Abstract
Costal cartilage injuries are frequently overlooked and yet can cause significant long-term morbidity. The taxonomy has been variable and failed to address the anatomic relationships of the costal cartilages. Management has been generally conservative, although this is changing as the evidence base increases. This is reliant on accurate coding of costal cartilage injuries, which is currently lacking, and the literature is based on case reports and small case series, with no prospective interventional clinical trials. This chapter addresses anatomy and taxonomy, investigation and management of costal cartilage injuries, including those of the costal cartilages, costochondral, sternochondral and interchondral joints, and injuries related to the costal margin.
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References
Nummela MT, Bensch FV, Pyhältö TT, Koskinen SK. Incidence and imaging findings of costal cartilage fractures in patients with blunt chest trauma: a retrospective review of 1461 consecutive whole-body CT examinations for trauma. Radiology. 2018;286(2):696–704.
Turk F, Kurt AB, Saglam S. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 2010;17(6):473–7.
Subhas N, Kline MJ, Moskal MJ, et al. MRI evaluation of costal cartilage injuries. AJR Am J Roentgenol. 2008;191(1):129–32.
Edwards JG, Clarke P, Pieracci F, et al. chest wall injury society: an international delphi consensus survey to agree definitions for multiple rib fractures. J Trauma Acute Care Surg. 2020;88(2):e40. https://doi.org/10.1097/TA.0000000000002282.
Clarke P, Simpson R, Dorman JR, et al. Determining the clinical significance of the chest wall injury society taxonomy for multiple rib fractures. J Trauma Acute Care Surg. 2019;87(6):1282–8. https://doi.org/10.1097/TA.0000000000002519.
Zotzmann V, Rilinger J, Lang CN, et al. Early full-body computed tomography in patients after extracorporeal cardiopulmonary resuscitation (eCPR). Resuscitation. 2020;146:149–54.
Gooseman MR, Rawashdeh M, Mattam K, et al. Unifying classification of transdiaphragmatic intercostal hernia and other costal margin injuries. Eur J Cardiothorac Surg. 2019;56(1):150–8.
Elliott DS, Newman KJH, Forward DP, et al. A unified theory of bone healing and nonunion: BHN theory. Bone Joint J. 2016;98-B(7):884.
Forman JL, Kent RW. The effect of calcification on the structural mechanics of the costal cartilage. Comput Methods Biomech Biomed Engin. 2014;17(2):94–107. https://doi.org/10.1080/10255842.2012.671307. Epub 2012 Apr 19.
Gao E, Li Y, Zhao T, et al. Simultaneous surgical treatment of sternum and costal cartilage fractures. Ann Thorac Surg. 2019;107(2):e119–20. https://doi.org/10.1016/j.athoracsur.2018.06.044.
Prins JTH, Wijffels MME. Operative treatment of multiple costochondral dislocations in a patient with severe rib fractures and a flail chest following trauma. BMJ Case Rep. 2021;14(3):e239511. https://doi.org/10.1136/bcr-2020-239511.
Sollender GE, White TW, Pieracci FM. Fracture of the costal cartilage: presentation, diagnosis, and management. Ann Thorac Surg. 2019;107(4):e267–8. https://doi.org/10.1016/j.athoracsur.2018.08.076. Epub 2018 Oct 22.
Schulz-Drost S, Luber AM, Simon K, et al. Elastic stable chest repair and its hybrid variants in 86 patients with pectus excavatum. J Thorac Dis. 2018;10(10):5736–46. https://doi.org/10.21037/jtd.2018.09.148.
Claydon O, Benamore R, Belcher E. Outcomes of chest wall fixation in cardiopulmonary resuscitation-induced flail chest. Interact Cardiovasc Thorac Surg. 2020;31(3):417–8. https://doi.org/10.1093/icvts/ivaa118.
Drahos A, Fitzgerald M, Ashley D, Christie DB 3rd. Chest wall stabilization with rib plating after cardiopulmonary resuscitation. J Thorac Dis. 2019;11(Suppl 8):S1103–5. https://doi.org/10.21037/jtd.2018.12.51.
Smith-Singares E. Thoracolaparoscopic management of a traumatic subacute transdiaphragmatic intercostal hernia. Second case reported. Trauma Case Rep. 2020;28:100314. Published 2020 May 29. https://doi.org/10.1016/j.tcr.2020.100314.
Cerfolio RJ, Price TN, Bryant AS, et al. Intracostal sutures decrease the pain of thoracotomy. Ann Thorac Surg. 2003;76(2):407–11; discussion 411-2. https://doi.org/10.1016/s0003-4975(03)00447-8.
Mary Parks R, Jadoon M, Duffy J. Nontraumatic rupture of the costal margin: a single-center experience. Asian Cardiovasc Thorac Ann. 2019;27(2):105–9. https://doi.org/10.1177/0218492318823367.
Sinopoli J, Strong A, Kroh M, et al. Spontaneous chest wall herniation in centrally obese patients: a single-center experience of a rare problem. Am Surg. 2021;87(2):222–7. https://doi.org/10.1177/0003134820950280. Sep 15:3134820950280.
Meinberg E, Agel J, Roberts C, et al. Fracture and dislocation classification compendium. J Orthop Trauma. 2018;32(1 Suppl):S161–5.
Moore EE, Malangoni MA, Cogbill TH, et al. Organ injury scaling IV: thoracic vascular, lung, cardiac and diaphragm. J Trauma. 1994;36:229–300.
Moore EE, Cognill TH, Jurkovich GJ, et al. Organ injury scaling III: chest wall, abdominal vascular, ureter, bladder and urethra. J Trauma. 1992;33:337–9.
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Edwards, J.G. (2022). Costal Cartilage Injury. In: Shiroff, A.M., Seamon, M.J., Kaplan, L.J. (eds) Management of Chest Trauma. Springer, Cham. https://doi.org/10.1007/978-3-031-06959-8_7
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