjury day. Tracheostomy was done along with fixation in the same sitting. Post-operatively, after 48 hours of positive pressure mechanical ventilation, the weaning was started and by the 4-5th day, the patient was on room air with a tracheostomy tube. The patient recovered uneventfully and was discharged on the eighth postoperative day.

Right cranial lung lobe torsion in a domestic ferret (Mustela putorius furo).

A 3-year-old male castrated domestic ferret presented with a 24h history of lethargy, weakness, and anorexia. The ferret was tachypneic, painful, dehydrated, pale, and obtunded on physical examination. Radiographs and thoracic CT were utilized to diagnose a 360° right cranial lung lobe torsion (LLT) with secondary pneumothorax and pleural effusion. This was confirmed on gross necropsy and histopathology. The LLT was suspected to be secondary to previous trauma based on chronic bilateral rib fractures. Lung lobe torsions are life-threatening conditions infrequently described in veterinary medicine. Based on our review of the literature, this is the first description of an LLT in a ferret.

Thoracic trauma in the geriatric population and possible preventive measures: a retrospective analysis of 261 cases.

The increase in the proportion of the elderly population within society is concurrently escalating their vulnerability to traumas, notably falls associated with age-related comorbidities. This retrospective analysis involved the examination of data pertaining to patients aged 65 and above who were admitted to our clinic for inpatient treatment following thoracic trauma. Various parameters were statistically compared between the groups with indoor and outdoor traumas. Of the 261 patients included in the study, 59.4% were male, and the average age in the entire sample was 75.52 ± 7.79. Moreover, 136 (52%) patients had indoor trauma, while 125 (48%) had outdoor trauma. The mean value for all the patients on the Itaki Fall Risk Scale (FRS) II score was 11.04 ± 4.18. The Itaki FRS II score was significantly higher for indoor accidents (11.90 ± 4.34) compared to outdoor accidents (10.10 ± 3.78) (p < 0.001). Additionally, the absence of a fall history and low risk according to the Itaki FRS II score were higher for outdoor accidents compared to indoor accidents, and the difference was statistically significant (p < 0.001). In geriatric trauma occurring outdoors, bilateral rib fractures and extrathoracic findings were significantly more prevalent (p = 0.011 and p = 0.010, respectively). The majority of patients were followed-up without any surgical intervention (73.9%), the most common surgical interventions were catheter (10.3%) and tube thoracostomy (10.3%), and 1.5% of the patients required surgical exploration. Trauma resulted in mortality in 1.5% of the patients. In the future, specialized measures and prospective studies tailored to the geriatric population, which will constitute the largest demographic segment of society, can facilitate the prevention of trauma-related morbidity and mortality, including associated financial costs.

Atelectasis After Bilateral Costal Cartilage Ear Reconstruction.

This study, through the case analysis of 2 patients with congenital bilateral microtia, explores the causes and preventive strategies of atelectasis after bilateral rib cartilage extraction surgery. Although ear reconstruction technology is quite mature, it may lead to complications, such as atelectasis, due to thoracic surgery and general anesthesia. Pediatric patients are more prone to such complications due to narrower airways, less pulmonary surfactant, and difficulties in pain management. Therefore, for children undergoing bilateral rib cartilage extraction surgery, health care providers need to closely monitor their respiratory status, effectively manage postoperative pain, and encourage them to engage in deep breathing and coughing exercises as much as possible to prevent and improve atelectasis.

Horner’s syndrome caused by the first rib fracture sustained during coronary artery bypass grafting: a case report and literature review

BackgroundHorner’s syndrome is a rare complication of cardiovascular surgery. A bone fragment and hematoma due to rib fracture after cardiac surgery may cause injury to the brachial nerve plexus and sympathetic nerve trunk, leading to neurologic disorders and Horner’s syndrome. However, few reports have revealed the etiology of Horner’s syndrome after cardiovascular surgery based on imaging. Herein we present a case in which a plain CT scan confirmed the etiology of Horner’s syndrome after coronary artery bypass grafting (CABG), reviewing 139 CABG cases retrospectively in our hospital and 6 case reports of Horner’s syndrome associated with cardiovascular surgery.Case presentationA 69-year-old woman with a history of percutaneous coronary intervention and total abdominal hysterectomy with bilateral salpingo-oophorectomy had chest pain on exertion. Coronary angiography showed severe triple vessel disease. She underwent off-pump coronary artery bypass grafting (CABG). A median sternotomy was performed, and the split sternums were widened using a sternal retractor. The bilateral internal thoracic arteries were harvested. A triple CABG was performed. She had left shoulder pain after surgery. She complained of anhidrosis involving the left face and hyperhidrosis involving the right face from postoperative day (POD) 6. Left ptosis and blurry vision appeared after discharge from the hospital, for which she saw a neurologist in our hospital on POD 48. Miosis could not be clearly confirmed. She was diagnosed with Horner’s syndrome. A plain CT scan revealed displaced fractures of the bilateral first ribs and left second rib. The bone fragment of the left first rib head was displaced 3 mm anteriorly compared to the left first rib head before surgery, which suggested that the fragment affected the stellate ganglion in the sympathetic trunk. The patient had regular follow-up evaluations. The anhidrosis persisted, but the ptosis improved, and the miosis was not confirmed at the 6-month follow-up evaluation.ConclusionsWe should recognize that Horner’s syndrome is one of the complications of cardiovascular surgery, especially CABG. Fracture of the first rib head with a displaced bone fracture was shown to be a contributor to ipsilateral Horner’s syndrome. When symptoms of Horner’s syndrome and other neurologic symptoms are noted after open heart surgery, a plain CT examination should be obtained.

Clavipectoral fascial plane block for clavicle fracture surgery: a case report.

Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis. A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period. Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.

A Case of Arterial Thoracic Outlet Syndrome Thrombus Extending to Juxtavertebral Artery

Arterial thoracic outlet syndrome (TOS) constitutes less than 1%, involving the second part of the subclavian artery (SCA). It can present as an acute upper limb ischemia or aneurysm formation. Here is a case of a 29-year-old male presented with complaints of rest pain over the left hand for the past 2 weeks. Upon evalution, found to have bilateral cervical rib with left subclavian artery occlusion. Treated by cervical rib excision decompression of scalene triangle, subclavian endarterectomy and left brachial embolectomy. Arterial TOS secondary to the cervical rib is rare; pathology involving this external compression results in repeated trauma in the intima of the SCA, resulting in subclavian stenosis, poststenotic dilatation, thrombosis, and aneurysm formation with mural thrombus and distal embolization. Symptomatic cases need decompression +/- arterial repair.

18F-FDG PET/CT findings in nevoid basal cell carcinoma syndrome: a systematic review and a new case report

BackgroundTo demonstrate and analyze the 18F-FDG positron emission tomography/computed tomography (PET/CT) findings in this rare nevoid basal cell carcinoma syndrome (NBCCS).Case presentationA 71-year-old woman with the left invasive breast cancer was treated with hormone therapy for six months and underwent the 18F-FDG PET/CT examination for efficacy evaluation. 18F-FDG PET/CT revealed the improvement after treatment and other unexpected findings, including multiple nodules on the skin with 18F-FDG uptake, bone expansion of cystic lesions in the bilateral ribs, ectopic calcifications and dilated right ureter. She had no known family history. Then, the patient underwent surgical excision of the all skin nodules and the postoperative pathology were multiple basal cell carcinomas. Finally, the comprehensive diagnosis of NBCCS was made. The patient was still in follow-up. Additionally, we have summarized the reported cases (n = 3) with 18F-FDG PET/CT from the literature.ConclusionsIt is important to recognize this syndrome on 18F-FDG PET/CT because of different diagnoses and therapeutic consequences.

Favourable outcome in survivors of CPR-related chest wall injuries

BackgroundThere is a lack of studies focusing on long-term chest function after chest wall injury due to cardiopulmonary resuscitation (CPR). The purpose of this cross-sectional study was to investigate long-term pain, lung function, physical function, and fracture healing after manual or mechanical CPR and in patients with and without flail chest. MethodsPatients experiencing out-of-hospital cardiac arrest between 2013 and 2020 and transported to Sahlgrenska University Hospital were identified. Survivors who had undergone a computed tomography (CT) showing chest wall injury were contacted. Thirty-five patients answered a questionnaire regarding pain, physical function, and quality of life and 25 also attended a clinical examination to measure the respiratory and physical functions 3.9 (SD 1.7, min 2-max 8) years after the CPR. In addition, 22 patients underwent an additional CT scan to evaluate fracture healing. ResultsThe initial CT showed bilateral rib fractures in all but one patient and sternum fracture in 69 %. At the time of the follow-up none of the patients had persistent pain, however, two patients were experiencing local discomfort in the chest wall. Lung function and thoracic expansion were significantly lower compared to reference values (FVC 14 %, FEV1 18 %, PEF 10 % and thoracic expansion 63 %) (p < 0.05). Three of the patients had remaining unhealed injuries. Patients who had received mechanical CPR in additional to manual CPR had a lower peak expiratory flow (80 vs 98 % of predicted values) (p=0.030) =0.030) and those having flail chest had less range of motion in the thoracic spine (84 vs 127 % of predicted) (p = 0.019) otherwise the results were similar between the groups. ConclusionNone of the survivors had long-term pain after CPR-related chest wall injuries. Despite decreased lower lung function and thoracic expansion, most patients had no limitations in physical mobility. Only minor differences were seen after manual vs. mechanical CPR or with and without flail chest.

Treatment of blunt thoracic trauma in a Level 1 Trauma Center

Blunt chest trauma has a significant high morbidity and mortality rate. In general, the treatment is conservative; in the case of hemothorax, pneumothorax, and hemopneumothorax chest tube drainage is often required. Immediate surgery is indicated in massive bleeding, tracheal and oesophageal injuries, and pericardial tamponade. Elective surgery should be performed in the case of retained hematoma, unresolved pneumothorax and flail chest. The first prioritized procedure is video-assisted thoracoscopy. The aim of this study is to analyze the treatment options and therapeutic results in reviewing 8,108 patients afflicted with blunt thoracic trauma. In over a three-year period 7,853 patients’ data were analyzed. Altogether 1,624 (20.68%) patients suffered severe injuries, such as sternal or rib fracture(s), pleural or lung injuries. In this group, a simple rib fracture (1-3) was diagnosed in 1,466 (90.27%), unilateral serial rib fracture (≥4) in 84 (5.17%), bilateral rib fracture in 16 (0.99%) and flail chest in 47 (2.89%) patients. In 11 (0.68%) cases, only parenchymal injuries without rib fracture were found. Altogether, 190 (11.70%) patients were afflicted with pneumothorax, hemothorax, or both, and only 86 (45.26%) of these cases required chest tube drainage. One immediate thoracotomy was needed to staunch massive bleeding and elective video-assisted thoracoscopy was performed in 6 cases. Lung contusion was diagnosed in 57 (3.51%) patients. The most frequent complication was pneumonia with a rate of 0.19% (15 patients). Empyema (3 patients), unresolved pneumothorax (1 patient), and retained hematoma (4 patients) occurred in 0.04%, 0.01% and 0.05% of the cases, respectively. Altogether, 13 (0.17%) patients succumbed at a mean age of 63.54±21.92 years. Three of these cases (23.08%) experienced multiple trauma and 12 (92.31%) suffered from concomitant chronic diseases. Patients with blunt chest trauma rarely required immediate operation. Overall, in the case of unresolved pneumothorax and retained hematoma, surgery is indicated, in which these cases video-assisted thoracoscopy is the first and primary option.

Neglected Sprengel’s deformity in an 80-year-old female cadaver: a case report

BackgroundSprengel’s deformity is a congenital abnormality of the shoulder girdle. Because scapular retraction, such as the Green procedure, is usually performed during childhood to improve esthetics and shoulder function, Sprengel’s deformity is rarely found in older patients.Case presentationWe presented a unique case of a Japanese female cadaver with Sprengel’s deformity at the age of 80 years. Anatomical dissection and radiological imaging revealed musculoskeletal anomalies associated with Sprengel’s deformity, including Klippel–Feil syndrome, presence of an omovertebral bone, and absence of the trapezius muscle. In addition, bilateral cervical ribs were in contact with the brachial plexus. These anomalies may lead to numbness, pain, and limited range of motion of the neck and upper girdle with aging.ConclusionsBecause most adult patients with Sprengel’s deformity experience neck pain and limited movement of the shoulder, the presented case is a rare case of neglected Sprengel’s deformity in an 80-year-old cadaver.

Case Report on Brown Tumor: An Unusual Expression of Renal Osteodystrophy and Secondary Hyperparathyroidism

The new term of ‘Chronic Kidney Disease- Mineral and Bone Disorders’ has been introduced to encompass a wide-ranging syndrome, capturing various abnormalities in bone and mineral metabolism seen in patients with chronic kidney disease. Multifactorial disorders affecting mineral metabolism and bone structure emerge early in the progression of Chronic Kidney Disease. Brown tumors, an uncommon type of bone lesion are distinctive manifestations of high-turnover bone disease. In this case, a patient with chronic kidney disease (dialysis dependent) with IgA nephropathy that presented with multiple osseous lesions of bilateral ribs, sternum, scapula, clavicle, mandible and vertebral bodies. The case highlights the significance of considering brown tumors in the differential diagnosis and management of patients with both an osseous mass and chronic kidney disease. Failing to establish an accurate diagnosis may result in unnecessary additional diagnostic procedures and extensive surgery, ultimately increasing patient morbidity. Through this case report, the importance of preventing, early diagnosing, and treating secondary hyperparathyroidism to reduce the prevalence of high-turnover bone disease and associated complications such as brown tumors is emphasized.

Novel Approach to Difficult Spinal Reconstruction: Bilateral Simultaneous Rib and Iliac Crest Vascularized Bone Graft Spinoplastic Surgery

Summary: Pseudoarthrosis is a severe complication of spinal fusion surgery with occurrence rates as high as 35%–40%. Current options of revision surgery to correct pseudoarthrosis frequently carry high failure rates and risk of developing junctional kyphosis. Pedicled vascularized bone grafts (VBGs) are an innovative approach to boost spinal fusion rates via improving structural integrity and increasing the delivery of blood to the donor site. This versatile technique can be performed at different spinal levels without additional skin incisions and with minimal added operative time. Here we present the first bilateral rib and iliac crest VBG spinoplastic surgery performed to augment spinal fusion in a 68-year-old woman with distal junctional kyphosis and severe positive sagittal balance with low back and neck pain and significant difficulty standing upright. The patient had history of multiple spinal operations with preoperative CT imaging demonstrating loosening and pull out of L3 and fracture of L2 screws. She underwent two-stage surgical treatment involving anterior lumbar interbody fusion L3-S1 followed by removal of hardware, T4 to pelvis fusion with L2-3 prone lateral interbody fusion, and T11-S1 posterior column osteotomies. The surgery was augmented by bilateral rib and iliac crest VBGs performed by plastic surgery. At three-month follow-up the patient demonstrated functional improvement, being able to maintain upright posture and walk; was satisfied with the result of the surgery; and demonstrated no graft-related complications. In conclusion, utilization of pedicled VBGs is a novel, promising approach to augment spinal surgery in high risk patients.

Surgical treatment for congenital vertebral anomalies with bilateral bifid intrathoracic rib in association: A series of five cases.

Congenital scoliosis is often associated with costal deformities, of which a bilateral bifid intrathoracic rib is very rare. The aim of this study was to retrospectively summarize the clinical manifestations, imaging characteristics, treatment strategies, and postoperative outcomes of five patients with bilateral bifid intrathoracic rib. We retrospectively reviewed the imaging findings and medical records of five pediatric patients (two girls, three boys) with bilateral bifid intrathoracic rib who were surgically treated for congenital kyphoscoliosis (mean age = 8 years). The clinical manifestations, imaging characteristics, treatment strategies, and postoperative outcome were summarized. Four of five patients showed abnormalities from birth. All five patients presented with kyphoscoliosis and a fused vertebral body or lamina. The bilateral bifid intrathoracic rib was located at T2-3 in three patients, T7 in one patient, and T10 in one patient. Various congenital spinal deformities and multiple system malformations were present in all five patients. Three patients had preoperative neurological deficits. For corrective surgery, one patient received a traditional growing rod implantation, one patient underwent resection of a bony septum, and three patients underwent spinal osteotomy. One patient suffered complete paralysis of the lower limbs after surgery. Bilateral bifid intrathoracic rib is a rare anomaly that typically occurs in patients with serious kyphoscoliosis. Bilateral bifid intrathoracic rib patients show similar clinical and radiological characteristics and are likely to exhibit neurological deficits before or following corrective surgery. Spinal surgeons should be aware of the high risk of permanent neurological complications related to surgery in these patients. level IV.

Utility and limitations of postmortem computed tomography in animal abuse suspected cases: A case series study of cats

ObjectivesInjuries caused by animal abuse are termed non-accidental injuries, and should be distinguished from accidental injuries. We compared postmortem computed tomography (PMCT) and necropsy findings in deceased cat bodies suspected of having been abused to determine whether findings previously reported to be associated with abuse or accident could be ascertained by necropsy or PMCT. Materials and methodsSeven deceased cat bodies requested by the police for necropsy because of suspicion of animal abuse were used to compare necropsy and PMCT findings. ResultsPMCT revealed gas distribution abnormalities, such as pneumocephalus and pneumothorax, and bone lesions findings, such as cervical and pelvic fracture; however, several of these were not confirmed at necropsy. Findings such as liver contusion and injury to the posterior vena cava were confirmed only by necropsy and not by PMCT. Findings related to animal abuse, i.e., ocular injuries, skull, bilateral rib, and femoral fractures were confirmed by both PMCT and necropsy in 3, 5, 2, and 2 cats, respectively. Pneumothorax, pelvic fracture, and sacroiliac luxation, related to accidents, were confirmed only by CT in 6 of 6, 1 of 4, and 2 of 2 bodies. ConclusionPMCT revealed gas- and some bone-related findings more efficiently than necropsy, and a combination of PMCT and necropsy is recommended to perform, particularly if the death circumstances is unknown.

Evaluation of congenital rib anomalies with multi-detector computed tomography in the Turkish population.

This study aimed to evaluate the congenital anomalies of ribs in the Turkish population using multi-detector computed tomography (CT) and to reveal the prevalence and distribution of these anomalies according to sexes and body sides. This study included 1120 individuals (592 male, 528 female) over 18 who presented to our hospital with a suspicion of COVID-19 and who had thoracic CT. Anomalies such as a bifid rib, cervical rib, fused rib, Srb anomaly, foramen rib, hypoplastic rib, absent rib, supernumerary rib, pectus carinatum, and pectus excavatum, which were previously defined in the literature, were examined. Descriptive statistics were performed with the distribution of anomalies. Comparisons were made between the sexes and body sides. A prevalence of 18.57% rib variation was observed. Females had 1.3 times more variation than males. Although there was a significant difference in the distribution of anomalies by sex (p = 0.000), there was no difference in terms of body side of anomaly (p > 0.05). The most common anomaly was the hypoplastic rib, followed by the absence of a rib. While the incidence of the hypoplastic rib was similar in females and males, 79.07% of the absent ribs was seen in females (p < 0.05). The study also includes a rare case of bilateral first rib foramen. At the same time, this study includes a rare case of rib spurs extending from the left 11th rib to the 11th intercostal space. This study demonstrates detailed information about congenital rib anomalies in the Turkish population, which may vary between people. Knowing these anomalies is essential for anatomy, radiology, anthropology, and forensic sciences.

Aortic Rupture Due to Blunt Force Trauma: A Case Report

Background: Aortic rupture is one of the most important life-threatening conditions. Aortic rupture can occur by several causes, including trauma and spontaneous rupture. Case Details: A 62-year-old man was brought for an autopsy examination in a mortuary with a history of road traffic accidents. As per history revealed by the police and relatives, the deceased was a retired army officer and was driving a car. Autopsy Finding: The deceased was an elderly male. On external examination, the deceased sustained multiple reddish abraded contusions over the chest and both sides of the chest. On opening the thorax, the following injuries were present. Fracture of sternum was present at junction of body and manubrium associated with extravasations of blood in surrounding area. Multiple fracture of bilateral ribs associated with extravasations of blood in surrounding area. Discussion: All aortic segments are prone to rupture following sudden blunt trauma. In various studies it is found that 92% of aortic rupture occur at isthmus followed by arch of aorta (4%) followed by ascending aorta (3%).

Retrograde thromboembolism and recurrent stroke in an adolescent boy with bilateral cervical rib.

Retrograde thromboembolism and recurrent stroke in an adolescent boy with bilateral cervical rib.

Injuries Associated with Prehospital CPR Provided by Professionals and Non-Professionals in Bangkok EMS

Background: This study is to concentrate on adverse outcomes of CPR in out-of-hospital cardiac arrest (OHCA) among different performers that are trained first responders, professional practitioners, and automated devices by exploring types of injuries and comparing between datasets. It is also to find out potential contributing factors for each injury which display statistical significance.&#x0D; Methods: Forensic autopsy data from a single center covering almost half of Bangkok and her outskirts which were performed during October 2020 to January 2021 were retrospectively collected and analyzed. The data were divided into 3 groups, namely, TFR (trained first responder), PP (professional practitioner), and Auto (automated device i.e. LUCAS system). Thoraco-abdominal injuries were recorded including soft tissue, bone and internal viscera. Factors including age, BMI, sternal length (SL) and chest circumference (CC) were categorized in each injury. Statistical comparison between groups and analysis for significant factors were performed.&#x0D; Results: A total number of 158 cases reported as OHCA with exclusion of thoraco-abdominal injuries were recruited. The most commonly found as a hallmark of CPR injuries are chest wall fractures especially those of ribs (65.7%). Bilateral anterior rib fractures are more common than unilateral. Significantly associated factors to rib fractures are age and BMI. Other injuries are sternal fractures, lung contusions and lacerations, epicardial and subendocardial hemorrhages, cardiac contusions, liver lacerations, and pancreatic and splenic hemorrhages. No statistical difference between injuries generated by trained first responders and professional practitioners. LUCAS devices show higher incidence of injuries than manual CPR.&#x0D; Conclusion: This study may provide useful information for clinicians to investigate and monitor potential CPR complications as well as for forensic physicians to concern the injuries possibly caused by CPR.