First Rib Fracture Research Articles

FIRST RIB FRACTURE: STILL A MARKER OF TRAUMA SEVERITY?

First rib fractures (FRFs) have historically been a marker for severe trauma and poor outcomes. The aim of this study was to assess whether an association still exists between a fractured first rib and global trauma scores suffered by the patient, examine mortality rate and identify other commonly associated injuries.This study examined patients who presented to the Rockhampton Hospital with a traumatic FRF between the dates of July 2015 to June 2020. Patient demographics, mortality rate and additional injuries sustained by the patients were collected. The Injury Severity Score (ISS) was utilised and calculated for each patient. Analysis was conducted to determine associations between trauma scores and FRFs, mortality rate and other injuries sustained at the time of rib fracture.In total, 545 patients had a rib fracture with 48 patients identified as having an FRF. Median age was 50 years. Thirty-seven (77%) were male. The most common mechanism of FRF was motor vehicle/motorbike accidents (71%). Fifty percent of patients with an observed FRF had the highest global ISS of very severe, with 13% severe, 22% moderate and 15% mild. No patients died from their injuries. Of those with an FRF, 79% experienced fractures other than ribs, 75% had other rib fractures and 52% had chest injuries.A larger than expected proportion of FRFs were not associated with severe trauma scores or high mortality. These findings suggest that patients with an FRF may have a greater chance of surviving their traumatic FRF than previously reported. Clinicians should be aware of the potential for severity and other associated injuries, such as chest wall fractures and thoracic injuries, when treating a patient with a fracture of their first rib.

Upper Extremity Monoplegia following Prone Surrender Position for Spinal Surgery.

Background Secondary peripheral nerve injuries remain a significant perioperative problem due to patient positioning and contribute to reduced patient quality of life and exacerbated professional liability. Comorbidities and concomitant lesions can further elicit these injuries in patients undergoing spinal surgeries. Case Presentation We report a case of a 70-year-old male polytrauma patient presenting with a left first-rib fracture and an adjacent hematoma around the brachial plexus without preoperative deficits. Subsequent to a lumbar spinal fusion in the prone position, he developed a postoperative left upper extremity monoplegia. The postoperative magnetic resonance imaging revealed an enhanced asymmetric signal in the trunks and cords of the left brachial plexus. He progressively improved with rehabilitation, a year after the initial presentation, with a residual wrist drop. Conclusions Pan brachial plexus monoplegia, following spine surgery, is rare and under-reported pathology. To minimize the occurrence of this rare morbidity, appropriate considerations in preoperative evaluation and counseling, patient positioning, intraoperative anesthetic, and electrophysiological monitoring should be performed. We emphasize an unreported risk factor in polytrauma patients, predisposing this rare injury that is associated with prone spinal surgery positioning, SEPs being an extremely sensitive test intraoperatively and highlight the importance of counseling patients and families to the possibility of this rare occurrence.

First rib fracture: Still a marker of trauma severity?

First rib fractures (FRFs) have historically been a marker for severe trauma and poor outcomes. The aim of the present study was to assess whether an association still exists between a fractured first rib and global trauma scores suffered by the patient, examine mortality rates and identify other commonly associated injuries. This retrospective study examined records collected from patients from the Rockhampton Hospital with a traumatic FRF from July 2015 to June 2020. Patient demographics, mortality rate and injuries sustained were compiled. The Injury Severity Score (ISS) was utilised and calculated for each patient. Analysis was conducted to determine associations between trauma scores and FRFs. In total, 545 patients had a rib fracture with 48 patients identified as having an FRF. Median age was 50 years. Thirty-seven (77%) were male. The most common mechanism of FRF was motor vehicle/motorbike accidents (71%). Fifty percent of patients with an observed FRF had the highest global ISS of very severe, with 13% severe, 22% moderate and 15% mild. No patients died from their injuries. Of those with an FRF, 79% experienced fractures other than ribs, 75% had other rib fractures and 52% had chest injuries. A larger than expected proportion of FRFs were not associated with severe trauma scores or high mortality. These findings suggest that patients with an FRF may have a greater chance of surviving their traumatic FRF than previously reported. Clinicians should be aware of the potential for severity and specific associated injuries when treating a patient with FRFs.

第1肋骨骨折端により生じた遅発性鎖骨下動脈損傷に対して，血管内治療と骨折端摘除を併用した1例(Endovascular therapy and fractured–rib resection for delayed subclavian artery injury caused by a first rib fracture: a case report)

要旨 肋骨骨折は血管損傷をしばしば合併しうる。肋骨骨折により生じた鎖骨下動脈損傷に関して，確立された治療方針はない。63歳の男性が乗用車に衝突され受傷し，当院へ救急搬送された。Computed tomography（CT）で右第1肋骨骨折を含む両側多発肋骨骨折を認めた。第12病日，呼吸困難と血圧低下が突然生じた。造影CTで右鎖骨下動脈仮性瘤・右血胸を認め，第1肋骨骨折端により生じた鎖骨下動脈損傷と診断した。ステントグラフト留置により鎖骨下動脈損傷を修復した後，第1肋骨骨折端を摘除した。退院から1年経過した時点で，ステントグラフトの閉塞や，右肩関節の可動域制限を認めていない。第1肋骨骨折端が鎖骨下動脈近傍にある場合，鎖骨下動脈損傷を遅発性に起こす可能性がある。第1肋骨骨折端による鎖骨下動脈損傷に対して，血管内治療と骨折端摘除の併用療法は有用である。

First-Rib Fracture in a Baseball Pitcher

First-Rib Fracture in a Baseball Pitcher

Finite Element Analysis for Athletic First-rib Fracture

Finite Element Analysis for Athletic First-rib Fracture

First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

Background: First-rib fractures are relatively rare compared with fractures of other ribs because of the broad structure deeply placed and protected location of the first rib. A high amount of energy is needed to cause a first-rib fracture; violent trauma, such as that involving motor vehicle accident, is a frequent cause of these fractures, as well as other serious intra-thoracic, head, cervical spine, and intra-abdominal injuries. First-rib fractures have traditionally been considered indicators of increased injury severity and mortality in major trauma patients. The aim was to study the significance of first-rib fractures as indicators of serious intra-thoracic and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality in a high-altitude area in Al-Taif, Saudi Arabia.Methods: This is a retrospective study conducted in King Abdul-Aziz Specialist Hospital (KASH), Taif City, KSA. Patients with chest injuries who presented to the emergency department and were admitted to the hospital between November 2013 and March 2016 were included in the study. Data regarding first-rib fracture were collected, and the relationship between first-rib injuries and associated intra-thoracic and extra-thoracic injuries was analyzed.Results: There was a high incidence of first-rib fracture (23.45%), and 35.8% were bilateral. The most common associated chest injury was a pulmonary contusion (58.5%), followed by pneumothorax (32.1%), hemopneumothorax (20.7%), and surgical emphysema (20.7%). The most common associated extra-thoracic injuries in our study were skeletal injuries (47.4%), cervical spine injuries (11.3%), and head trauma (24.5%).Conclusions: Fractures of the first-rib are associated with serious thoracic and extra-thoracic injuries; they are associated only with increased morbidity in patients with polytrauma and have no independent impact on mortality.

First rib fracture: A harbinger of severe trauma?

BackgroundPrior to routine CT scanning, first rib fractures (FRFs) were considered a harbinger of great vessel injuries. We hypothesized FRFs identified on screening CXR have significant associated injuries, while those identified on CT alone do not. MethodsWe reviewed adult blunt thoracic trauma patients 2014–2015 to identify all FRFs and then tabulated demographics, injury characteristics, and outcomes. ResultsOf 429 patients with chest trauma, 56 had a FRF. CXR diagnosed 20% and CT 80%. Those diagnosed on CXR were older (61 vs 48 p = 0.03), had more severe chest trauma (45% vs 13% chest AIS>3, p = 0.029), longer ICU stays (10 vs 4 days, p = 0.046), and risk for intubation (73% vs 27%, p = 0.011). There was only one major vascular injury in each group. Most FRF patients had associated injuries, including 82% with pelvic fractures. ConclusionsWidespread use of CT scanning has resulted in a 5-fold increase in FRF diagnoses. While vascular injuries are not common, especially when identified on initial CXR, FRFs correlate with morbidity and associated injuries.

A prospective randomized trial on trauma thoracic cage with rib fracture especially first rib fracture and associated complications

Background: Thoracic cage is an osseocartilaginous cavity which not only protects and supports vital organs but also has dynamic role in mechanism of respiration. The aim was t o study the mechanism of first rib fracture, incidence and complications of first rib and other ribs’ fracture and their sequelae. Methods: A prospective randomized trial was conducted on 300 patients of trauma thoracic cage having rib fracture with or without associated injuries at NIMS Medical College and Hospital, Jaipur, Rajasthan, India from April 2013 to March 2016. All patients were examined on a fixed protocol (age, sex, mode of injury, vital status, number and site of rib fracture) with associated injury and complications. Results: Maximum patients (including males and females both) with first and other rib fractures were in the age group of 11-30 years. The most common mode of trauma was roads traffic accident (RTA). First rib fractured at shaft by indirect trauma mostly. Commonly reported chest, abdomen and associated injury complications were haemothorax, haemoperitoneum and head injury respectively. Most of the patients were treated conservatively except 1% patients who required thoracotomy. Conclusions: Most common cause of chest trauma with rib fracture was RTA and first rib fracture was indirect trauma. The most common cause of mortality was an associated head injury.

First-rib stress fracture in two adolescent swimmers: a case report

ABSTRACTFirst-rib stress fractures have been described in adolescent athletes in various sports, with only one prior case report of first-rib stress fractures in an adolescent female swimmer. There is a need for research on the cause, management, and prevention of these injuries as they lead to significant morbidity and critical time away from sport for these aspiring athletes. We aimed to describe first-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent swimmers and to discuss the different presentations, unique risk factors, treatment, and potential injury prevention strategies of such fractures. We discussed two such cases which were successfully treated with activity modification with restriction of all overhead activity, gradually progressive physical therapy and a return to swimming protocol. First-rib stress fractures can vary in presentation and should be in the differential diagnosis in adolescent swimmers with chronic shoulder pain. These injuries can be successfully managed with rest from overhead activities and physical therapy. Gradual return to competitive swimming can be achieved even with non-union of a first-rib stress fracture. Emphasis on balanced strength training in different muscle groups and proper swimming technique is essential to prevent these injuries.

Isolated Bilateral First-Rib Fractures

Introduction: Bilateral fractures of the first rib are extremely rare and usually associated with either multiple rib fractures or serious traumatic injuries. In many cases, first rib fracture is related to serious trauma of the intrathoracic, head, and cervical spine, including neurovascular injuries. We present a case report of isolated bilateral first rib resulting from fracture following falling down from approximately 3 meters in height. Case Report: A 52-year-old woman, with Glasgow coma scale score 15, fell down 2 hours ago and was admitted to the emergency department. Patient’s vital signs were stable. Breath and heart sounds and pulse examinations in the bilateral carotid arteries and upper extremities were not determined to be aberrant. The cervical spine radiographic figures were obtained as intact; however, the bilateral first ribs were fractured by direct radiography and thoracal computerized tomography. There were no other pathological findings related to the patient. Conclusion: The first rib is deeply placed and protected by the shoulder girdle and muscles, the fracture of which remains the rarest of all rib fractures. We know that potential life-threatening injuries occur with only first-rib fracture; so, we think that the potential risk of that trauma is too high in the case of bilateral firstrib fractures. Our patient was fortunate.

Dominant-Sided First-Rib Stress Fracture in a Collegiate Baseball Pitcher: A Case Report.

The incidence of asymptomatic fatigue fractures of the first rib in the young, active male population is very low; these fractures were observed in only 0.001% of retrospectively reviewed chest radiographs in one series1. First-rib fractures have been postulated to result from several primary mechanisms: high-energy direct impact such as a motor vehicle collision2, indirect trauma such as a fall on an outstretched arm3, fatigue fractures from repeated muscular contracture4, or sudden, violent muscular forces resulting in stress fractures5. Although the exact incidence of first-rib stress fracture caused by sudden muscular contracture is not known, many repetitive activities, including gymnastics, tennis, basketball, weightlifting, and even coughing or sneezing, have been associated with this mechanism6. We present the case of a first-rib stress fracture in a collegiate baseball pitcher and discuss the relevant literature. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A nineteen-year-old right-hand-dominant male collegiate baseball pitcher presented to the office with the symptom of right shoulder pain. He denied any history of trauma but stated that he had felt a popping sensation in the shoulder while pitching several days prior to presentation, and he had had pain since that time with both pitching and activities of daily living. He denied any change in the pitching mechanics or increase in the number of pitches in the preceding several weeks. He had no prior history of trauma to the spine or thorax. The pain was aggravated by the late-cocking phase of throwing. He also admitted to difficulty with deep inspiration because of the pain at the base of the neck, but had no dyspnea at rest. On examination, he was 6′8″ (203.2 cm) tall and weighed 193 lb …

Traumatic First-Rib Fracture in a Collegiate Football Player: A Case Review

Traumatic First-Rib Fracture in a Collegiate Football Player: A Case Review

Dislocation of the first costovertebral articulation on one side and fracture of first rib on another side

Costovertebral dislocation of first rib on one side and first rib fracture on other side is a rare injury. We are elaborating the diagnosis and its presentation.

An important but easily overlooked medical complication of multiple trauma

A 53-year-old man was trapped under a hydraulic lift on the back of his lorry trailer. He was found to have spinal injuries with a comminuted unstable fracture of T6 and stable fracture of T12. He had further fractures of the left first rib, right second rib, and his sternum. He was admitted to the orthopaedic ward for conservative management with a spinal splint for five weeks. He remained stable until day 20 of his admission when he became hypotensive and tachycardic. Blood tests demonstrated hyponatraemia and hyperkalaemia. Despite fluid resuscitation and emergency treatment for hyperkalaemia he remained hypotensive and hyponatraemic. An endocrine opinion was requested and he was found to have an abnormal short synacthen test (cortisol of 436 nmol/L falling to 398 nmol/L at 30 min). ACTH was high at 208 ng/L, and thyroid function tests were normal (TSH 2.02 mU/L, FT4 15.4 pmol/L) indicating an intact pituitary axis. His hypotension and electrolyte abnormality rapidly responded to glucocorticoid and mineralocorticoid treatment. A repeat short synacthen test has confirmed persistent hypoadrenalism (peak cortisol 175 nmol/L at 30 min). Although the adrenal glands lie retroperitoneally at the level of T12 which was fractured, a CT scan at the time of trauma showed no signs of adrenal gland damage. A repeat scan one year post event showed no calcification to suggest previous haemorrhage.

Fracture of first rib after sternotomy

Fracture of first rib after sternotomy

Isolated Bilateral First-Rib Fractures

Isolated Bilateral First-Rib Fractures

Stress Fracture of the First Rib in a Weightlifter

A 20-year-old woman elite weightlifter presented with acute onset debilitating right shoulder pain while attempting the "clean and jerk." There was no previous relevant history, including no prior fracture in the region. Examination confirmed vague tenderness in the right supraclavicular fossa with no discernible neurologic or vascular deficit within the right arm. X-ray was normal. The patient had a bone scan, including SPECT, suggesting a fracture of the right first rib, subsequently confirmed on CT examination.

Acute Traumatic First-Rib Fracture in the Contact Athlete

Acute Traumatic First-Rib Fracture in the Contact Athlete

肋骨骨折を合併した胸頚部鈍的外傷に伴う総頚動脈・内頚静脈損傷の１例

A thirty-year-old male was transferred to our emergency department after being injured in an automobile accident. He was conscious at the time of admission. Chest X-ray revealed fracture of the left first rib and a gradually increasing mediastinal shadow, which suggested injury to the subclavian artery. On the day of injury, the patient exhibited right hemiparesis, without any abnormality on head CT scan. There was no laterality or blood flow reduction on SPECT, and no major vessel occlusions were detected with using TCD. Thoracic CT scan revealed fractures of the 4th and 5th thoracic vertebrae, but no spinal cord injuries were found using MRI. Angiography revealed complete occlusion of the left common carotid artery and collateral circulation. His right hemiparesis gradually improved, and MRI revealed no infarcted lesion in the brain. In this case, blunt thoraco-cervical trauma caused fracture of the first rib, which has lead to injury of the carotid artery and jugular vein. These major vessel injuries led to transient hemiparesis and increasing mediastinal bleeding. Carotid artery injury is a rare complication of traumatic head and neck injury, and common carotid injury caused by thoraco-cervical trauma is extremely rare. Angiography is the gold standard for diagnosis of such vessel injuries, and aggressive examination is recommended for such complicated injuries.