Bony and Thoracic Chest Wall Injuries

  • Stefan Wirth
  • Stephan Jansen
Part of the Medical Radiology book series (MEDRAD)


Trauma is very common and has a major impact on both mortality and morbidity worldwide. More than 100,000 people die annually from the consequences of trauma in the United States. Thoracic trauma occurs in 12 persons per 1 million population daily, of which one-third require hospital admission (Mancini et al. 2014). Injuries are complexly associated with each other in up to 90 % of the cases (Traub et al. 2007) and their occurrence is regularly predictable. The following section deals with trauma mechanisms of bony and thoracic chest wall injuries, as well as their significance for diagnostic workup, treatment options and outcome.


Spinal Cord Injury Injury Severity Score Subcutaneous Emphysema Clavicle Fracture Intercostal Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. ACR A. C. o. R. (1999) ACR appropriateness criteria-suspected spine trauma [Online]. Available: Accessed 5 Feb 2016, 00:58
  2. Allman FL Jr (1967) Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 49:774–784PubMedGoogle Scholar
  3. Alton TB, Gardner MJ (2015) Scapular fractures: diagnosis and treatment plan [Online]. Medscape Multispecialty Curr Orthop Pract 26(2). Available: Accessed 4 Jan 2016, 17:36
  4. Armstrong CP, Van Der Spuy J (1984) The fractured scapula: importance and management based on a series of 62 patients. Injury 15:324–329CrossRefPubMedGoogle Scholar
  5. Audige L, Kellam JF, Lambert S, Madsen JE, Babst R, Andermahr J, Li W, Jaeger M (2014) The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement. J Shoulder Elbow Surg 23:189–196CrossRefPubMedGoogle Scholar
  6. Ball CG, Kirkpatrick AW, Laupland KB, Fox DI, Nicolaou S, Anderson IB, Hameed SM, Kortbeek JB, Mulloy RR, Litvinchuk S, Boulanger BR (2005) Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma. J Trauma 59:917–924; discussion 924–925CrossRefPubMedGoogle Scholar
  7. Barrett-Connor E, Nielson CM, Orwoll E, Bauer DC, Cauley JA (2010) Epidemiology of rib fractures in older men: osteoporotic fractures in men (MrOS) prospective cohort study. BMJ 340:c1069CrossRefPubMedPubMedCentralGoogle Scholar
  8. Barrios C Jr, Pham J, Malinoski D, Dolich M, Lekawa M, Cinat M (2010) Ability of a chest X-ray and an abdominal computed tomography scan to identify traumatic thoracic injury. Am J Surg 200:741–744; discussion 744–745CrossRefPubMedGoogle Scholar
  9. Bartonicek J, Tucek M, Fric V, Obruba P (2014) Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop 38:2163–2173CrossRefPubMedGoogle Scholar
  10. Battle CE, Hutchings H, James K, Evans PA (2013) The risk factors for the development of complications during the recovery phase following blunt chest wall trauma: a retrospective study. Injury 44:1171–1176CrossRefPubMedGoogle Scholar
  11. Begemann PG, Kemper J, Gatzka C, Stork A, Nolte-Ernsting C, Adam G (2004) Value of multiplanar reformations (MPR) in multidetector CT (MDCT) of acute vertebral fractures: do we still have to read the transverse images? J Comput Assist Tomogr 28:572–580CrossRefPubMedGoogle Scholar
  12. Bier G, Schabel C, Othman A, Bongers MN, Schmehl J, Ditt H, Nikolaou K, Bamberg F, Notohamiprodjo M (2015) Enhanced reading time efficiency by use of automatically unfolded CT rib reformations in acute trauma. Eur J Radiol 84(11):2173–2180CrossRefPubMedGoogle Scholar
  13. Brink M, Deunk J, Dekker HM, Kool DR, Edwards MJ, VAN Vugt AB, Blickman JG (2008) Added value of routine chest MDCT after blunt trauma: evaluation of additional findings and impact on patient management. AJR Am J Roentgenol 190:1591–1598CrossRefPubMedGoogle Scholar
  14. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ (2000) Rib fractures in the elderly. J Trauma 48:1040–1046; discussion 1046–1047CrossRefPubMedGoogle Scholar
  15. Burke JF (1962) Early diagnosis of traumatic rupture of the bronchus. JAMA 181:682–686CrossRefPubMedGoogle Scholar
  16. Calhoon JH, Trinkle JK (1997) Pathophysiology of chest trauma. Chest Surg Clin N Am 7:199–211PubMedGoogle Scholar
  17. Cha JR, Park KB, Ko SH (2011) Post-traumatic lumbar epidural hematoma with neurology: report of 1 case. Asian Spine J 5:130–132CrossRefPubMedPubMedCentralGoogle Scholar
  18. Chesterman JT, Satsangi PN (1966) Rupture of the trachea and bronchi by closed injury. Thorax 21:21–27CrossRefPubMedPubMedCentralGoogle Scholar
  19. Cho SH, Sung YM, Kim MS (2012) Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT. Br J Radiol 85:e845–e850CrossRefPubMedPubMedCentralGoogle Scholar
  20. Chung JH, Cox CW, Mohammed TL, Kirsch J, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Kanne JP, Kazerooni EA, Ketai LH, Ravenel JG, Saleh AG, Shah RD, Steiner RM, Suh RD (2014) American College of Radiology appropriateness criteria for blunt chest trauma. J Am Coll Radiol 11(4):345–351CrossRefPubMedGoogle Scholar
  21. Clark GC, Schecter WP, Trunkey DD (1988) Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 28:298–304CrossRefPubMedGoogle Scholar
  22. Cser I, Vajda A (1976) Bilateral fracture of the scapulae caused by a convulsive seizure (author’s transl). Arch Orthop Unfallchir 86:227–233CrossRefPubMedGoogle Scholar
  23. Curfman KR, Robitsek RJ, Salzler GG, Gray KD, Lapunzina CS, Kothuru RK, Schubl SD (2015) Massive hemothorax caused by a single intercostal artery bleed ten days after solitary minimally displaced rib fracture. Case Rep Surg 2015:120140PubMedPubMedCentralGoogle Scholar
  24. Demirhan R, Onan B, Oz K, Halezeroglu S (2009) Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interact Cardiovasc Thorac Surg 9:450–453CrossRefPubMedGoogle Scholar
  25. Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8:817–831CrossRefGoogle Scholar
  26. Ebraheim NA, Pearlstein SR, Savolaine ER, Gordon SL, Jackson WT, Corray T (1987) Scapulothoracic dissociation (closed avulsion of the scapula, subclavian artery, and brachial plexus): a newly recognized variant, a new classification, and a review of the literature and treatment options. J Orthop Trauma 1:18–23CrossRefPubMedGoogle Scholar
  27. Ecker RR, Libertini RV, Rea WJ, Sugg WL, Webb WR (1971) Injuries of the trachea and bronchi. Ann Thorac Surg 11:289–298CrossRefPubMedGoogle Scholar
  28. Emircan S, Ozguc H, Akkose Aydin S, Ozdemir F, Koksal O, Bulut M (2011) Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg 17:329–333CrossRefPubMedGoogle Scholar
  29. Euler E, Habermeyer P, Kohler W, Schweiberer L (1992) Scapula fractures – classification and differential therapy. Orthopade 21:158–162PubMedGoogle Scholar
  30. Feeman TG (2010) The mathematics of medical imaging: a beginner’s guide. Springer undergraduate texts in mathematics and technology. Springer united states, ISBN10: 0387927123, ISBN13: 9780387927121Google Scholar
  31. Fleming S, Bird R, Ratnasingham K, Sarker SJ, Walsh M, Patel B (2012) Accuracy of FAST scan in blunt abdominal trauma in a major London trauma centre. Int J Surg 10:470–474CrossRefPubMedGoogle Scholar
  32. Friederichs J, Morgenstern M, Buhren V (2014) Scapula fractures in complex shoulder injuries and floating shoulders: a classification based on displacement and instability. J Trauma Manag Outcomes 8:16CrossRefPubMedPubMedCentralGoogle Scholar
  33. Harvey E, Audige L, Herscovici D Jr, Agel J, Madsen JE, Babst R, Nork S, Kellam J (2012) Development and validation of the new international classification for scapula fractures. J Orthop Trauma 26:364–369CrossRefPubMedGoogle Scholar
  34. Helm EJ, Rahman NM, Talakoub O, Fox DL, Gleeson FV (2013) Course and variation of the intercostal artery by CT scan. Chest 143:634–639CrossRefPubMedGoogle Scholar
  35. Henry TS, Kirsch J, Kanne JP, Chung JH, Donnelly EF, Ginsburg ME, Heitkamp DE, Kazerooni EA, Ketai LH, Mccomb BL, Parker JA, Ravenel JG, Restrepo CS, Saleh AG, Shah RD, Steiner RM, Suh RD, Mohammed TL (2014) ACR Appropriateness Criteria(R) rib fractures. J Thorac Imaging 29:364–366CrossRefPubMedGoogle Scholar
  36. Homann G, Mustafa DF, Ditt H, Spengler W, Kopp HG, Nikolaou K, Horger M (2015a) Improved detection of bone metastases from lung cancer in the thoracic cage using 5- and 1-mm axial images versus a new CT software generating rib unfolding images: comparison with standard (1)(8)F-FDG-PET/CT. Acad Radiol 22:505–512CrossRefPubMedGoogle Scholar
  37. Homann G, Weisel K, Mustafa DF, Ditt H, Nikolaou K, Horger M (2015b) Improvement of diagnostic confidence for detection of multiple myeloma involvement of the ribs by a new CT software generating rib unfolded images: comparison with 5- and 1-mm axial images. Skeletal Radiol 44:971–979CrossRefPubMedGoogle Scholar
  38. Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461CrossRefPubMedGoogle Scholar
  39. Imatani RJ (1975) Fractures of the scapula: a review of 53 fractures. J Trauma 15:473–478CrossRefPubMedGoogle Scholar
  40. Inaba K, Nosanov L, Menaker J, Bosarge P, Williams L, Turay D, Cachecho R, DE Moya M, Bukur M, Carl J, Kobayashi L, Kaminski S, Beekley A, Gomez M, Skiada D (2015) Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: an American Association for the Surgery of Trauma Multi-Institutional Trials Group Study. J Trauma Acute Care Surg 78:459–465; discussion 465–467CrossRefPubMedGoogle Scholar
  41. Kaewlai R, Avery LL, Asrani AV, Novelline RA (2008) Multidetector CT of blunt thoracic trauma. Radiographics 28:1555–1570CrossRefPubMedGoogle Scholar
  42. Katrancioglu O, Akkas Y, Arslan S, Sahin E (2015) Spontaneous rib fractures. Asian Cardiovasc Thorac Ann 23:701–703CrossRefPubMedGoogle Scholar
  43. Kessel B, Dagan J, Swaid F, Ashkenazi I, Olsha O, Peleg K, Givon A, Alfici R (2014) Rib fractures: comparison of associated injuries between pediatric and adult population. Am J Surg 208:831–834CrossRefPubMedGoogle Scholar
  44. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S (2004) Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma Inj Infect Crit Care 57:288–295CrossRefGoogle Scholar
  45. Kirsh MM, Orringer MB, Behrendt DM, Sloan H (1976) Management of tracheobronchial disruption secondary to nonpenetrating trauma. Ann Thorac Surg 22:93–101CrossRefPubMedGoogle Scholar
  46. Knobloch K, Wagner S, Haasper C, Probst C, Krettek C, Otte D, Richter M (2006) Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims. Ann Thorac Surg 82:444–450CrossRefPubMedGoogle Scholar
  47. Knobloch K, Wagner S, Haasper C, Probst C, Krettek C, Vogt PM, Otte D, Richter M (2008) Sternal fractures are frequent among polytraumatised patients following high deceleration velocities in a severe vehicle crash. Injury 39:36–43CrossRefPubMedGoogle Scholar
  48. Lalande E, Wylie K (2014) Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: ultrasound in the diagnosis of rib fractures. Emerg Med J 31:169–170PubMedGoogle Scholar
  49. Lee RB, Bass SM, Morris JA Jr, Mackenzie EJ (1990) Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma 30:689–694CrossRefPubMedGoogle Scholar
  50. Locicero J 3rd, Mattox KL (1989) Epidemiology of chest trauma. Surg Clin North Am 69:15–19CrossRefPubMedGoogle Scholar
  51. Lomoschitz FM, Eisenhuber E, Linnau KF, Peloschek P, Schoder M, Bankier AA (2003) Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms. Eur J Radiol 48:61–70CrossRefPubMedGoogle Scholar
  52. Macklin MT, Macklin CC (1944) Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine 23:281–358CrossRefGoogle Scholar
  53. Magu S, Yadav A, Agarwal S (2009) Computed tomography in blunt chest trauma. Indian J Chest Dis Allied Sci 51:75–81PubMedGoogle Scholar
  54. Mancini MC, Talavera F, Karwande SV, Geibel J, Roe BB, Sawyer MAJ, Jablons DM, Kukreja J (2014) Blunt chest trauma: overview, relevant anatomy, workup [Online]. Available: Accessed 9 Oct 2015, 14:54
  55. Mathews RE, Cocke TB, D’Ambrosia RD (1983) Scapular fractures secondary to seizures in patients with osteodystrophy. Report of two cases and review of the literature. J Bone Joint Surg Am 65:850–853PubMedGoogle Scholar
  56. Matsushima K, Frankel HL (2011) Beyond focused assessment with sonography for trauma: ultrasound creep in the trauma resuscitation area and beyond. Curr Opin Crit Care 17:606–612CrossRefPubMedGoogle Scholar
  57. Mcgahan JP, Rab GT, Dublin A (1980) Fractures of the scapula. J Trauma 20:880–883CrossRefPubMedGoogle Scholar
  58. Melton LJ 3rd, Kallmes DF (2006) Epidemiology of vertebral fractures: implications for vertebral augmentation. Acad Radiol 13:538–545CrossRefPubMedGoogle Scholar
  59. Mettler FA, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog [Online]. Available: Accessed 9 Jan 2016, 18:45
  60. Mirvis SE, Kubal WS, Shanmuganathan K, Soto JA, Yu J (2014) Problem solving in emergency radiology. Elsevier – Health Sciences Division, Saunders; 1 Har/Psc edition 592 pages, ISBN-10: 145575417X, ISBN-13: 978-1455754175Google Scholar
  61. Mueck FG, Wirth K, Muggenthaler M, Kreimeier U, Geyer L, Kanz KG, Linsenmaier U, Wirth S (2016) Radiological mass casualty incident (MCI) workflow analysis: single-centre data of a mid-scale exercise. Br J Radiol 0:20150918, 89:1061. doi: 10.1259/bjr.20150918
  62. Nedeltchev K, Baumgartner RW (2005) Traumatic cervical artery dissection. Front Neurol Neurosci 20:54–63CrossRefPubMedGoogle Scholar
  63. Neuerburg C, Schmidmaier R, Schilling S, Kammerlander C, Bocker W, Mutschler W, Stumpf U (2015) [Identification, diagnostics and guideline conform therapy of osteoporosis (DVO) in trauma patients: a treatment algorithm]. Unfallchirurg 118(11):913–924CrossRefPubMedGoogle Scholar
  64. Neuhaus V, Bot AG, Guitton TG, Ring DC, Abdel-Ghany MI, Abrams J, Abzug JM, Adolfsson LE, Balfour GW, Bamberger HB, Barquet A, Baskies M, Batson WA, Baxamusa T, Bayne GJ, Begue T, Behrman M, Beingessner D, Biert J, Bishop J, Alves MB, Boyer M, Brilej D, Brink PR, Brunton LM, Buckley R, Cagnone JC, Calfee RP, Campinhos LA, Cassidy C, Catalano L 3rd, Chivers K, Choudhari P, Cimerman M, Conflitti JM, Costanzo RM, Crist BD, Cross BJ, Dantuluri P, Darowish M, De Bedout R, Decoster T, Dennison DG, Denoble PH, Desilva G, Dienstknecht T, Duncan SF, Duralde XA, Durchholz H, Egol K, Ekholm C, Elias N, Erickson JM, Esparza JD, Fernandes CH, Fischer TJ, Fischmeister M, Forigua Jaime E, Getz CL, Gilbert RS, Giordano V, Glaser DL, Gosens T, Grafe MW, Filho JE, Gray RR, Gulotta LV, Gummerson NW, Hammerberg EM, Harvey E, Haverlag R, Henry PD, Hobby JL, Hofmeister EP, Hughes T, Itamura J, Jebson P, Jenkinson R, Jeray K, Jones CM, Jones J, Jubel A, Kaar SG, Kabir K, Kaplan FT, Kennedy SA, Kessler MW, Kimball HL, Kloen P, Klostermann C, Kohut G, Kraan GA, Kristan A, Loebenberg MI, Malone KJ, Marsh L, Martineau PA, Mcauliffe J, Mcgraw I, Mehta S et al (2014) Scapula fractures: interobserver reliability of classification and treatment. J Orthop Trauma 28:124–129CrossRefPubMedGoogle Scholar
  65. Paffrath T, Lefering R, Flohe S (2014) How to define severely injured patients? – an Injury Severity Score (ISS) based approach alone is not sufficient. Injury 45(Suppl 3):S64–S69CrossRefPubMedGoogle Scholar
  66. Palvanen M, Kannus P, Niemi S, Parkkari J (2004) Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoporos Int 15:649–653CrossRefPubMedGoogle Scholar
  67. Pluskiewicz W, Wilk R, Wielgorecki A, Golba KS, Drozdzowska B (2011) Fracture status in men assessed by quantitative ultrasound measurements at the calcaneus. J Ultrasound Med 30:877–882PubMedGoogle Scholar
  68. Pneumaticos SG, Triantafyllopoulos GK, Giannoudis PV (2013) Advances made in the treatment of thoracolumbar fractures: current trends and future directions. Injury 44:703–712CrossRefPubMedGoogle Scholar
  69. Raskin MM (2001) Why radiologists get sued [Online]. Medscape Multisecialty Appl Radiol 30(8). Available: Accessed 2 Jan 2016, 15:54
  70. Reissig A, Copetti R, Kroegel C (2011) Current role of emergency ultrasound of the chest. Crit Care Med 39:839–845CrossRefPubMedGoogle Scholar
  71. Ringl H, Lazar M, Topker M, Woitek R, Prosch H, Asenbaum U, Balassy C, Toth D, Weber M, Hajdu S, Soza G, Wimmer A, Mang T (2015) The ribs unfolded – a CT visualization algorithm for fast detection of rib fractures: effect on sensitivity and specificity in trauma patients. Eur Radiol 25:1865–1874CrossRefPubMedGoogle Scholar
  72. Rothlin MA, Naf R, Amgwerd M, Candinas D, Frick T, Trentz O (1993) Ultrasound in blunt abdominal and thoracic trauma. J Trauma 34:488–495CrossRefPubMedGoogle Scholar
  73. Rowe CR (1963) Fractures of the scapula. Surg Clin North Am 43:1565–1571CrossRefPubMedGoogle Scholar
  74. Rozycki GS, Tremblay L, Feliciano DV, Tchorz K, Hattaway A, Fountain J, Pettitt BJ (2002) A prospective study for the detection of vascular injury in adult and pediatric patients with cervicothoracic seat belt signs. J Trauma 52:618–623; discussion 623–624PubMedGoogle Scholar
  75. Sajjan SG, Barrett-Connor E, Mchorney CA, Miller PD, Sen SS, Siris e (2012) Rib fracture as a predictor of future fractures in young and older postmenopausal women: National Osteoporosis Risk Assessment (NORA). Osteoporos Int 23:821–828CrossRefPubMedGoogle Scholar
  76. Salimi J, Khaji A, Karbakhsh M, Saadat S, Eftekhar B (2008) Scapular fracture: lower severity and mortality. Sao Paulo Med J 126:186–189CrossRefPubMedGoogle Scholar
  77. Scheurecker G (2015) Traumatic bone and cartilage injuries of the shoulder. Radiologe 55:188–194CrossRefPubMedGoogle Scholar
  78. Schnyder P, Wintermark M (2000) Trauma of the chest wall. In: Radiology of blunt trauma of the chest, 1st edn. Springer, Berlin/HeidelbergCrossRefGoogle Scholar
  79. Schofer MD, Sehrt AC, Timmesfeld N, Stormer S, Kortmann HR (2009) Fractures of the scapula: long-term results after conservative treatment. Arch Orthop Trauma Surg 129:1511–1519CrossRefPubMedGoogle Scholar
  80. Schulz-Drost S, Oppel P, Grupp S, Krinner S, Langenbach A, Lefering R, Mauerer A (2015a) [Bony injuries of the thoracic cage in multiple trauma : Incidence, concomitant injuries, course and outcome]. Unfallchirurg doi  10.1007/s00113-015-0026-7
  81. Schulz-Drost S, Oppel P, Grupp S, Taylor D, Krinner S, Langenbach A, Hennig F, Mauerer A (2015b) The oblique fracture of the manubrium sterni caused by a seatbelt-a rare injury? Treatment options based on the experiences gained in a level I trauma centre. Int Orthop doi:  10.1007/s00264-015-2801-z
  82. Shalhub S, Starnes BW, Hatsukami TS, Karmy-Jones R, Tran NT (2011) Repair of blunt thoracic outlet arterial injuries: an evolution from open to endovascular approach. J Trauma 71:E114–E121CrossRefPubMedGoogle Scholar
  83. Shanmuganathan K, Matsumoto J (2006) Imaging of penetrating chest trauma. Radiol Clin North Am 44:38, viiiGoogle Scholar
  84. Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A (1987) Blunt thoracic trauma. Analysis of 515 patients. Ann Surg 206:200–205CrossRefPubMedPubMedCentralGoogle Scholar
  85. Sirmali M, Turut H, Topcu S, Gulhan E, Yazici U, Kaya S, Tastepe I (2003) A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg 24:133–138CrossRefPubMedGoogle Scholar
  86. Skinner DL, DEN Hollander D, Laing GL, Rodseth RN, Muckart DJ (2015) Severe blunt thoracic trauma: differences between adults and children in a level I trauma centre. S Afr Med J 105:47–51CrossRefPubMedGoogle Scholar
  87. Stephan K, Huber S, Haberle S, Kanz KG, Buhren V, Van Griensven M, Meyer B, Biberthaler P, Lefering R, Huber-Wagner S (2015) Spinal cord injury – incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU. Spine J 15:1994–2001CrossRefPubMedGoogle Scholar
  88. Thompson DA, Flynn TC, Miller PW, Fischer RP (1985) The significance of scapular fractures. J Trauma 25:974–977CrossRefPubMedGoogle Scholar
  89. Tillou A, Gupta M, Baraff LJ, Schriger DL, Hoffman JR, Hiatt JR, Cryer HM (2009) Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma 67:779–787CrossRefPubMedGoogle Scholar
  90. Tonkopi E, Ross AA (2016) Assessment of effective dose from cone beam CT imaging in SPECT/CT examination in comparison with other modalities. Radiat Prot Dosimetry (Epub ahead of print)Google Scholar
  91. Traub M, Stevenson M, Mcevoy S, Briggs G, Lo SK, Leibman S, Joseph T (2007) The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury 38:43–47CrossRefPubMedGoogle Scholar
  92. Turkalj I, Petrovic K, Stojanovic S, Petrovic D, Brakus A, Ristic J (2014) Blunt chest trauma – an audit of injuries diagnosed by the MDCT examination. Vojnosanit Pregl 71:161–166CrossRefPubMedGoogle Scholar
  93. Vevaina J, Bone RC, Kassoff E (2012) Legal aspects of medicine: including cardiology, pulmonary medicine, and critical care medicine. Springer, New YorkGoogle Scholar
  94. Veysi VT, Mittal R, Agarwal S, Dosani A, Giannoudis PV (2003) Multiple trauma and scapula fractures: so what? J Trauma 55:1145–1147CrossRefPubMedGoogle Scholar
  95. Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV (2009) Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop 33:1425–1433CrossRefPubMedPubMedCentralGoogle Scholar
  96. Watts NB, Lewiecki EM, Miller PD, Baim S (2008) National Osteoporosis Foundation 2008 Clinician’s Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J Clin Densitom 11:473–477CrossRefPubMedGoogle Scholar
  97. Weening B, Walton C, Cole PA, Alanezi K, Hanson BP, Bhandari M (2005) Lower mortality in patients with scapular fractures. J Trauma 59:1477–1481CrossRefPubMedGoogle Scholar
  98. Welter S, Hoffmann H (2013) Injuries to the tracheo-bronchial tree. Zentralbl Chir 138:111–116CrossRefPubMedGoogle Scholar
  99. Wiedemann E (2004) Fractures of the scapula. Unfallchirurg 107:1124–1133CrossRefPubMedGoogle Scholar
  100. Wilkerson RG, Stone MB (2010) Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med 17:11–17CrossRefPubMedGoogle Scholar
  101. Wirth S (2014) Polytraumabefundung: Wenn jede Sekunde zählt. Reiser M, 8. Internationales Symposium Mehrschicht-CT und Aktualisierungskurs Fachkunde Strahlenschutz nach RöV und StrlSchV (inkl. CT-Grundkurs: Protokolle und Anwendungen für Ärzte und MTRAs), Garmisch-Partenkirchen, 22–25 January 2014; [wissenschaftliches Programm]. EurokongressGoogle Scholar
  102. Wirth S (2016) Wann brauchen wir notfallmäßig ein MRT? 9. Internationales Symposium Mehrschicht CT, Garmisch-Partenkirchen [Online]. Available: Accessed 14 Feb 2016, 19:47
  103. Wirth S, Treitl M (2012) The role of interventional radiology. In: Scaglione M, Linsenmaier U, Schueller G (eds) Emergency radiology of the abdomen: imaging features and differential diagnosis for a timely management approach. Springer, Milan/New YorkGoogle Scholar
  104. Wirth S, Korner M, Treitl M, Linsenmaier U, Leidel BA, Jaschkowitz T, Reiser MF, Kanz KG (2009) Computed tomography during cardiopulmonary resuscitation using automated chest compression devices – an initial study. Eur Radiol 19:1857–1866CrossRefPubMedGoogle Scholar
  105. World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129Google Scholar
  106. World Health Organization (2004) WHO scientific group on the asessment of osteoporosis at primary health care level [Online]. Available: Accessed 2 Nov 2015, 18:57
  107. World Health Organization (2015a) Road traffic injuries [Online]. Available: Accessed 8 Oct 2015, 15:20
  108. World Health Organization (2015b) Spinal cord injury [Online]. Available: Accessed 8 Oct 2015, 15:12
  109. Wuermser LA, Achenbach SJ, Amin S, Khosla S, Melton LJ, 3rd (2011) What accounts for rib fractures in older adults? J Osteoporos 2011:457591CrossRefPubMedPubMedCentralGoogle Scholar
  110. Ziegler DW, Agarwal NN (1994) The morbidity and mortality of rib fractures. J Trauma 37:975–979CrossRefPubMedGoogle Scholar

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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Insitute for Clinical RadiologyHospital of the Ludwig-Maximilians-UniversityMunichGermany
  2. 2.Ludwig-Maximilians-UniversityMunichGermany

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