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Pathophysiology of Rib Fractures and Lung Contusion

  • Jeffrey J. Skubic
  • Barbara U. Okafor
  • Deepika Nehra
Chapter

Abstract

Rib fractures and lung contusions are common among traumatically injured patients and are a major source of morbidity and mortality. These injuries typically result from significant force to the chest wall most commonly blunt in nature, but penetrating mechanisms can also be implicated. The effective care of these patients necessitates an understanding of the pathophysiology of the disease, which we will review in this chapter. We will start with a review of the relevant anatomy followed by a discussion focused on the pathophysiology of rib fractures and pulmonary contusions in addition to associated conditions involving the chest such as hemothoraces and pneumothoraces. We will conclude with a discussion of differences in pathophysiology among patients at the extremes of age.

Keywords

Rib fracture Pulmonary contusion Lung contusion Hemothorax Pneumothorax Flail chest 

References

  1. 1.
    Sharma OP, Oswanski MF, Jolly S, Lauer SK, Dressel R, Stombaugh HA. Perils of rib fractures. Am Surg. 2008;74(4):310–4.PubMedGoogle Scholar
  2. 2.
    Majercik S, Pieracci FM. Chest wall trauma. Thorac Surg Clin. 2017;27(2):113–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Gupta A, Jamshidi M, Rubin JR. Traumatic first rib fracture: is angiography necessary? A review of 730 cases. Cardiovasc Surg. 1997;5(1):48–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Livoni JP, Barcia TC. Fracture of the first and second rib: incidence of vascular injury relative to type of fracture. Radiology. 1982;145(1):31–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Rostas JW, Lively TB, Brevard SB, Simmons JD, Frotan MA, Gonzalez RP. Rib fractures and their association with solid organ injury: higher rib fractures have greater significance for solid organ injury screening. Am J Surg. 2017;213(4):791–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the national trauma data bank. J Trauma Acute Care Surg. 2014;76(2):462–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: an eastern Association for the Surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Oppenheimer L, Craven KD, Forkert L, Wood LD. Pathophysiology of pulmonary contusion in dogs. J Appl Physiol Respir Environ Exerc Physiol. 1979;47(4):718–28.PubMedGoogle Scholar
  9. 9.
    Davis KA, Fabian TC, Croce MA, Proctor KG. Prostanoids: early mediators in the secondary injury that develops after unilateral pulmonary contusion. J Trauma. 1999;46(5):824–31. discussion 831-822CrossRefPubMedGoogle Scholar
  10. 10.
    Moomey CB Jr, Fabian TC, Croce MA, Melton SM, Proctor KG. Determinants of myocardial performance after blunt chest trauma. J Trauma. 1998;45(6):988–96.CrossRefPubMedGoogle Scholar
  11. 11.
    Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003;23(3):374–8.CrossRefPubMedGoogle Scholar
  12. 12.
    MacLeod JB, Ustin JS, Kim JT, Lewis F, Rozycki GS, Feliciano DV. The epidemiology of traumatic hemothorax in a level I trauma center: case for early video-assisted thoracoscopic surgery. Eur J Trauma Emerg Surg. 2010;36(3):240–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Earl-Royal E, Shofer F, Ruggieri D, Frasso R, Holena D. Variation of blunt traumatic injury with age in older adults: statewide analysis 2011–14. West J Emerg Med. 2016;17(6):702–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Shulzhenko NO, Zens TJ, Beems MV, et al. Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma. Surgery. 2017;161(4):1083–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):717–23. discussion 723-715CrossRefPubMedGoogle Scholar
  16. 16.
    Sirmali M, Turut H, Topcu S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24(1):133–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Skinner DL, den Hollander D, Laing GL, Rodseth RN, Muckart DJ. Severe blunt thoracic trauma: differences between adults and children in a level I trauma Centre. S Afr Med J. 2015;105(1):47–51.CrossRefPubMedGoogle Scholar
  18. 18.
    Rosenberg G, Bryant AK, Davis KA, Schuster KM. No breakpoint for mortality in pediatric rib fractures. J Trauma Acute Care Surg. 2016;80(3):427–32.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jeffrey J. Skubic
    • 1
  • Barbara U. Okafor
    • 1
  • Deepika Nehra
    • 1
  1. 1.Division of Trauma, Burns and Surgical Critical Care, Department of SurgeryBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

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