Investigation of the relationship of the number, localization, and displacement of rib fractures with intrathoracic structures and abdominal solid organ complications using computed tomography

Abstract

Purpose

This study aimed at evaluating the fracture properties, intrathoracic structures, and abdominal solid organ complications in patients with traumatic rib fractures.

Methods

Chest CT images of 305 patients were retrospectively evaluated to determine the number and level of rib fractures and measure the magnitude of displacement. The relationship of rib fractures and displacement patterns with intrathoracic structures and abdominal solid organ complications was investigated.

Results

The fractures were most located in the fifth, sixth, and seventh ribs. The mean age of the patients with displaced fractures was statistically significantly higher than the non-displaced fracture group with pneumothorax, hemothorax or lung injury. RibScore was statistically significantly higher in patients with pneumothorax, hemothorax, and lung parenchyma injury, as well as those with liver, spleen, and kidney injury. Hepatic, splenic, and renal injuries were markedly higher in patients with displaced fractures, but this was not statistically significant. Spleen and kidney injuries were statistically significantly more frequent among the patients with the fractures of the 10th to 12th ribs. The rib fracture displacement cut-off values for pneumothorax, hemothorax, and lung injury were found to be 2.18 mm, 2.32 mm, and 2.82 mm, respectively.

Conclusion

The presence of a displaced rib fracture is a strong predictor of intrathoracic complications. A more careful intrathoracic evaluation of rib fractures with more than 2 mm displacement will contribute to patient management.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Kani KK, Mulcahy H, Porrino JA, Chew FS. Thoracic cage injuries. Eur J Radiol. 2019;110:225–32.

    Article  Google Scholar 

  2. 2.

    Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am CollSurg. 2003;196(4):549–55.

    Google Scholar 

  3. 3.

    Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracic trauma. Radiographics. 2008;28(6):1555–70. https://doi.org/10.1148/rg.286085510.

    Article  PubMed  Google Scholar 

  4. 4.

    Dennis BM, Bellister SA, Guillamondegui OD. Thoracic trauma. SurgClin North Am. 2017;97(5):1047–64.

    Article  Google Scholar 

  5. 5.

    Bugaev N, Breeze JL, Alhazmi M, Anbari HS, Arabian SS, Rabinovici R. Displacement patterns of blunt rib fractures and their relationship to thoracic coinjuries: minimal displacements count. Am Surg. 2016;82(3):199–206.

    Article  Google Scholar 

  6. 6.

    Chien CY, Chen YH, Han ST, Blaney GN, Huang TS, Chen KF. The number of displaced rib fractures is more predictive for complications in chest trauma patients. Scand J Trauma ResuscEmerg Med. 2017;25(1):19. https://doi.org/10.1186/s13049-017-0368-y.

    Article  Google Scholar 

  7. 7.

    Sirmali M, Türüt H, Topçu S, Gülhan E, Yazici U, Kaya S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J CardiothoracSurg. 2003;24(1):133–8.

    Article  Google Scholar 

  8. 8.

    Edwards JG, Clarke P, Pieracci FM, et al. Taxonomy of multiple rib fractures: results of the chest wall injury society international consensus survey. J Trauma Acute Care Surg. 2020;88(2):e40–5.

    Article  Google Scholar 

  9. 9.

    Lu MS, Huang YK, Liu YH, Liu HP, Kao CL. Delayed pneumothorax complicating minor rib fracture after chest trauma. Am J Emerg Med. 2008;26(5):551–4. https://doi.org/10.1016/j.ajem.2007.08.022.

    Article  PubMed  Google Scholar 

  10. 10.

    Al-Hassani A, Abdulrahman H, Afifi I, Almadani A, Al-Den A, Al-Kuwari A, et al. Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury. Am Surg. 2010;76(8):888–91.

    Article  Google Scholar 

  11. 11.

    Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43(1):8–17.

    Article  Google Scholar 

  12. 12.

    Majercik S, Cannon Q, Granger SR, VanBoerum DH, White TW. Long-term patient outcomes after surgical stabilization of rib fractures. Am J Surg. 2014;208(1):88–92.

    Article  Google Scholar 

  13. 13.

    Chapman BC, Herbert B, Rodil M, et al. RibScore: a novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy. J Trauma Acute Care Surg. 2016;80(1):95–101.

    Article  Google Scholar 

  14. 14.

    Talbot BS, Gange CJ, Chaturvedi A, et al. Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment. Radiographics. 2017;37:628–51.

    Article  Google Scholar 

  15. 15.

    Pressley CM, Fry WR, Philp AS, Berry SD, Smith RS. Predicting outcome of patients with chest wall injury. Am J Surg. 2012;204(6):910–4.

    Article  Google Scholar 

  16. 16.

    Fokin A, Wycech J, Crawford M, Puente I. Quantification of rib fractures by different scoring systems. J Surg Res. 2018;229:1–8.

    Article  Google Scholar 

  17. 17.

    Support ATL. Student course manual. 9th ed. Maywood, IL: American College of Surgeons Committee on Trauma; 2012.

    Google Scholar 

  18. 18.

    Shweiki E, Klena J, Wood GC, Indeck M. Assessing the true risk of abdominal solid organ injury in hospitalized rib fracture patients. J Trauma. 2001;50(4):684–8.

    CAS  Article  Google Scholar 

Download references

Funding

There is no funding.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Muhammed Said Beşler.

Ethics declarations

Conflict of ınterest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Parlak, S., Beşler, M.S. Investigation of the relationship of the number, localization, and displacement of rib fractures with intrathoracic structures and abdominal solid organ complications using computed tomography. Eur J Trauma Emerg Surg (2020). https://doi.org/10.1007/s00068-020-01547-2

Download citation

Keywords

  • Computed tomography
  • Rib fracture
  • Pneumothorax
  • Hemothorax