Costal Fractures Research Articles

Pneumorachis, A Rare Post-Traumatic Complication

The presence of air in the spinal canal defines pneumorachis, which is a rarely reported entity; exceptionally, it is found during a road traffic accident (MVA). We present the case of a 36-year-old patient who suffered an MVA. The work-up showed multiple fractures of the cephalic extremity, pneumocephalus, pulmonary contusions, pneumomediastinum, moderate bilateral hemopneumothorax, thoracic vertebral and costal fractures and moderate cervicothoracic pneumorachis. Spinal lesions are thought to be the cause of this pneumorachis. Lesions of the parietal pleura and meninges are thought to be responsible for air escaping from the pleural space into the spinal canal from D2 to D7. Although rare, the literature reports similar observations of post-traumatic pneumorachis. The diffusion of air bubbles into the spinal canal is a direct consequence of the rupture of a solid organ and a spinal lesion. The discovery of air bubbles should therefore prompt a search for other lesions that may explain their formation.

Toraks Travmalı Olgularda Travma Mekanizmasının Vertebra Fraktürü Eşlik Etme Sıklığına Etkisi

Introduction: Thoracic traumas are the third most common trauma among all trauma cases after head-neck and extremity traumas. The most common causes are motor vehicle accidents, falls from height, gunshot wounds, and stab wounds. In our study, it was aimed to investigate the mechanism of trauma and its effect on the frequency of accompanying vertebral fracture in patients who applied to the emergency department of a university hospital due to thoracic trauma.
 Material – Method: Our study was planned retrospectively. The information of the patients who applied to the emergency department of our hospital between 01.01.2017 and 01.01.2021 due to thoracic trauma was examined. Demographic characteristics of the patients, mechanism of trauma, trauma-related thoracic injuries and accompanying vertebral fractures were evaluated.
 Results: The data of 515 patients exposed to thoracic trauma were analyzed. The median age of the patients included in the study was 52 and 72.4% (n: 373) were male. 96.3% (n: 496) of the patients presented because of blunt trauma. The most common trauma mechanisms were in-vehicle traffic accident (46.6% n:240) and falling from height (30.9% n:159).
 Pneumothorax was found in 34.7% (n: 179) of the patients, hemothorax in 40.2% (n: 207), and costal fracture in 81.9% (n: 422). The frequency of concomitant vertebral fracture was 33.98% (n: 175). Vertebral fractures were most commonly detected in the lumbar region (53.1%) and were most common in patients admitted after a non-vehicle traffic accident. A significant difference was found between the mechanism of trauma and accompanying vertebral fracture; vertebral fracture was seen in 53.8% (n:28) of the patients who applied after a non-vehicle traffic accident. (p=0.004)
 Conclusion: It should be kept in mind that the trauma mechanism may increase the frequency of accompanying vertebral fracture in patients admitted to the emergency department after blunt trauma and evaluated for thoracic trauma.

Anatomical and pathological characteristics of ribs in the Atlantic salmon (Salmo salar L.) and its relevance to soft tissue changes.

Studies on the anatomical and pathological characteristics of ribs in farmed Atlantic salmon (Salmo salar L.) are warranted due to their possible association with red and melanized focal changes (RFC and MFC) in the fillet, a major quality and animal welfare concern. In this work, we provide an anatomical description of ribs based on radiographical and histological analyses. We also address various pathological rib changes and their association to RFC and MFC. In total, 129 fish were investigated; captured wild (n= 10) and hatchery reared (n= 119) Atlantic salmon (3.5-6.1 kg). The fish were selected based on the macroscopic presence of RFC, MFC or no changes (controls). Radiographic results revealed costal abnormalities in all fish groups. By histological investigations of the variations herein, our results provide new insight into the anatomical characteristics including vascularization within the ribs; a potential site for haemorrhage following costal fractures. Costal fractures were detected by radiology in 40 of 129 samples (RFC: 38.4%, MFC: 47.2%, controls: 9.5 %). A statistically significant association was found between costal fractures and red (p= 0.007) and melanized changes (p= 0.000). However, red and melanized changes were also observed in samples with no costal fractures (n= 45), indicating that also other factors influence the development of RFC/MFC.

A new remarkable cimicoid genus and species (Hemiptera, Heteroptera, Cimicomorpha) from mid-Cretaceous Burmese amber, with implications for its aberrant male genitalia

A new genus and species of cimicoid true bug,Ecpaglocoris ditomeusYamada & Yamamoto,gen. et sp. nov., is described and illustrated from mid-Cretaceous (Cenomanian–Albian) amber in the Kachin State of northern Myanmar (Burma). This new fossil genus and species is reminiscent of members of Anthocoridae by the strongly flattened and elongated body, four-segmented labium, distinct costal fracture and presence of fossula spongiosa on fore tibiae, but should not be ascribed to this family. The new taxon cannot be placed in any extant cimicoid families, based upon hemelytral, male genital and other morphological structures. Based on the hemelytral membrane venation and presence of dorsal laterotergites on abdominal segments I to VIII, it can be assumed that this new genus belongs to the extinct family Vetanthocoridae.Ecpaglocoris ditomeusgen. et sp. nov.has aberrant male genitalia characterised by sickle-shaped left and right parameres and grooves running throughout the paramere. This characteristic indicates that traumatic insemination occurred in this genus. The peculiar combination of male genital characteristics seen inEcpaglocorisgen. nov.prevents its placement in any of the extant cimicoid families.

Estudio observacional retrospectivo correlacionando las fracturas traumáticas de pelvis y sus lesiones asociadas según la clasificación de Tile

IntroductionPelvic fractures due to high energy trauma present a high risk of associated injuries that compromise the functional and vital prognosis of the patients. The objective of this study was to analyze the relationship between traumatic pelvic fractures and their associated injuries according to the Tile classification. MethodsRetrospective observational study of patients who suffered traumatic pelvic fractures (Type A, B or C of the Tile classification) with concomitant associated injuries, analyzing hemoglobin levels, between 6/2013 and 1/2016. ResultsA total of 42 patients were included; of those 69% (n=29) were males, mean age was 48 years. 45% (n=19) suffered traffic accidents and 26.2% (n=11) falls. There was a different proportion in pelvic injuries: Tile A (n=15, 35.7%), B (n=20, 47.6%), and C (n=7, 16.6%) of cases. 54.8% (n=23) underwent surgery, 21.4% (n=9) needed temporary or definitive external fixation. Significant differences were found between Tile A type and scapula fractures (P=.032), and Tile B with sacral fractures (P=.033) and visceral injuries (P=.049), while there is a tendency without a statistical significal between Tile C and costal fractures. 61.9% (n=26) needed blood transfusion; 9.5% (n=4) presented hypovolemic shock. ConclusionsTile A pelvic fractures were associated with scapular fractures, and Tile B with transforaminal fractures of the sacrum and with visceral injuries (lungs, liver and genitourinary). The small number of Tile C prevent us to confirm an association with any pathology, although they are the ones which presnt more hemodynamically instability and thoracic injuries.

Retrospective observational study correlating traumatic pelvic fractures and their associated injuries according to the Tile classification

IntroductionPelvic fractures due to high energy trauma present a high risk of associated injuries that compromise the functional and vital prognosis of the patients. The objective of this study was to analyze the relationship between traumatic pelvic fractures and their associated injuries according to the Tile classification. MethodsRetrospective observational study of patients who suffered traumatic pelvic fractures (Type A, B or C of the Tile classification) with concomitant associated injuries, analyzing hemoglobin levels, between 6/2013 and 1/2016. ResultsA total of 42 patients were included; of those 69% (n = 29) were males, mean age was 48 years. 45% (n = 19) suffered traffic accidents and 26.2% (n = 11) falls. There was a different proportion in pelvic injuries: Tile A (n = 15, 35.7%), B (n = 20, 47.6%), and C (n = 7, 16.6%) of cases. 54.8% (n = 23) underwent surgery, 21.4% (n = 9) needed temporary or definitive external fixation. Significant differences were found between Tile A type and scapula fractures (P = .032), and Tile B with sacral fractures (P = .033) and visceral injuries (P = .049), while there is a tendency without a statistical significal between Tile C and costal fractures. 61.9% (n = 26) needed blood transfusion; 9.5% (n = 4) presented hypovolemic shock. ConclusionsTile A pelvic fractures were associated with scapular fractures, and Tile B with transforaminal fractures of the sacrum and with visceral injuries (lungs, liver and genitourinary). The small number of Tile C prevent us to confirm an association with any pathology, although they are the ones which presnt more hemodynamically instability and thoracic injuries.

Combined Disruption of the Thoracic Spine and Costal Arch Fracture: An Indicator of a Severe Chest Trauma.

Blunt high-energy chest trauma is often associated with thoracic and abdominal organ injuries. Literature for a hyperextension-distraction mechanism resulting in a costal arch fracture combined with a thoracic spine fracture is sparse. A 65-year-old male suffered a fall from a height of six meters. Initial X-ray of the chest shows left-sided high-riding diaphragm and CT scan proves anterior cartilage fracture, posterolateral serial rib fractures, traumatic intercostal pulmonary hernia, avulsion of the diaphragm, and 7th thoracic vertebral fracture. An exploratory thoracotomy was performed and the rupture of the diaphragm, creating a two-cavity injury, had been re-fixed, the pulmonary hernia was closed, and locking plate osteosyntheses of the fractured ribs including the costal arch were performed. We generally recommend surgical therapy of the thorax to restore stability in this severe injury entity. The spine was fixed dorsally using a screw-rod system. In conclusion, this thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Since two-cavity traumata and particularly diaphragmatic injuries are often diagnosed delayed, injuries to the costal arch can act as an indicator of severe trauma. They should be detected through clinical examination and assessment of the trauma CT in the soft tissue window.

New Cretaceous Bugs from Northeastern China Imply the Systematic Position of Pachymeridiidae (Hemiptera: Heteroptera).

Simple SummaryA new genus and species of Pachymeridiidae is described from the Early Cretaceous of Northeastern China. The structure of the well-developed coastal facture, claws, and male parameres are preserved. The documentation of these structures is provided for exploring the systematic position of Pachymeridiidae and the evolution of the costal fracture in Heteroptera.Varicapitatus sinuolatus gen. et sp. nov. is described from the Yixian Formation of Northeastern China. Based on the new specimens, this study discusses the morphological characteristics and taxonomic position of Pachymeridiidae: Pachymeridiidae belongs to Pentatomomorpha and is more closely related to Lygaeoidea. In Heteroptera, the costal fracture of the forewing is a homoplastic characteristic, already evolved independently several times among most taxa before the Early Cretaceous. The pulvillus under the claw in Pentatomomorpha is also a homoplastic characteristic. In Pachymeridiidae, the forewing costal fracture and absence of pulvillus can be recognized as an independent evolution or convergence, implying that pachymeridiids may have different flight and crawling behaviors distinct from other Pentatomomorpha groups.

Favorable outcomes within a comprehensive therapeutic rehabilitative program in a complex case of severe polytrauma

A polytrauma patient after a car accident represents a challenge for the health care system due to the multiple traumatic injuries, at least one of them potentially being life threatening. Many of these injuries require intense nursing and rehabilitation treatment, because some of them can cause permanent disability, affecting the patient’s future quality of life. Materials and methods: With the permission of the THEBA Ethics Committee (no 24389 / 28.06.2021), this paper presents a case of a 37-year-old patient with a severe polytrauma due to a car accident (driver), occurred on October 18, 2020. The patient was hospitalized in the Intensive Care Unit of the Emergency County Hospital of Targoviste, in a severe condition, being orotracheal intubated and having a thoracic polytrauma (multiple bilateral costal fractures, anterior-superior flail chest with acute respiratory failure) and mandible fracture. After clinical and hemodynamic stabilization, he was transferred to Bucharest Emergency University Hospital and after specific paraclinical investigations, he was surgically treated with thoracic fixation with metal plates, sternal fixation with plate and screws, thoraco-abdominal skin grafting and mandibular stabilization. Afterwards he was transferred to THEBA at the Plastic Surgery Clinic Department for lumbar-sacral pressure sore, where he suffered multiple surgical interventions. In our Neuromuscular Rehabilitation Department, the patient was admitted in 16.02.2021 with pain and severe functional impairments in the right elbow and the right knee, surgically treated sacral pressure sore still in the process of healing and having a severe deficiency of self-care and locomotion. He initially followed a rehabilitative nursing program and continued with a recovery therapy according to clinical stages. The patient was functionally assessed using the following scales: Medical Research Council (MRC) Scale for Muscle Strength, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale and Independence Assessment Scale in Daily Activities (ADL/IADL). Results: Although the patient's evolution was slow, he had favorable outcomes with an increase in the scores of the evaluated scales at discharge. He benefited from specific surgical care of the pressure sores and a complex neuro-muscular rehabilitative program. The patient’s final performance in our clinic was walking on medium distances with support from another person. Conclusion: The multidisciplinary team approach with the addition of complex nursing measures and a personalized rehabilitative program for a young patient with polytrauma caused by a car accident established neuro-locomotor improvements which led to an increase in patient’s quality of life. Keywords: neuro-muscular rehabilitation, polytrauma

A peculiar new genus of Scytinopteridae (Hemiptera, Cicadomorpha) from the Permian-Triassic boundary beds of Mongolia

Scytinopteridae Handlirsch, 1906 is a widespread family of extinct Cicadomorpha known worldwide from the Permian and Triassic (Lambkin, 2016). This family was understood very broadly (e.g., Evans, 1956), but was later restricted to the genera with heavily sclerotized punctate tegmina having a costal fracture and a hypocostal socket fixed on the thorax in repose, and was placed in the superfamily Scytinopteroidea Handlirsch, 1906 (Shcherbakov, 1984). Based on these features, scytinopteroids are considered inhabitants of waterside vegetation capable of temporary submergence, and are ancestors of true bugs (Shcherbakov, 1996, 2000). In the beds near the Permian-Triassic boundary of Mongolia, an unusual new genus of Scytinopteridae was discovered with pointed coleopterous tegmina lacking the costal fracture and the claval furrow. These modifications indicate that the flying ability in the new scytinopterid was reduced or lost, and the peculiar shape of the tegmina probably helped to mimic host plant buds or seeds (plant-part mimicry).

Emergency whole-body CT scans in pediatric patients with trauma: patterns of injuries, yield of dual-phase scanning, and influence of second read on detection of injuries.

To describe injury patterns in children with multiple trauma (MT), evaluate the yield of dual-phase whole-body CT (WBCT), and quantify missed injuries detected on second reading. Remotely analyzed WBCT performed between 2011 and 2020 in 63 emergency departments on children admitted for MT were included. Second reading occurred within 24 h. Collected data included age, sex, mechanism, Injury Severity Score (ISS), radiologists' experience, time and duration of first reading, conclusion of both readings, and dosimetry. Melvin score assessed the clinical impact of missed injuries. Overall, 1114 patients were included, 1982 injuries were described in 662 patients (59.4%), 452/1114 (40.6%) WBCT were negative, and 314 (28.2%) patients had MT (≥ 2 body parts injured). The most frequent injuries were pulmonary contusions (8.3%), costal fractures (6.2%), and Magerl A1 vertebral fractures (4.9%). Overall, 151 injuries were missed in 92 (8.3%) patients. Independent predictors for missed injuries were age ≤ 4 years (p = 0.03), number of injured body parts ≥ 2 (p = 0.01), and number of injuries ≥ 3 (p < 0.001). Melvin score grade 3 lesions were found in 16/92 (17.4%) patients with missed injuries (1.4% of all WBCT), where only prolonged follow-up was necessary. Thirteen active bleeding or pseudoaneurysms were detected (0.7% of injuries). Injuries were diagnosed in 59.4% of patients. Double-reading depicted additional injuries in 8.3% of patients, significantly more in children ≤ 4 years, with ≥ 3 injuries or ≥ 2 injured body parts. As 28 % of patients had MT and 1.1% had active extravasation or pseudoaneurysm, indication for WBCT should be carefully weighted. • When performed as a first-line imaging evaluation, approximately 41% of WBCT for MT children were considered normal. • The three most common injuries were pulmonary contusions, costal fractures, and Magerl A1 vertebral fractures, but the patterns of traumatic injuries on WBCT depended on the children's age and the trauma mechanism. • The independent predictors of missed injuries were age ≤ 4 years, number of body parts involved ≥ 2, and total number of injuries ≥ 3.

Gamma heavy chain disease associated with rheumatoid arthritis: a\xa0case report

BackgroundGamma heavy chain disease (γ-HCD) is a monoclonal gammopathy defined by an abnormal clonal and isolated production of incomplete heavy chain gamma (γ), unable to bind with light chains kappa or lambda. This disease is rare and remains poorly described. Its association to lymphoid neoplasm is well established, but exceptional forms of γ-HCD may also accompany auto-immune diseases. We report here a new case of γ-HCD characterized by an indolent course with a 4-year follow-up, and its association with quiescent rheumatoid arthritis (RA).Case presentationWe report the case of a 85-year old French white man followed for quiescent anti-CCP+ rheumatoid arthritis treated by prednisolone 4 mg/day and hydroxychloroquine 200 mg/day since 10 years, and a monoclonal gammopathy of undetermined significance for 6 years, who was hospitalized for costal fractures after a fall. Serum protein electrophoresis showed a stable small monoclonal peak, and capillary electrophoresis/immunosubtraction technique identified an isolated clonal γ-heavy chain (HC). Bone marrow aspiration was normal and he had no other lymphoproliferation. The monoclonal peak remained stable after 4 years of follow-up.ConclusionsIn case of monoclonal peak without complete monoclonal Ig on serum protein electrophoresis, the diagnosis of γ-HCD should be discussed and capillary electrophoresis/immune-subtraction is a mean to detect isolated monoclonal heavy chain (HC). Gamma-HC disease is rare, may be associated to RA, and may have an indolent course.

A complex case of neuro-muscular rehabilitation with favorable evolution, in a patient with incomplete tetraplegia post cervical and thoracic spinal cord injury - surgically treated, in a politraumatic context, by car accident

Introduction: Spinal cord injuries (SCI) are major conditions that usually determine severe and permanent dysfunctions, or even important loss of basic functions, generating severe or rather permanent sequels. They can have important chronic consequences such as: tetraplegia or paraplegia.(1). Materials and Methods: This paper presents the case of a young 19-year-old patient who suffered in March 2019, a car accident (passenger) with spinal cord injury (SCI) at cervical and thoracic level in a politraumatic context, hospitalized at the Neurosurgery Clinic (NS) II of TEHBA in a severe condition, for complete AIS/Frankel A tetraplegia, with a C7 fracture, T3, T4, T5 cominutive fractures with fragments in the medullary channel, minor traumatic brain injury, multiple costal fractures, abdominal trauma and respiratory failure. When the patient became hemodynamic and respiratory stable it was decided a neuro-surgical intervention, initially at cervical level through an anterior approach, with mixed osteo-sinthesis and C7 discectomy. Because of the spine instability, thoracic surgical treatment was delayed with 11 days, when he suffers a neurosurgery for medullary decompression, drainage and stabilization of the spine. In our clinical division, the patient was admitted with an incomplete AIS/Frankel B tetraplegia and initially followed a rehabilitation nursing program and subsequently continued with a recovery therapy according to clinical stages. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL / IADL), Walking Scale for Spinal Cord Injury (WISCI). Results: The patient benefited from a complex neuro-muscular rehabilitation program, having a favorable evolution, with an increase in the evaluated scales scores – passing from AIS/Frankel B classification to a severe AIS/Frankel C stage, and thus, at the moment he is performing walking on short distances, through parallel bars, with long left leg orthosis and support from another person. It was tried a sphincter re-education, but, after urologic examination, because of the important spasticity in the lower limbs and of the urinary catheterization discomfort, it was decided that for a while the patient to remain with fixed urinary catheterization. Conclusions: Even if there is still no cure for SCI sequels, the accurate clinical-functional evaluation, the neurosurgical prompt therapeutic approach, adding complex nursing measures, personalized rehabilitative and kinetotherapy programs, in a young patient with SCI by car accident, determined neuro-locomotor improvements with an increase in patient’s quality of life.(1),(2). Keywords: spinal cord injuries, tetraplegia, traumatism, rehabilitation,

Mimicry in Cretaceous Bugs.

SummaryMimicry is ubiquitous in nature, yet understanding its origin and evolution is complicated by the scarcity of exceptional fossils that enable behavioral inferences about extinct animals. Here we report bizarre true bugs (Hemiptera) that closely resemble beetles (Coleoptera) from mid-Cretaceous amber. The unusual fossil bugs are described as Bersta vampirica gen. et sp. nov. and Bersta coleopteromorpha gen. et sp. nov. and are placed into a new family, Berstidae fam. nov. The specialized mouthparts of berstids indicate that they were predaceous on small arthropods. Their striking beetle-like appearance implies that they were either involved in defensive mimicry or mimicked beetles to attack unsuspecting prey. The latter would represent the first case of aggressive mimicry in the invertebrate fossil record. These findings enrich our understanding of the paleoecological associations and extinct behavioral strategies of Mesozoic insects.

Our Experience in the Treatment of Severe Thoracic Trauma.

Background: Severe thoracic trauma is main cause of deaths in US about 10-20 % of deaths. Causes of severe thoracic Trauma are :Penetrating trauma,Gunshot wounds,Stab wounds ;Lower mortality rate less massive, less multiorgan injury Gunshot wounds on the chest is the most lethal – 50% .Only 7-10% undergoes hospitalization prior to death .Death due to heart &amp; great vessel injuries.&#x0D; Aim of study: Analyses of patients with Severe Thoracic Trauma ,Initial Evaluation and Management analyses of our cases period of time 2004-2017 treated in thoracic surgery service&#x0D; Material and methods: 95 patients are treated in our hospital during July 2004- July 2017 timeframe. Male to female was ratio 3:1. Age of presentation 9-71 years old, mean age presentation 49 years old. Blunt chest wall trauma 36 (38%) and penetraiting chest wall trauma 59 (62%) patients. Ribs and sternal fractures , two or more costal fractures in 15 (15.7%) patients (flail chest 7 patients );unilateral pneumothorax 34 (35.7%) patients ,bilaterally pmeumothorax 10 (10.5%) patients;massive hemothorax 12 (12.6%) patients , pneumomediastin et subcutaneous emphysema 6 (6.31%) patients Hammans syndrome, lung contusion and parenchimal pulmonary hemathoma in 15 (15.7%) patients; bronchial rupture 2 (2.1%) patients ,tracheal rupture 1 (1%) patient.&#x0D; Results: Only medical treatment in 22 (23%) patients,unilateral pleural tub drainage 42 (44%) patients, bilateral chest drainage 18 (18.9%) patients ;thoracotomy in 29(30.5%) patients ,wedge resection,lung hemostasis and aerostasis from lung lacerations, bronchial lobar rupture left lower lob 1 (1%) patient, bilateral thoracotomy 3 (3%) patients, clamshell incision in 1 (1%) patient;,thoracoabdominal approach 2 ( 2%) patients. flail chest wall stabilization 7 (7.3%) patients by vicryl suture ,steel wire suture 3(3%)patients,titanium plate 3(3%) patient.By VATS are treated 2(2.1%) patients.Mean hospital stay was 11 days (average 3-36 days).Morbidity rate in 6 (6.3%)patients , mortality was on 5 (5%)patients.&#x0D; Conclusion: Most common injury locations was lung and chest wall and less common abdominal and cranial trauma.Surgical and intensive treatment are very important and with low mortality rate.

P3.16-14 SBRT in Early Stages of Lung Cancer

We present the experience in our department with SBRT in early stages of lung cancer. Between April 2012 and January 2018, 59 patients with 65 different locations underwent to SBRT in early stages of lung cancer (51 men and 8 woman, with a median age of 76 years). 44 patients had histological confirmation (22 adenocarcinomas, 13 squamous cell carcinomas, 1 adenosquamous and 1 typical carcinoid). There was not histological confirmation in 15 patients. In all patients, PET-CT was used for the diagnosis. The T-stage classification (8th Edition of the TNM Classification), was the following: T1a (6), T1b (24), T1c (16), T2a (10), T2b (6), T3 (3). The treatment planning was made using vacuum body fixation and abdominal compression to reduce intrafractional organ motion. We made five CTs planning in all patients: 3 free breathing, inhalation and exhalation. The internal target volume (ITV) was delineated based on the fusion of five CTs. The planning target volume (PTV) was determined an adding additional setup margin to ITV. We made different fraction schemes, and the most used were 5x1200 cGy and 8x750 cGy. The assessment of response was performed with CT and/or PET-CT. With a median follow up of 24 months, the local control was 88%, with an overall survival of 76%. The tolerance to treatment was excellent, appearing as acute toxicity, rib pain (G1-G2) in 4 patients, asthenia (G1) in 3 patients, and as chronic toxicity, costal fracture in one patient. The local control obtained in early stages of lung cancer treated with SBRT in our series is high, with an excellent clinical tolerance.

“From today’s medical card” A case of severe wheezing caused by trachea stricture due to a costal bone fracture in Japanese black calf

“From today’s medical card” A case of severe wheezing caused by trachea stricture due to a costal bone fracture in Japanese black calf

Maladie osseuse liée à la mucoviscidose : mise au point

With the increasing life expectancy of patients with cystic fibrosis (CF), prevalence of late complications such as CF-related bone disease (CFBD) has increased. It was initially described in 24% of the adult population with CF and has also been reported in the pediatric population. CFBD is multifactorial and progresses in different steps. Both decreased bone formation and increased bone resorption (in different amounts) are observed. CFBD is likely primitive (directly related to the CFTR defect itself), but is also worsened by acquired secondary factors such as lung infections, chronic inflammation, denutrition, vitamin deficiency, and decreased physical activity. CFBD may be clinically apparent (i.e., mainly vertebral and costal fractures), or clinically asymptomatic (therefore corresponding to abnormalities in bone density and architecture). CFBD management mainly aims to prevent the occurrence of fractures. Prevention and regular monitoring of bone disease as early as 8years of age is of the utmost importance, as is the control of possible secondary deleterious CFBD factors. New radiological tools, such as high-resolution peripheral quantitative computed tomography, allow an accurate evaluation of cortical and trabecular bone micro-architecture in addition to compartmental density; as such, they will likely improve the assessment of the bone fracture threat in CF patients in the near future.

Biomechanical investigation of impact induced rib fractures of a porcine infant surrogate model

This study investigated the structural, biomechanical and fractographic features of rib fractures in a piglet model, to test the hypothesis that fist impact, apart from thoracic squeezing, may result in lateral costal fractures as observed in abused infants. A mechanical fist with an accelerometer was constructed and fixed to a custom jig. Twenty stillborn piglets in the supine position were impacted on the thoracic cage. The resultant force versus time curves from the accelerometer data showed a number of steps indicative of rib fracture. The correlation between impact force and number of fractures was statistically significant (Pearson׳s r=0.528). Of the fractures visualized, 15 completely pierced the parietal pleura of the thoracic wall, and 5 had butterfly fracture patterning. Scanning electron microscopy showed complete bone fractures, at the zone of impact, were normal to the axis of the ribs. Incomplete vertical fractures, with bifurcation, occurred on the periphery of the contact zone. This work suggests the mechanism of rib failure during a fist impact is typical of the transverse fracture pattern in the anterolateral region associated with cases of non-accidental rib injury. The impact events investigated have a velocity of ~2–3m/s, approximately 2×104 times faster than previous quasi-static axial and bending tests. While squeezing the infantile may induce buckle fractures in the anterior as well as posterior region of the highly flexible bones, a fist punch impact event may result in anterolateral transverse fractures. Hence, these findings suggest that the presence of anterolateral rib fractures may result from impact rather than manual compression.

Ribs osteosynthesis in patients with isolated and combined chest trauma

Rapid methods of costal fractures fixation using special costal plates are becoming more common. To evaluate the efficacy of ribs osteosynthesis in patients with isolated and combined chest trauma. It is presented an experience of surgical treatment of patients with costal fractures in case of isolated (30) and combined (29) chest injury. System for ribs osteosynthesis was used predominantly in surgical tactics. Immediate surgical results were analyzed. Most patients had increase of blood gas parameters, oxygenation in the postoperative period. In case of isolated chest injury mean duration of mechanical ventilation was 1.3±1.1, incidence of complications - 3.3%, mortality rate - 0%. In group of combined injuries those indexes were 4.6±3.05, 13.8% and 13.8% respectively. The method of ribs osteosynthesis in patients with isolated and combined chest trauma showed high efficiency.