Materiały źródłowe

• #1 Epidemiology and outcome of rib fractures: a nationwide study in the Netherlands

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8825616/

  Rib fractures following thoracic trauma are frequently encountered injuries and associated with a significant morbidity and mortality. The aim of this study was to provide current data on the epidemiology, in-hospital outcomes and 30-day mortality of rib fractures, and to evaluate these results for different subgroups. […] A total of 14,850 patients were admitted between 2015 and 2017 with one or more rib fractures, which was 6.0% of all trauma patients. […] The incidence rate of patients with rib fractures for the entire cohort was 29 per 100.000 person-years. The overall 30-day mortality was 6.9% (n=1208) with higher rates observed in flail chest (11.9%), polytrauma (14.8%), and elderly patients (11.7%). […] Rib fractures are a relevant and frequently occurring problem among the trauma population. Subgroup analyses showed that there is a substantial heterogeneity among patients with rib fractures with considerable differences regarding the epidemiology, in-hospital outcomes, and 30-day mortality.

• #2

  https://link.springer.com/article/10.1007/s00068-020-01412-2

  Rib fractures following thoracic trauma are frequently encountered injuries and associated with a significant morbidity and mortality. The aim of this study was to provide current data on the epidemiology, in-hospital outcomes and 30-day mortality of rib fractures, and to evaluate these results for different subgroups. […] A total of 14,850 patients were admitted between 2015 and 2017 with one or more rib fractures, which was 6.0% of all trauma patients. […] The incidence rate of patients with rib fractures for the entire cohort was 29 per 100.000 person-years. […] The overall 30-day mortality was 6.9% (n=1208) with higher rates observed in flail chest (11.9%), polytrauma (14.8%), and elderly patients (11.7%). […] Rib fractures are a relevant and frequently occurring problem among the trauma population.

• #3 Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank | Trauma Surgery & Acute Care Open

  https://tsaco.bmj.com/content/5/1/e000441

  Traumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. […] The primary aim of this nationwide database study was to determine the epidemiology, injury characteristics and in-hospital outcomes of patients with traumatic rib fractures. […] Traumatic rib fractures must be considered as a surrogate marker of severe injury, as about half of our cohort consisted of patients with polytrauma. […] The highest mortality rate was observed among patients with flail chest (13.0%), followed by patients with polytrauma (10.6%) and elderly patients (7.6%). […] This study primarily shows that patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. […] Future studies should recognize these differences and treatment should be evaluated accordingly.

• #4 Rib fractures | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/rib-fractures?embed_domain=external.radpair.com%25252527%2525255b0%2525255dfavicon.icofavicon.icofavicon.ico&lang=us

  Rib fractures are a common consequence of trauma and can cause life-threatening complications. […] Rib fractures are often associated with other injuries and the greater the number of rib fractures the more likely are associated injuries. […] The 4th-10th ribs are the most commonly fractured. […] Fractures of the 1st-3rd ribs are associated with high-energy trauma. […] Rib fractures themselves are treated symptomatically and have a good prognostic outcome. […] Aside from immediate traumatic complications outlined above atelectasis and pneumonia may develop, mainly due to poor respiratory effort secondary to pain, and this increases the morbidity and mortality due to rib fractures. […] The number of displaced rib fractures is more predictive for complications in chest trauma patients. […] Epidemiology of Rib Fractures in Older Men: Osteoporotic Fractures in Men (MrOS) Prospective Cohort Study.

• #5 Broken or bruised ribs

  https://www.nhs.uk/conditions/broken-or-bruised-ribs/

  Broken or bruised ribs are usually caused by a fall, a blow to the chest or severe coughing. […] Broken or bruised ribs usually get better by themselves within 2 to 6 weeks. […] You might need stronger painkillers or have a chest infection that needs antibiotics. […] It could mean a broken rib has damaged something else, like your lung, liver or spleen.

• #6 Urgent Care Considerations for the Patient with Suspected Rib Fracture – Journal of Urgent Care Medicine

  https://www.jucm.com/urgent-care-considerations-for-the-patient-with-suspected-rib-fracture/

  Rib fractures are frequently encountered among patients after sustaining blunt thoracic trauma presenting to the emergency department (ED) or UC, with falls and motor vehicle collisions (MVC) accounting for the largest proportion of cases. […] Based on aggregate data from the National Trauma Data Bank, rib fractures have been found to occur more frequently in Caucasian and male patients with a median age of 51 years at the time of diagnosis. […] Importantly, to date, there have been no studies published describing the prevalence of rib fractures and associated injuries in patients presenting to UC centers after thoracic trauma. […] A systematic review of 73 studies on patients with chest injury revealed the most significant risk factors for mortality associated with blunt chest wall trauma: Age 65 years, Presence of 3 or more rib fractures, Presence of comorbid cardiopulmonary disease. […] Patients at the highest risk for complications after rib fracture include the elderly (65 years), those with multiple rib fractures, and/or underlying pulmonary disease.

• #7 PPT – Multiple Rib Fractures: Epidemiology and Management Overview PowerPoint Presentation – ID:9347667

  https://www.slideserve.com/steelee/blunt-trauma-multiple-rib-fractures-powerpoint-ppt-presentation

  Learn about the epidemiology, pathophysiology, and management of multiple rib fractures associated with blunt trauma, including their impact on respiration and risk factors. […] Frequency Dramatically underreported 2 million blunt mechanisms of injury occur annually as MVC Chest injury 67-70% of those. […] International Prevalence is linked to underlying cause of trauma More common in countries with higher incidence of MVC Mortality/Morbidity Rib f(x) not usually dangerous alone Pneumonia / atelectasis largest risk Morbidity correlates with degree of injury to underlying structures. […] Mortality rates of 12% in one study of rib f(x) 94% had associated injuries / 32% had a HTX/PTX Ziegler, W. J Trauma, Dec 2004. 50% required operative or ICU care Average blood loss was 150-200ml per rib f(x).

• #8 Epidemiology and outcome of rib fractures: a nationwide study in the Netherlands

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8825616/

  The mortality rates among hospitalized patients with rib fractures range from 10 to 22%, with higher mortality rates among the elderly and in patients with flail chest. […] This nationwide study demonstrates an overall 30-day mortality of 6.9%, which is lower than previously reported mortality rates. […] The findings of our subgroup analyses illustrate the considerable clinical heterogeneity among patients with rib fractures and emphasizes the importance of subgroup identification. […] Elderly patients had a lower median ISS compared to their younger counterparts (10 vs. 13) and only a third were polytrauma patients. Nevertheless, the elderly showed to have a considerably higher mortality rate (11.7% vs. 3.0%) as well as a longer HLOS than patients under 65 years of age (7 vs. 5 days). This illustrates the high clinical impact of rib fractures on the elderly population, and once again emphasizes the importance of subgroup identification. […] This epidemiological study reports on the population-based incidence rates of rib fractures and demonstrates that rib fractures still remain a frequently occurring injury associated with a significant morbidity.

• #9 Rib Fracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541020/

  The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. Children are less likely to sustain rib fractures than adults due to their more elastic ribs. The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.[6] […] Rib fractures can be traumatic or atraumatic. Most rib fractures are due to direct penetrating or blunt trauma to the chest. Ribs 1 through 3 are the hardest to break and signify a significant degree of trauma if fractured. Ribs 4 through 10 are typically the most vulnerable while ribs 11 through 12 are more mobile and therefore more difficult to break. In the elderly, falls are a common etiology of rib fractures and are associated with higher mortality and morbidity than younger patients.[2] Rib fractures may also be pathologic as a result of cancer metastasis from other organs.

• #10 Rib Fracture Lawyer | Free Consultation

  https://autoaccident.com/rib-fractures/

  The incidence and prevalence of broken ribs will vary on the injury and extent of trauma. Younger people are less prone to suffering fractured ribs than their elderly counterparts, predisposed to higher morbidity and mortality. Conversely, adults are more likely to sustain rib fractures than adolescents because children have more elastic ribs. […] A fracture of the rib may cause injury to internal organs and major blood vessels. The risk may increase with the number of fractured ribs. The types of complications may vary on which rib sustains a break. Potential complications may include: […] According to Mayo Clinic, a fractured rib is a common injury. It may occur when there is a crack or break in one of the bones in the thoracic cage. The most common reason for a broken rib is chest trauma from contact sports, motor vehicle crashes, and slip and fall accidents.

• #11 Rib fractures – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000236

  Rib fractures may be due to blunt force injury, falls, non-accidental injury, CPR, or more rarely, sporting activities, or metastatic lesions and primary bone tumours. […] Among infants aged younger than 12 months presenting with rib fractures, as many as 82% sustained these injuries non-accidentally (i.e., through physical abuse). […] An increased number of ribs fractured correlates with increased morbidity and mortality. […] Rib fractures can be relatively benign, but often may be a marker of concomitant injuries such as pneumothorax, haemopneumothorax, pulmonary contusions, flail chest, and possible non-thoracic injuries.

• #12 Rib fractures | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/rib-fractures?lang=us

  Rib fractures are a common consequence of trauma and can cause life-threatening complications. […] Rib fractures are often associated with other injuries and the greater the number of rib fractures the more likely are associated injuries. […] The 4th-10th ribs are the most commonly fractured. […] Fractures of the 1st-3rd ribs are associated with high-energy trauma. […] Rib fractures themselves are treated symptomatically and have a good prognostic outcome. […] Aside from immediate traumatic complications outlined above atelectasis and pneumonia may develop, mainly due to poor respiratory effort secondary to pain, and this increases the morbidity and mortality due to rib fractures. […] The number of displaced rib fractures is more predictive for complications in chest trauma patients.

• #13 Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States

  https://www.jtraumainj.org/journal/view.php?doi=10.20408/jti.2023.0065

  Different mechanisms of injury result in distinct rib fracture patterns. […] The mechanism of injury (MOI) is an important predictor of the extent of injury in trauma patients. […] The major finding of this investigation is that there is a significant association between the MOI and rib fracture pattern. […] Unique rib fracture patterns are generated by different mechanisms of injury. […] These patterns should be considered when conducting evaluations, assessing the possible use of diagnostic modalities, and considering the need for potential interventions on patients with acute thoracic trauma. […] Research focusing on the association between MOI and rib fracture patterns, and the implications of morbidity and mortality, is ongoing.

• #14 PPT – Multiple Rib Fractures: Epidemiology and Management Overview PowerPoint Presentation – ID:9347667

  https://www.slideserve.com/steelee/blunt-trauma-multiple-rib-fractures-powerpoint-ppt-presentation

  Each additional rib fracture increases mortality by 19% Increases incidence of pneumonia by 27%. […] Should raise high suspicion for severe injury Mortality rates 36% reported w/associated 1st rib fracture. […] Elderly more prone than young Pulmonary sequelae including atelectasis, pneumonia and respiratory arrest more likely in elderly Cardiopulmonary disease increases morbity/mortality in patients 65 y/o.

• #15 Inpatient management of traumatic rib fractures and flail chest in adults – UpToDate

  https://www.uptodate.com/contents/inpatient-management-of-traumatic-rib-fractures-and-flail-chest-in-adults

  Traumatic rib fractures are the consequence of significant forces impacting the chest wall and are most commonly due to blunt injuries (eg, motor vehicle crash, falls, assault), but penetrating injuries (eg, gunshot) can also fracture ribs. Rib fractures are a marker of more severe injuries and are present in 10 percent of all trauma patients and approximately 30 percent of patients with significant chest trauma. The number of fractured ribs also directly correlates with the presence of intrathoracic injury. […] Multiply fractured ribs or flail chest can significantly compromise respiratory function. Pneumonia is often the common pathway to acute respiratory failure resulting from rib fractures, and prevention offers the best means to avoid potentially preventable deaths. The main goal of treatment is to prevent pneumonia and other complications of rib fractures (eg, nonunion). Conservative treatment includes pain control and aggressive supportive pulmonary care to avoid the need for intubation. For patients in whom these conservative measures are not adequate, rib fracture stabilization may be beneficial. […] Although less common, chronic, forceful coughing, as may be seen in patients with severe asthma, cystic fibrosis, or poorly controlled emphysema, can also result in rib fractures.

• #16 Rib Fracture: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/825981-overview

  The incidence of rib fractures is dramatically underreported. More than 2 million blunt mechanisms of injury occur annually just as motor vehicle collisions, with reported incidence of chest injury between 67 and 70% of those. The prevalence of rib fractures is linked to the prevalence of the underlying cause of the trauma. Rib fractures are more common in countries with higher incidence of MVAs. […] Older persons are more prone to rib fractures than younger adults and, therefore, the pulmonary sequelae such as atelectasis, pneumonia, and respiratory arrest. The presence of cardiopulmonary disease also significantly increases morbidity and mortality rates in patients older than 65 years. […] Rib fractures are not usually dangerous in and of themselves. Patients may develop pneumonia from splinting. Morbidity correlates with the degree of injury to underlying structures.

• #17 Rib Fracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541020/

  The most severe complications related to rib fractures are the flail chest and damage to the underlying structures. Solid organ injuries associated with rib fractures include liver injuries and splenic injuries. Typically, the higher the rib fracture is within the thoracic cage, the more likely it is to cause a liver or splenic injury.[14]

• #18 Bruised vs. Broken Ribs: What’s the Difference?

  https://www.verywellhealth.com/bruised-broken-or-fractured-ribs-4582241

  Broken and bruised ribs are different injuries. With a broken rib, the bone has been fractured either particularly or completely. A „bruised” rib means the supportive muscles and tissues around your ribcage have been injured. […] Most rib injuries happen when there is blunt force trauma to the chest wall, such as from a car accident or a fall. […] A major rib injury can lead to a condition called a flail chest. When this happens, your chest movements will be opposite to what they should be when you breathe. […] Pneumonia is one of the most common complications of broken ribs. It usually happens when a person avoids coughing because it hurts too much. […] A 2017 study in the British Medical Journal Open found that having one broken rib increases the risk of pneumonia by about 4% while having two broken ribs raises it to over 17%. […] Rib injuries are not usually life-threatening on their own, but they can lead to serious complications. […] Rib injuries can often be diagnosed based on your symptoms and a physical exam. […] The treatment involves time, rest, and pain management.

• #19 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  Rib fractures are the most common injury after thoracic (chest) trauma, accounting for approximately two-thirds of cases. […] Rib fractures are quite common after blunt trauma to the trunk, with motor vehicle crashes and falls being the leading causes. […] In the majority of cases, rib fractures are uncomplicated. However, because of the associated pain, patients with such injuries often need to be admitted to hospital for pain control. […] A common dogma among doctors is that pain after rib fractures that have been treated just with pain relief lasts up to six weeks. Unfortunately, this isn’t really the case. There are recent studies describing persistent pain and disability, with up to 76% of patients with uncomplicated rib fractures reporting pain at two months after the injury, and up to 56% of them still complaining of pain six months after the injury. Approximately 13% of patients report that their quality of life is being affected by chronic pain one year after simple rib fractures.

• #20 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  Additionally, in another study, 30% of patients with rib fractures that had been managed conservatively with standard pain relief were not able to return to pre-injury employment even two years after their injury. […] This significant long-term pain and disability has a huge socio-economic impact and is putting increasing pressure on doctors to find and try alternative treatments for uncomplicated rib fracture injuries. […] A recent American multicentre, prospective, controlled clinical trial revealed that there might be an answer in costal-fixation surgery for uncomplicated rib fractures, especially since it showed an improvement in pain-intensity levels within the operative group, as compared with the non-operative group. […] Since the only predictive factor for ongoing pain and disability identified so far is the pain intensity during the first few days after injury, it has been suggested that the possible mechanism leading to the chronicity of the pain after rib fractures is that the initial high-intensity pain might be sensitising the central nervous system to pain perception.

• #21 Rib fracture pain and disability: Do we need a more aggressive approach?

  https://researchoutreach.org/articles/rib-fracture-pain-disability-aggressive-approach/

  The PAROS study, a multicentre randomised clinical trial, aims to compare the pain-control effect of rib-fixation surgery to that achieved with just standard medical analgesia in patients with uncomplicated rib fractures. […] Rib fractures are a very common injury often associated with immense levels of persistent pain and disability, which have a large psycho-socio-economic impact on patients and our healthcare systems. […] New methods for treating rib-fracture patients that alleviate pain and reduce disability are urgently required and are expected to have a positive impact not only on individual patients but also on the wider community. […] It therefore doesn’t come as a surprise that the surgical treatment of rib fractures in the absence of a flail chest is drawing increased surgical attention lately.

• #22 Treatment of traumatic rib fractures: an overview of current evidence and future perspectives – Franssen – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/88701/html

  Operative management of rib fractures has gained significant popularity over the last years, however, it remains a controversial topic, due to the substantial heterogeneity among rib fracture patients with considerable differences in epidemiology. […] The substantial heterogeneity among rib fracture patients with considerable differences in epidemiology perhaps prevents a one-size-fits-all solution to rib fracture management. […] The importance to detect rib fractures is underlined by the fact that the pulmonary morbidity and mortality directly increases with each additional rib fracture, approaching a mortality of 40% if more than six ribs are fractured. […] Over the last two to three decades, surgical stabilization of rib fractures (SSRF) has gained popularity compared to conservative treatment options, especially for flail chest.

• #23 Treatment of traumatic rib fractures: an overview of current evidence and future perspectives – Franssen – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/88701/html

  The Chest Wall Injury Society (CWIS), represented by a variety of surgical and non-surgical specialists, seeks optimal outcomes for patients with both non-operative and operative management of rib fracture. […] CWIS set distinct recommendations on the indications to perform SSRF for both ventilated and non-ventilated patients. […] The society also outlined contraindications for SSRF, both absolute and relative. […] Timing of surgical rib fracture repair is essential and should consider inflammation and callus formation. […] While the short-term clinical patient outcomes after SSRF are clearly described in the literature, more studies are now investigating long-term benefits of SSRF. […] The current potential of peripheral nerve blocks is believed to surpass neuraxial techniques in the future. […] Thus, future research should focus on elucidating the efficacy of stand-alone cryoanalgesia for rib fracture pain management.

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