Materiały źródłowe

• #1 Rib Fractures – Pacific Thoracic Surgery

  https://pacificthoracicsurgery.com/category/rib-fractures/

  Each year trauma accounts for 41 million emergency department visits and 2.3 million hospital admissions across the nation. Simple rib fractures are the most common injury sustained following blunt chest trauma, accounting for more than half of thoracic injuries from nonpenetrating trauma. Approximately 10% of all patients admitted after blunt chest trauma have one or more rib fractures. […] The most common mechanism of injury for rib fractures in elderly persons is a fall from height or from standing. Each year, 2.5 million older people are treated in emergency departments for fall injuries and over 700,000 patients a year are hospitalized because of a fall injury. […] Motor vehicle accident is the most common mechanism in adults, and recreational activities in young adults. […] Pain control is fundamental to the management of rib fractures to decrease chest wall splinting and alveolar collapse, which is necessary to clear pulmonary secretions. The more broken ribs a patient has, the greater the impact on their pulmonary function.

• #2 Update on Chest Wall Trauma and Minimally Invasive (MIMS) Ribs Fixation – Pacific Thoracic Surgery

  https://pacificthoracicsurgery.com/2017/07/24/update-on-chest-wall-trauma-and-minimally-invasive-mims-ribs-fixation/

  Each year trauma accounts for 41 million emergency department visits and 2.3 million hospital admissions across the nation. Simple rib fractures are the most common injury sustained following blunt chest trauma, accounting for more than half of thoracic injuries from nonpenetrating trauma. Approximately 10% of all patients admitted after blunt chest trauma have one or more rib fractures. […] Pain control is fundamental to the management of rib fractures to decrease chest wall splinting and alveolar collapse, which is necessary to clear pulmonary secretions. The more broken ribs a patient has, the greater the impact on their pulmonary function. […] Minimally Invasive Muscle Sparing (MIMS) Rib fixation is a less invasive option for surgical treatment of rib fractures. MIMS rib fixation utilizes a video scope in the chest to reduce fractures and localize fractures. The small incision for fixation spares the muscle fibers and thus causes less pain.

• #3 Rib Fracture – StatPearls – NCBI Bookshelf

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

  Rib fractures can occur from either direct penetrating or blunt trauma. […] The most feared complication of rib fractures is the flail chest where three or more rib fractures at two points on the involved ribs, creating a floating rib segment and causes this segment to move paradoxically with the rest of the chest wall. […] Rib fractures can be traumatic or atraumatic. […] Most rib fractures are due to direct penetrating or blunt trauma to the chest. […] Rib fractures may also be pathologic as a result of cancer metastasis from other organs. […] Through repetitive stress and microtrauma, athletes can develop rib fractures with chronic use. […] Spontaneous rib fractures can also occur due to severe cough and are more likely to occur in those with osteoporosis or underlying lung disease. […] The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. […] The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.

• #4

  https://www.aast.org/resources-detail/rib-fractures

  The most common mechanism causing rib fractures is blunt trauma (i.e. automobile accidents, falls from height, assault, or even severe coughing). Blunt trauma causes rib fractures by exerting direct pressure on the rib causing it to break. Approximately 10% of all patients admitted for blunt chest trauma have one or more rib fractures. Although the injury mechanism itself is an important consideration when discussing rib fractures; patient specific considerations are also important. Patients with advanced age, osteoporosis or osteopenia have an increased risk of number and severity of fractures. […] Rib fractures are typically diagnosed on chest x-ray and the severity of the fracture is easily seen. Simple (non-displaced) fractures appear as cracks in the rib or a jagged edge. Displaced fractures appear to lack contour along the edge of the rib on x-ray. Floating segments of ribs, known as a flail chest, can also be easily seen on x-ray. Other imaging modalities such as CT scans also diagnose rib fractures and are more sensitive to identify them. CT scans are useful to determine if underlying lung injury is present, known as a contusion, or to identify if air has escaped the lung as a pneumothorax.

• #5 Rib Fracture and Pneumothorax Complication | SportsMD

  https://www.sportsmd.com/sports-injuries/chest-rib-injuries/rib-fracture-pneumothorax-complication/

  Rib fractures can be caused by both direct and indirect forces. Direct forces would include being hit, kicked, or punched with the resulting fracture at the site of contact. […] An indirect force can cause rib fractures through general compression of the rib cage as when a football player is compressed by another player during a tackle. The weight of the opposing player can compress the injured player against a hard surface. If the external force is stronger than the tensile force of the ribs, the bones can be fractured.

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

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

  The mechanism of first-rib injury in motor vehicle accidents seems to be a violent contraction of the scalene muscles brought on by the sudden forward movement of the head and neck. […] A single blow may cause rib fractures in multiple places. Traumatic fractures most often occur at the site of impact or the posterolateral bend, where the rib is weakest. […] Due to the greater pliability of children’s ribs, greater force is required to produce a fracture.

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

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

  The mechanism of first-rib injury in motor vehicle accidents seems to be a violent contraction of the scalene muscles brought on by the sudden forward movement of the head and neck. […] A single blow may cause rib fractures in multiple places. Traumatic fractures most often occur at the site of impact or the posterolateral bend, where the rib is weakest. […] Due to the greater pliability of children’s ribs, greater force is required to produce a fracture.

• #8 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?id=3765

  Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. […] Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia. […] The mechanism of CIRF can be explained in several ways. First of all, CIRF is accepted as a specific and less common type of stress fracture; thus, repetitive mechanical stress on the ribs with adaptive bone remodeling and muscle fatigue is thought to play a role in the development of the CIRF. […] Repeated trauma due to repetitive cough may cause inelastic deformation of the middle third of the ribs between the fifth and 10th ribs, which is the most vulnerable part of the rib, as well as of the costochondral junctions.

• #9 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?id=3765

  Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. […] Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia. […] The mechanism of CIRF can be explained in several ways. First of all, CIRF is accepted as a specific and less common type of stress fracture; thus, repetitive mechanical stress on the ribs with adaptive bone remodeling and muscle fatigue is thought to play a role in the development of the CIRF. […] Repeated trauma due to repetitive cough may cause inelastic deformation of the middle third of the ribs between the fifth and 10th ribs, which is the most vulnerable part of the rib, as well as of the costochondral junctions.

• #10 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?lang=en&id=3765

  This may result in minor cracks in the bone and, if the trauma continues, extends to complete fracture. […] The second mechanism is thought to be linked with contrary muscle forces acting on the ribs. […] The opposing actions of these muscles on the ribs may result in cough fractures. […] Several risk factors for the development of CIRF have been reported. Osteoporosis, COPD, prolonged use of high dose steroids, and asthma are among them. […] The CIRF is also common in older age, renal failure, pregnancy, mechanical ventilation, and radiation-therapy. […] In our study, we found that multiple CIRF was significantly common in older patients, in the presence of COVID-19 pneumonia, and of metabolic disease of bone. […] In conclusion, one should be aware of that cough may cause rib fracture and should be suspected, when localized chest pain develops following coughing.

• #11 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?id=3765

  Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. […] Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia. […] The mechanism of CIRF can be explained in several ways. First of all, CIRF is accepted as a specific and less common type of stress fracture; thus, repetitive mechanical stress on the ribs with adaptive bone remodeling and muscle fatigue is thought to play a role in the development of the CIRF. […] Repeated trauma due to repetitive cough may cause inelastic deformation of the middle third of the ribs between the fifth and 10th ribs, which is the most vulnerable part of the rib, as well as of the costochondral junctions.

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

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

  The mechanism of first-rib injury in motor vehicle accidents seems to be a violent contraction of the scalene muscles brought on by the sudden forward movement of the head and neck. […] A single blow may cause rib fractures in multiple places. Traumatic fractures most often occur at the site of impact or the posterolateral bend, where the rib is weakest. […] Due to the greater pliability of children’s ribs, greater force is required to produce a fracture.

• #13 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  Fractures of the first rib are rare. The significance of a first rib fracture is the association with cervical spine trauma, multiple rib fractures, or life-threatening vascular injuries. […] Fractures of the first rib imply a violent force; this pattern of fractures may signify injury to the adjacent subclavian vein and brachial plexus. […] Fractures of the fifth to ninth ribs can be single or multiple. […] An inward displacement of the rib fracture fragments at the time of the injury may lacerate the lung parenchyma and produce a pneumothorax, with a possible hemothorax. […] Hemorrhage around and within the adrenal glands represents a risk that is associated with fractures of the lower ribs. […] A pneumothorax is a common sequela of blunt trauma. […] The incidence of a pneumothorax is not as high with one rib fracture, but the risk increases as the number of broken ribs increases.

• #14 Non-Traumatic First Rib Fractures Secondary to Opposing Muscle Contractions: A Case Series

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-5-113.php?jid=ijsem

  While first rib fractures typically occur from direct, traumatic injuries and have high rates of serious complication, less commonly, non-traumatic first rib fractures are encountered in young athletes. […] The mechanism for these non-traumatic fractures is thought to be due to sudden contractions of opposing muscle forces on developing bone. […] Non-traumatic first rib fractures, resulting from either chronic stress over time or from a sudden, forceful contraction of opposing muscles are exceedingly rare. […] In the absence of direct sudden trauma, the first rib tends to fracture at the subclavian grooves, the weakest point, when these opposing muscles are both suddenly and forcefully engaged. […] This sudden muscle contraction mechanism involves pulling from a posterolaterally extended neck with traction on the contralateral arm as described in the original surfer’s layback position case, and in the two current cases of the basketball player stretching to crack her neck and the cheerleader lifting another cheerleader.

• #15 Rib Fracture – StatPearls – NCBI Bookshelf

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

  Rib fractures can occur from either direct penetrating or blunt trauma. […] The most feared complication of rib fractures is the flail chest where three or more rib fractures at two points on the involved ribs, creating a floating rib segment and causes this segment to move paradoxically with the rest of the chest wall. […] Rib fractures can be traumatic or atraumatic. […] Most rib fractures are due to direct penetrating or blunt trauma to the chest. […] Rib fractures may also be pathologic as a result of cancer metastasis from other organs. […] Through repetitive stress and microtrauma, athletes can develop rib fractures with chronic use. […] Spontaneous rib fractures can also occur due to severe cough and are more likely to occur in those with osteoporosis or underlying lung disease. […] The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. […] The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.

• #16 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Rib fractures are common injuries that occur most often following blunt thoracic trauma but can also result from severe coughing, athletic activities (eg, rowing, swinging golf clubs), child abuse, and bone metastases. […] Most rib fractures are caused by direct trauma to the chest wall. This can occur from blunt (eg, motor vehicle collision) or penetrating (eg, gunshot) trauma. A single blow may cause rib fractures in multiple places. […] Pathologic fractures due to metastases – Cancers that metastasize to bone (eg, prostate, breast, kidney) frequently become apparent in a rib and cause pathologic fractures. Ribs are relatively thin compared with major long bones and are more likely to fracture when invaded by a metastatic lesion. […] Stress fractures – Ribs can sustain stress fractures from repetitive minor trauma. Stress fractures may be seen in patients with a chronic cough and in athletes, particularly rowers, golfers, throwers, and others.

• #17 Rib Fracture – StatPearls – NCBI Bookshelf

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

  Rib fractures can occur from either direct penetrating or blunt trauma. […] The most feared complication of rib fractures is the flail chest where three or more rib fractures at two points on the involved ribs, creating a floating rib segment and causes this segment to move paradoxically with the rest of the chest wall. […] Rib fractures can be traumatic or atraumatic. […] Most rib fractures are due to direct penetrating or blunt trauma to the chest. […] Rib fractures may also be pathologic as a result of cancer metastasis from other organs. […] Through repetitive stress and microtrauma, athletes can develop rib fractures with chronic use. […] Spontaneous rib fractures can also occur due to severe cough and are more likely to occur in those with osteoporosis or underlying lung disease. […] The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. […] The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.

• #18 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Rib fractures are common injuries that occur most often following blunt thoracic trauma but can also result from severe coughing, athletic activities (eg, rowing, swinging golf clubs), child abuse, and bone metastases. […] Most rib fractures are caused by direct trauma to the chest wall. This can occur from blunt (eg, motor vehicle collision) or penetrating (eg, gunshot) trauma. A single blow may cause rib fractures in multiple places. […] Pathologic fractures due to metastases – Cancers that metastasize to bone (eg, prostate, breast, kidney) frequently become apparent in a rib and cause pathologic fractures. Ribs are relatively thin compared with major long bones and are more likely to fracture when invaded by a metastatic lesion. […] Stress fractures – Ribs can sustain stress fractures from repetitive minor trauma. Stress fractures may be seen in patients with a chronic cough and in athletes, particularly rowers, golfers, throwers, and others.

• #19

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #20

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

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

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

  The chest wall protects underlying sensitive structures by surrounding internal organs with hard osseous structures, including the ribs, clavicles, sternum, and scapulae. An intact chest wall is necessary for normal respiration. […] Rib fractures may compromise ventilation by a variety of mechanisms. Pain from rib fractures can cause respiratory splinting, resulting in atelectasis and pneumonia. Multiple contiguous rib fractures (ie, flail chest) interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiency. Fragments of fractured ribs can also act as penetrating objects leading to the formation of a hemothorax or a pneumothorax. Ribs commonly fracture at the point of impact or at the posterior angle (structurally their weakest area). Ribs 4 through 9 are the ones most commonly injured.

• #22 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/

  Morbidity and mortality associated with rib fractures increases linearly with the number of fractured ribs. […] 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. […] The most common ribs fractured are ribs 5-9, with a median number fractures being 2. […] Fracturing ribs 1-3 requires higher force mechanisms as they are anatomically well-protected by the larger thoracic muscles and shoulder girdle, and such fractures are a marker of more significant mechanism.

• #23

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #24

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #25 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  Tear in a lung. The jagged end of a broken middle rib can punch a hole in a lung and cause it to cave in. […] Ripped spleen, liver or kidneys. The bottom two ribs rarely break because they can move more than the upper and middle ribs. But the ends of a broken lower rib can cause serious harm to the spleen, liver or a kidney.

• #26

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #27

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #28

  https://www.aast.org/resources-detail/rib-fractures

  The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles which assist with breathing. They are also attached to the spine for added stability. A rib fracture, simply put, is a break in the rib. Rib fractures that are single and non-displaced are classified as hairline fractures or simple fractures. Ribs usually fracture at the point of impact or in the back where structurally they are weakest. More complex fractures can cause the edges of the bone to become misaligned or displaced. A serious condition involved with rib fractures is called flail chest. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment which is free-floating and moves independently. The most common ribs fractured are the 7th through 10th ribs. Fractures of the first and second ribs are rare but may be associated with serious damage to the brachial plexus of nerves, the subclavian vessels or associated with head, facial or thoracic aorta injuries. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen.

• #29 Rib Fracture – StatPearls – NCBI Bookshelf

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

  Rib fractures can occur from either direct penetrating or blunt trauma. […] The most feared complication of rib fractures is the flail chest where three or more rib fractures at two points on the involved ribs, creating a floating rib segment and causes this segment to move paradoxically with the rest of the chest wall. […] Rib fractures can be traumatic or atraumatic. […] Most rib fractures are due to direct penetrating or blunt trauma to the chest. […] Rib fractures may also be pathologic as a result of cancer metastasis from other organs. […] Through repetitive stress and microtrauma, athletes can develop rib fractures with chronic use. […] Spontaneous rib fractures can also occur due to severe cough and are more likely to occur in those with osteoporosis or underlying lung disease. […] The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. […] The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.

• #30 Buckle rib fracture | Radiology Reference Article | Radiopaedia.org

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

  Buckle rib fractures are incomplete fractures involving only the inner cortex. They typically occur due to an anterior compressive force to the chest, most commonly during external cardiac massage, but can be seen following any such traumatic injury. […] Buckle fractures are usually seen in the middle ribs (anterior one-third) and in a line. The anterior force responsible for the rib injury may also cause a similar sternal fracture. […] Buckle is an engineering term describing cortical disruption to the compressive (inner) side of a structure (i.e. the rib) and maintenance of the tensile (outer) side cortex.

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

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

  The chest wall protects underlying sensitive structures by surrounding internal organs with hard osseous structures, including the ribs, clavicles, sternum, and scapulae. An intact chest wall is necessary for normal respiration. […] Rib fractures may compromise ventilation by a variety of mechanisms. Pain from rib fractures can cause respiratory splinting, resulting in atelectasis and pneumonia. Multiple contiguous rib fractures (ie, flail chest) interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiency. Fragments of fractured ribs can also act as penetrating objects leading to the formation of a hemothorax or a pneumothorax. Ribs commonly fracture at the point of impact or at the posterior angle (structurally their weakest area). Ribs 4 through 9 are the ones most commonly injured.

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

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

  The chest wall protects underlying sensitive structures by surrounding internal organs with hard osseous structures, including the ribs, clavicles, sternum, and scapulae. An intact chest wall is necessary for normal respiration. […] Rib fractures may compromise ventilation by a variety of mechanisms. Pain from rib fractures can cause respiratory splinting, resulting in atelectasis and pneumonia. Multiple contiguous rib fractures (ie, flail chest) interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiency. Fragments of fractured ribs can also act as penetrating objects leading to the formation of a hemothorax or a pneumothorax. Ribs commonly fracture at the point of impact or at the posterior angle (structurally their weakest area). Ribs 4 through 9 are the ones most commonly injured.

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

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

  The chest wall protects underlying sensitive structures by surrounding internal organs with hard osseous structures, including the ribs, clavicles, sternum, and scapulae. An intact chest wall is necessary for normal respiration. […] Rib fractures may compromise ventilation by a variety of mechanisms. Pain from rib fractures can cause respiratory splinting, resulting in atelectasis and pneumonia. Multiple contiguous rib fractures (ie, flail chest) interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiency. Fragments of fractured ribs can also act as penetrating objects leading to the formation of a hemothorax or a pneumothorax. Ribs commonly fracture at the point of impact or at the posterior angle (structurally their weakest area). Ribs 4 through 9 are the ones most commonly injured.

• #34

  https://www.aast.org/resources-detail/rib-fractures

  The most common symptom of rib fractures is pain. Pain is typically elicited with breathing or coughing. If the fractures are complex, the patient may suffer from additional damage to underlying structures. The sharp fractured end of the rib can puncture the lung, causing air leakage, a condition called a pneumothorax, which is potentially life threatening. In addition to pain, shortness of breath and decreased oxygen content in the blood can result from these injuries. A flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can result in a clinical entity called acute lung injury. In its most severe form, acute lung injury can lead to a life threatening entity called adult respiratory distress syndrome (ARDS). Respiratory failure is usually caused by the underlying pulmonary contusion but not by the anatomic flail chest itself. In addition, the flail segment moves in the opposite direction as the rest of the chest wall because of the ambient pressure in comparison to the pressure inside the lungs. This so-called „paradoxical motion” can increase the work and pain involved with breathing.

• #35 Rib Fractures: Review of Presentation, Diagnosis, Treatment, and Outcomes – AOAO Journal

  https://journal.aoao.org/?p=655

  Sufficient force directed on a rib will result in a rib fracture. […] The mainstay of treatment is often nonoperative management. […] Recently, a rise in operative management of rib fractures has become apparent. ORIF of rib fractures has been shown to reduce complications of rib fractures, including pneumonia, reduce time on the ventilator, and reduce mortality. […] The pathomechanism for this correlation is that patients with pain will decrease tidal volume and retain mucus, rendering them more susceptible to pneumonia. […] There has been a recent increase in the usage of open reduction and internal fixation (ORIF) or rib fractures, particularly when chest wall instability is present. […] Instability of the chest wall includes flail chest, the presence of 3 consecutive ribs broken in 2 locations, and 3 consecutive bi-cortically displaced rib fractures.

• #36

  https://www.aast.org/resources-detail/rib-fractures

  The most common symptom of rib fractures is pain. Pain is typically elicited with breathing or coughing. If the fractures are complex, the patient may suffer from additional damage to underlying structures. The sharp fractured end of the rib can puncture the lung, causing air leakage, a condition called a pneumothorax, which is potentially life threatening. In addition to pain, shortness of breath and decreased oxygen content in the blood can result from these injuries. A flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can result in a clinical entity called acute lung injury. In its most severe form, acute lung injury can lead to a life threatening entity called adult respiratory distress syndrome (ARDS). Respiratory failure is usually caused by the underlying pulmonary contusion but not by the anatomic flail chest itself. In addition, the flail segment moves in the opposite direction as the rest of the chest wall because of the ambient pressure in comparison to the pressure inside the lungs. This so-called „paradoxical motion” can increase the work and pain involved with breathing.

• #37 The Pathophysiology of Flail Chest Injury | Thoracic Key

  https://thoracickey.com/the-pathophysiology-of-flail-chest-injury/

  Anatomically, a flail segment is a part of the chest wall which has lost its continuity with the chest wall and usually results from multiple rib fractures. In simple terms, it can be defined as a fracture of three or more ribs at two or more places. […] The common factor in both definitions is the presence of an unstable segment, which is not continuous with the chest wall and moves in a paradoxical fashion inward during inspiration and outward during expiration. […] Paradoxical movement of the flail segment occurs mainly because of two factors: loss of anatomical continuity and the effect of the negative intrapleural pressure acting on the detached segment. […] The flail segment occurs after compressive forces are applied to the chest, with the thorax able to withstand about 20 % volume compression before a rib fracture can occur.

• #38 The Pathophysiology of Flail Chest Injury | Thoracic Key

  https://thoracickey.com/the-pathophysiology-of-flail-chest-injury/

  Anatomically, a flail segment is a part of the chest wall which has lost its continuity with the chest wall and usually results from multiple rib fractures. In simple terms, it can be defined as a fracture of three or more ribs at two or more places. […] The common factor in both definitions is the presence of an unstable segment, which is not continuous with the chest wall and moves in a paradoxical fashion inward during inspiration and outward during expiration. […] Paradoxical movement of the flail segment occurs mainly because of two factors: loss of anatomical continuity and the effect of the negative intrapleural pressure acting on the detached segment. […] The flail segment occurs after compressive forces are applied to the chest, with the thorax able to withstand about 20 % volume compression before a rib fracture can occur.

• #39 The Pathophysiology of Flail Chest Injury | Thoracic Key

  https://thoracickey.com/the-pathophysiology-of-flail-chest-injury/

  The main factors leading to serious morbidity in patients with rib fractures are respiratory insufficiency due to pain, underlying lung collapse, paradoxical movement, and underlying pulmonary contusion. […] However, certain canine-based studies later refuted this hypothesis. Now, it is widely believed and accepted that it is the underlying pulmonary contusion (PC) which is the major cause of the poor prognosis following a flail chest along with rib fractures causing secondary problems of pain and muscular splinting. […] The pathophysiology of pulmonary contusion (PC) is still not fully understood, but primarily involves alveolar and capillary wall rupture leading to intra-alveolar hemorrhage and flooding resulting in ventilation-perfusion (V/Q) mismatch and subsequent hypoxia.

• #40 The Pathophysiology of Flail Chest Injury | Thoracic Key

  https://thoracickey.com/the-pathophysiology-of-flail-chest-injury/

  The main factors leading to serious morbidity in patients with rib fractures are respiratory insufficiency due to pain, underlying lung collapse, paradoxical movement, and underlying pulmonary contusion. […] However, certain canine-based studies later refuted this hypothesis. Now, it is widely believed and accepted that it is the underlying pulmonary contusion (PC) which is the major cause of the poor prognosis following a flail chest along with rib fractures causing secondary problems of pain and muscular splinting. […] The pathophysiology of pulmonary contusion (PC) is still not fully understood, but primarily involves alveolar and capillary wall rupture leading to intra-alveolar hemorrhage and flooding resulting in ventilation-perfusion (V/Q) mismatch and subsequent hypoxia.

• #41 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  A broken rib occurs when one of the bones in the rib cage breaks or cracks. […] A broken rib is a common injury that occurs when one of the bones in the rib cage breaks or cracks. The most common causes are hard impacts from falls, car accidents or contact sports. […] Many broken ribs are simply cracked. Cracked ribs are painful. But they don’t cause the problems that ribs that have broken into pieces can. The sharp edge of a broken bone can harm major blood vessels or lungs and other organs. […] A broken rib can harm blood vessels and internal organs. Having more than one broken rib increases the risk. […] Complications depend on which ribs break. Possible complications include: […] Tear in the main artery of the body, known as the aorta. A sharp end from a break in one of the first three ribs at the top of the rib cage could pierce a major blood vessel, including the aorta.

• #42 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  A broken rib occurs when one of the bones in the rib cage breaks or cracks. […] A broken rib is a common injury that occurs when one of the bones in the rib cage breaks or cracks. The most common causes are hard impacts from falls, car accidents or contact sports. […] Many broken ribs are simply cracked. Cracked ribs are painful. But they don’t cause the problems that ribs that have broken into pieces can. The sharp edge of a broken bone can harm major blood vessels or lungs and other organs. […] A broken rib can harm blood vessels and internal organs. Having more than one broken rib increases the risk. […] Complications depend on which ribs break. Possible complications include: […] Tear in the main artery of the body, known as the aorta. A sharp end from a break in one of the first three ribs at the top of the rib cage could pierce a major blood vessel, including the aorta.

• #43 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  A broken rib occurs when one of the bones in the rib cage breaks or cracks. […] A broken rib is a common injury that occurs when one of the bones in the rib cage breaks or cracks. The most common causes are hard impacts from falls, car accidents or contact sports. […] Many broken ribs are simply cracked. Cracked ribs are painful. But they don’t cause the problems that ribs that have broken into pieces can. The sharp edge of a broken bone can harm major blood vessels or lungs and other organs. […] A broken rib can harm blood vessels and internal organs. Having more than one broken rib increases the risk. […] Complications depend on which ribs break. Possible complications include: […] Tear in the main artery of the body, known as the aorta. A sharp end from a break in one of the first three ribs at the top of the rib cage could pierce a major blood vessel, including the aorta.

• #44 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  Tear in a lung. The jagged end of a broken middle rib can punch a hole in a lung and cause it to cave in. […] Ripped spleen, liver or kidneys. The bottom two ribs rarely break because they can move more than the upper and middle ribs. But the ends of a broken lower rib can cause serious harm to the spleen, liver or a kidney.

• #45 Broken ribs – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/broken-ribs/symptoms-causes/syc-20350763

  Tear in a lung. The jagged end of a broken middle rib can punch a hole in a lung and cause it to cave in. […] Ripped spleen, liver or kidneys. The bottom two ribs rarely break because they can move more than the upper and middle ribs. But the ends of a broken lower rib can cause serious harm to the spleen, liver or a kidney.

• #46 Rib fracture characteristics increasing the risk of hemothorax: a multicenter study | Scientific Reports

  https://www.nature.com/articles/s41598-024-79548-z

  Approximately 33% of blunt trauma patients develop hemothorax following a rib fracture. […] Hemothorax typically originates from damage to intercostal or parenchymal vascular structures caused by a rib fracture. […] This study focused on identifying the independent factors that contribute to an increased risk of hemothorax in patients who experience rib fractures following blunt thoracic trauma. […] It is a plausible theory that increasing the number of broken ribs increases the risk of hemothorax. […] Our study provided concrete evidence of this relationship, demonstrating that each additional rib fracture increased the risk of hemothorax by 38%. […] The second specific data identified in our study was the correlation between displaced rib fractures and the occurrence of hemothorax.

• #47 Rib fracture characteristics increasing the risk of hemothorax: a multicenter study | Scientific Reports

  https://www.nature.com/articles/s41598-024-79548-z

  Approximately 33% of blunt trauma patients develop hemothorax following a rib fracture. […] Hemothorax typically originates from damage to intercostal or parenchymal vascular structures caused by a rib fracture. […] This study focused on identifying the independent factors that contribute to an increased risk of hemothorax in patients who experience rib fractures following blunt thoracic trauma. […] It is a plausible theory that increasing the number of broken ribs increases the risk of hemothorax. […] Our study provided concrete evidence of this relationship, demonstrating that each additional rib fracture increased the risk of hemothorax by 38%. […] The second specific data identified in our study was the correlation between displaced rib fractures and the occurrence of hemothorax.

• #48 Rib fracture characteristics increasing the risk of hemothorax: a multicenter study | Scientific Reports

  https://www.nature.com/articles/s41598-024-79548-z

  Approximately 33% of blunt trauma patients develop hemothorax following a rib fracture. […] Hemothorax typically originates from damage to intercostal or parenchymal vascular structures caused by a rib fracture. […] This study focused on identifying the independent factors that contribute to an increased risk of hemothorax in patients who experience rib fractures following blunt thoracic trauma. […] It is a plausible theory that increasing the number of broken ribs increases the risk of hemothorax. […] Our study provided concrete evidence of this relationship, demonstrating that each additional rib fracture increased the risk of hemothorax by 38%. […] The second specific data identified in our study was the correlation between displaced rib fractures and the occurrence of hemothorax.

• #49 Rib fracture characteristics increasing the risk of hemothorax: a multicenter study | Scientific Reports

  https://www.nature.com/articles/s41598-024-79548-z

  Our study clearly demonstrated a concrete relationship, showing that the presence of at least one displaced rib fracture increased the risk of hemothorax by a factor of 2.7. […] Our study aligns with the existing literature in demonstrating that anterior rib fractures have the lowest risk of hemothorax when considering the clinical reflection of anatomical features. […] The occurrence of hemothorax has been linked to the nature and intensity of trauma in numerous studies documented in the literature. […] Our study suggests that the risk of hemothorax is influenced by the local characteristics of the rib fracture, regardless of the severity of trauma. […] Our study concluded that there is a significant increase in the risk of hemothorax associated with more rib fractures and specifically more posterior rib fractures. […] We discovered that the displacement of even a single rib fracture significantly increased the risk of hemothorax.

• #50 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  The incidence of hemopneumothoraces in patients with rib fractures is 30%. […] Rib fractures are associated with pulmonary contusions in 20-40% of cases. […] The idea that thoracic cage injuries are predictive of acute traumatic aortic tears is controversial. […] A flail chest is present when a paradoxical respiratory movement occurs in a segment of the chest wall, the result of at least 2 segmental fractures in each of 3 adjacent ribs or costal cartilages. […] The number of rib fractures correlates with mortality in adult trauma patients, rising sharply in patients with more than 6 fractured ribs. […] The association of lower rib fractures with pelvic fractures has been associated with a higher incidence of solid organ injury.

• #51

  https://www.aast.org/resources-detail/rib-fractures

  The most common symptom of rib fractures is pain. Pain is typically elicited with breathing or coughing. If the fractures are complex, the patient may suffer from additional damage to underlying structures. The sharp fractured end of the rib can puncture the lung, causing air leakage, a condition called a pneumothorax, which is potentially life threatening. In addition to pain, shortness of breath and decreased oxygen content in the blood can result from these injuries. A flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can result in a clinical entity called acute lung injury. In its most severe form, acute lung injury can lead to a life threatening entity called adult respiratory distress syndrome (ARDS). Respiratory failure is usually caused by the underlying pulmonary contusion but not by the anatomic flail chest itself. In addition, the flail segment moves in the opposite direction as the rest of the chest wall because of the ambient pressure in comparison to the pressure inside the lungs. This so-called „paradoxical motion” can increase the work and pain involved with breathing.

• #52 The Pathophysiology of Flail Chest Injury | Thoracic Key

  https://thoracickey.com/the-pathophysiology-of-flail-chest-injury/

  The main factors leading to serious morbidity in patients with rib fractures are respiratory insufficiency due to pain, underlying lung collapse, paradoxical movement, and underlying pulmonary contusion. […] However, certain canine-based studies later refuted this hypothesis. Now, it is widely believed and accepted that it is the underlying pulmonary contusion (PC) which is the major cause of the poor prognosis following a flail chest along with rib fractures causing secondary problems of pain and muscular splinting. […] The pathophysiology of pulmonary contusion (PC) is still not fully understood, but primarily involves alveolar and capillary wall rupture leading to intra-alveolar hemorrhage and flooding resulting in ventilation-perfusion (V/Q) mismatch and subsequent hypoxia.

• #53 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  The incidence of hemopneumothoraces in patients with rib fractures is 30%. […] Rib fractures are associated with pulmonary contusions in 20-40% of cases. […] The idea that thoracic cage injuries are predictive of acute traumatic aortic tears is controversial. […] A flail chest is present when a paradoxical respiratory movement occurs in a segment of the chest wall, the result of at least 2 segmental fractures in each of 3 adjacent ribs or costal cartilages. […] The number of rib fractures correlates with mortality in adult trauma patients, rising sharply in patients with more than 6 fractured ribs. […] The association of lower rib fractures with pelvic fractures has been associated with a higher incidence of solid organ injury.

• #54

  https://www.aast.org/resources-detail/rib-fractures

  The most common symptom of rib fractures is pain. Pain is typically elicited with breathing or coughing. If the fractures are complex, the patient may suffer from additional damage to underlying structures. The sharp fractured end of the rib can puncture the lung, causing air leakage, a condition called a pneumothorax, which is potentially life threatening. In addition to pain, shortness of breath and decreased oxygen content in the blood can result from these injuries. A flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can result in a clinical entity called acute lung injury. In its most severe form, acute lung injury can lead to a life threatening entity called adult respiratory distress syndrome (ARDS). Respiratory failure is usually caused by the underlying pulmonary contusion but not by the anatomic flail chest itself. In addition, the flail segment moves in the opposite direction as the rest of the chest wall because of the ambient pressure in comparison to the pressure inside the lungs. This so-called „paradoxical motion” can increase the work and pain involved with breathing.

• #55 Rib Fracture – StatPearls – NCBI Bookshelf

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

  Rib fractures can occur from either direct penetrating or blunt trauma. […] The most feared complication of rib fractures is the flail chest where three or more rib fractures at two points on the involved ribs, creating a floating rib segment and causes this segment to move paradoxically with the rest of the chest wall. […] Rib fractures can be traumatic or atraumatic. […] Most rib fractures are due to direct penetrating or blunt trauma to the chest. […] Rib fractures may also be pathologic as a result of cancer metastasis from other organs. […] Through repetitive stress and microtrauma, athletes can develop rib fractures with chronic use. […] Spontaneous rib fractures can also occur due to severe cough and are more likely to occur in those with osteoporosis or underlying lung disease. […] The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. […] The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.

• #56 Rib Fracture – StatPearls – NCBI Bookshelf

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

  Rib fractures can occur from either direct penetrating or blunt trauma. […] The most feared complication of rib fractures is the flail chest where three or more rib fractures at two points on the involved ribs, creating a floating rib segment and causes this segment to move paradoxically with the rest of the chest wall. […] Rib fractures can be traumatic or atraumatic. […] Most rib fractures are due to direct penetrating or blunt trauma to the chest. […] Rib fractures may also be pathologic as a result of cancer metastasis from other organs. […] Through repetitive stress and microtrauma, athletes can develop rib fractures with chronic use. […] Spontaneous rib fractures can also occur due to severe cough and are more likely to occur in those with osteoporosis or underlying lung disease. […] The incidence and prevalence of rib fractures depend on the injury and the severity of the trauma. […] The elderly tend to be more prone to rib fractures than younger individuals, with higher mortality and morbidity.

• #57

  https://www.aast.org/resources-detail/rib-fractures

  The most common mechanism causing rib fractures is blunt trauma (i.e. automobile accidents, falls from height, assault, or even severe coughing). Blunt trauma causes rib fractures by exerting direct pressure on the rib causing it to break. Approximately 10% of all patients admitted for blunt chest trauma have one or more rib fractures. Although the injury mechanism itself is an important consideration when discussing rib fractures; patient specific considerations are also important. Patients with advanced age, osteoporosis or osteopenia have an increased risk of number and severity of fractures. […] Rib fractures are typically diagnosed on chest x-ray and the severity of the fracture is easily seen. Simple (non-displaced) fractures appear as cracks in the rib or a jagged edge. Displaced fractures appear to lack contour along the edge of the rib on x-ray. Floating segments of ribs, known as a flail chest, can also be easily seen on x-ray. Other imaging modalities such as CT scans also diagnose rib fractures and are more sensitive to identify them. CT scans are useful to determine if underlying lung injury is present, known as a contusion, or to identify if air has escaped the lung as a pneumothorax.

• #58

  https://journals.lww.com/aotm/fulltext/2007/02040/isolated_rib_fractures_in_geriatric_patients.6.aspx

  The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. […] Rib fractures occur more commonly with increasing age, which usually associated with decreased bone density. […] Increased morbidity and mortality in elderly patients with traumatic rib fractures are attributed to several factors such as anatomical difference between young and elderly people (osteoporosis, decreased muscle mass and thinned vertebral bodies), as well as decreased physiological reserve (low cardiopulmonary status and lower immunity), and more likelihood of presence of associated comorbidities. […] Increased number of rib fractures was found to correlate with the morbidity in our patients. […] Increase in the number of rib fractures correlated directly with increasing pulmonary morbidity and mortality. […] In the current study, chronic lung disease was found correlated with mortality; this explains the causes of mortality in this study, viz, respiratory failure and pulmonary infection. […] Pneumonia was found to be an independent predictor of death in old patients with fractured ribs.

• #59

  https://journals.lww.com/aotm/fulltext/2007/02040/isolated_rib_fractures_in_geriatric_patients.6.aspx

  The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. […] Rib fractures occur more commonly with increasing age, which usually associated with decreased bone density. […] Increased morbidity and mortality in elderly patients with traumatic rib fractures are attributed to several factors such as anatomical difference between young and elderly people (osteoporosis, decreased muscle mass and thinned vertebral bodies), as well as decreased physiological reserve (low cardiopulmonary status and lower immunity), and more likelihood of presence of associated comorbidities. […] Increased number of rib fractures was found to correlate with the morbidity in our patients. […] Increase in the number of rib fractures correlated directly with increasing pulmonary morbidity and mortality. […] In the current study, chronic lung disease was found correlated with mortality; this explains the causes of mortality in this study, viz, respiratory failure and pulmonary infection. […] Pneumonia was found to be an independent predictor of death in old patients with fractured ribs.

• #60

  https://journals.lww.com/aotm/fulltext/2007/02040/isolated_rib_fractures_in_geriatric_patients.6.aspx

  The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. […] Rib fractures occur more commonly with increasing age, which usually associated with decreased bone density. […] Increased morbidity and mortality in elderly patients with traumatic rib fractures are attributed to several factors such as anatomical difference between young and elderly people (osteoporosis, decreased muscle mass and thinned vertebral bodies), as well as decreased physiological reserve (low cardiopulmonary status and lower immunity), and more likelihood of presence of associated comorbidities. […] Increased number of rib fractures was found to correlate with the morbidity in our patients. […] Increase in the number of rib fractures correlated directly with increasing pulmonary morbidity and mortality. […] In the current study, chronic lung disease was found correlated with mortality; this explains the causes of mortality in this study, viz, respiratory failure and pulmonary infection. […] Pneumonia was found to be an independent predictor of death in old patients with fractured ribs.

• #61 Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?id=3765

  This may result in minor cracks in the bone and, if the trauma continues, extends to complete fracture. […] The second mechanism is thought to be linked with contrary muscle forces acting on the ribs. […] Several risk factors for the development of CIRF have been reported. Osteoporosis, COPD, prolonged use of high dose steroids, and asthma are among them. […] The CIRF is also common in older age, renal failure, pregnancy, mechanical ventilation, and radiation-therapy. […] In our study, we found that multiple CIRF was significantly common in older patients, in the presence of COVID-19 pneumonia, and of metabolic disease of bone. […] In conclusion, one should be aware of that cough may cause rib fracture and should be suspected, when localized chest pain develops following coughing.

• #62 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. […] Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. […] Worse outcomes were predominantly observed among patients with polytrauma and flail chest. […] The present study aimed to describe the epidemiology, injury characteristics and in-hospital outcomes of patients with traumatic rib fractures. […] In this study, we demonstrated that traumatic rib fractures must be considered as a surrogate marker of severe injury, as about half of our cohort consisted of patients with polytrauma. […] Consequently, as previously emphasized by Sirmali et al, the ISS seem to be of great importance for the evaluation of trauma severity as well as for the accurate decision making in the subsequent treatment.

• #63 Outcomes after rib fractures: more complex than a single number

  https://www.jtraumainj.org/journal/view.php?doi=10.20408/jti.2021.0096

  Rib fractures are common injuries that can lead to morbidity and mortality. […] Rib fractures are often associated with polytrauma and may occur alongside head, abdominal, chest wall, pulmonary, or spinal injuries, which can complicate the management of these patients. […] Research suggests that older patients are at significantly higher risk of mortality and morbidity associated with rib fractures, although the age at which the risk increases is still unclear. […] The factors associated with rib fracture mortality are complex and cannot be explained by a single variable. […] Age, ISS, and comorbidities were independently associated with the risk of mortality; however, they were not accurate predictors of death. […] This study also highlights the importance of CAHs, as 82% of patients were initially evaluated at a critical access hospital.

• #64 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Rib fractures in victims of blunt trauma are generally identified clinically or by chest radiograph (CXR). A definitive diagnosis of rib fractures is not always necessary. The presence of isolated rib fractures does not have to be radiologically confirmed in all patients once associated injury has been adequately excluded, typically with a CXR, which is obtained primarily to identify pneumothorax, hemothorax, and other signs of intrathoracic injury. […] An increasing number of rib fractures correlates with serious intrathoracic and intra-abdominal injuries. Displaced fractures increase the risk of internal injury and delayed bleeding. […] First rib fractures are associated with greater overall injury severity and life-threatening internal injury (including injuries to the brain, spine, lungs, and pelvis), while isolated first rib fractures from playing sports do not carry the same risk.

• #65 Initial evaluation and management of rib fractures – UpToDate

  https://www.uptodate.com/contents/initial-evaluation-and-management-of-rib-fractures

  Fractures of superior ribs (numbers 1 to 3) reflect trauma involving significant force and the potential for injury to mediastinal structures, major blood vessels (eg, aorta), and lung parenchyma. […] Three or more adjacent ribs each fractured in two places (ie, flail chest) is often associated with significant morbidity from pulmonary contusion as well as injuries elsewhere. […] Treatment of rib fractures should be focused on early and adequate pain relief to avoid complications (eg, pneumonia) from splinting and atelectasis. Analgesia for isolated rib fractures includes nonsteroidal anti-inflammatory drugs (NSAIDs) with or without opioids.

• #66 Rib Fractures – Pacific Thoracic Surgery

  https://pacificthoracicsurgery.com/category/rib-fractures/

  Minimally Invasive Muscle Sparing (MIMS) Rib fixation is a less invasive option for surgical treatment of rib fractures. MIMS rib fixation utilizes a video scope in the chest to reduce fractures and localize fractures. The small incision for fixation spares the muscle fibers and thus causes less pain. […] Surgical fixation of rib fractures has become a more attractive treatment option because of the immediate and long term advantages of surgery. […] Rib Fractures are often underestimated and overlooked. Many patients die each year from rib fractures alone after a simple fall from standing. MIMS rib fixation is a safe and effective treatment for broken ribs. […] The MIMS rib fixation procedure is a less invasive technique with less tissue disruption and less surgical trauma. Our data shows a much faster recovery than what has been seen with other types of procedures and most patients have little to no pain after surgery. Patients do not have to suffer with rib fractures as there are now ideal surgical treatment options as discussed in this article.

• #67 Rib Fractures – Uncomplicated : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/rib-fractures-uncomplicated/

  The most common mechanism associated with rib fracture is blunt trauma (1). […] Rib fractures and associated injuries often carry a high mortality. In adults a mortality of up to 10% has been shown and this increases up to 20% in patient populations >65 yo (2,3). […] 1st and 2nd rib fractures may be associated with great vessel injury, whereas fractures to ribs 9-12 can cause splenic, liver or kidney laceration (4). […] Pulmonary complications including pneumothorax, hemothorax, pulmonary contusion, pneumonia and atelectasis are common and may be seen in 16-52% of blunt trauma cases with rib fracture (4). […] Pain can compound an underlying pulmonary contusion leading a patient into Acute Respiratory Distress Syndrome (5). […] Not recognizing associated injuries either pulmonary (listed above), abdominal solid organ or thoracic great vessels.

• #68 Rib Fractures – Uncomplicated : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/rib-fractures-uncomplicated/

  The most common mechanism associated with rib fracture is blunt trauma (1). […] Rib fractures and associated injuries often carry a high mortality. In adults a mortality of up to 10% has been shown and this increases up to 20% in patient populations >65 yo (2,3). […] 1st and 2nd rib fractures may be associated with great vessel injury, whereas fractures to ribs 9-12 can cause splenic, liver or kidney laceration (4). […] Pulmonary complications including pneumothorax, hemothorax, pulmonary contusion, pneumonia and atelectasis are common and may be seen in 16-52% of blunt trauma cases with rib fracture (4). […] Pain can compound an underlying pulmonary contusion leading a patient into Acute Respiratory Distress Syndrome (5). […] Not recognizing associated injuries either pulmonary (listed above), abdominal solid organ or thoracic great vessels.

• #69 Rib Fractures – Uncomplicated : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/rib-fractures-uncomplicated/

  The most common mechanism associated with rib fracture is blunt trauma (1). […] Rib fractures and associated injuries often carry a high mortality. In adults a mortality of up to 10% has been shown and this increases up to 20% in patient populations >65 yo (2,3). […] 1st and 2nd rib fractures may be associated with great vessel injury, whereas fractures to ribs 9-12 can cause splenic, liver or kidney laceration (4). […] Pulmonary complications including pneumothorax, hemothorax, pulmonary contusion, pneumonia and atelectasis are common and may be seen in 16-52% of blunt trauma cases with rib fracture (4). […] Pain can compound an underlying pulmonary contusion leading a patient into Acute Respiratory Distress Syndrome (5). […] Not recognizing associated injuries either pulmonary (listed above), abdominal solid organ or thoracic great vessels.

• #70 Pathophysiology – RCEMLearning India

  https://www.rcemlearning.org/modules/ultrasound-guided-serratus-anterior-plane-block/lessons/pathophysiology-44/

  Rib fractures are associated with multiple complications including pneumonia, acute respiratory distress syndrome, atelectasis and lung collapse. Pain from rib fractures causes hypoventilation and increased pulmonary complications. Patients with multiple rib fractures often require critical care admission. […] The addition of a SAPB to standard rib fracture care is reported to improve pain scores and reduce in-hospital opioid requirements. […] These nerves can be blocked in the superficial or deep space to provide analgesia from ribs one to nine. They are ideal for anterior or lateral fractures. More posterior fractures may be better suited to a more posterior nerve block such as an erector spinae (ESP) block, paravertebral block, or neuraxial technique if suitable. Nevertheless, in those where the lateral or sitting position to allow more posterior nerve block techniques is not possible (pain, concomitant injury, spinal precautions), an SAPB, which is able to be performed in the supine position, will likely provide analgesia for more posterior fractures.

• #71 Rib Fracture Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/395172-overview

  The incidence of hemopneumothoraces in patients with rib fractures is 30%. […] Rib fractures are associated with pulmonary contusions in 20-40% of cases. […] The idea that thoracic cage injuries are predictive of acute traumatic aortic tears is controversial. […] A flail chest is present when a paradoxical respiratory movement occurs in a segment of the chest wall, the result of at least 2 segmental fractures in each of 3 adjacent ribs or costal cartilages. […] The number of rib fractures correlates with mortality in adult trauma patients, rising sharply in patients with more than 6 fractured ribs. […] The association of lower rib fractures with pelvic fractures has been associated with a higher incidence of solid organ injury.

• #72 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

  The highest mortality rate was found in patients with flail chest (n=3039, 13.0%), polytrauma (n=26898, 10.6%) and elderly patients (n=12239, 7.6%). […] Patients with flail chest tend to have significantly worse outcomes than those diagnosed with multiple rib fractures. […] The stability of the chest wall appears to be an important prognostic factor for mortality, and flail chest is often associated with high impact trauma. […] Therefore, patients with flail chest should be considered as an independent entity and surgical treatment might play a pivotal role in improving outcome for these patients.

• #73 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

  The highest mortality rate was found in patients with flail chest (n=3039, 13.0%), polytrauma (n=26898, 10.6%) and elderly patients (n=12239, 7.6%). […] Patients with flail chest tend to have significantly worse outcomes than those diagnosed with multiple rib fractures. […] The stability of the chest wall appears to be an important prognostic factor for mortality, and flail chest is often associated with high impact trauma. […] Therefore, patients with flail chest should be considered as an independent entity and surgical treatment might play a pivotal role in improving outcome for these patients.

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

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

  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. […] 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.

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

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

  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. […] 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.

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

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

  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. […] 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.

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

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

  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. […] It also showed an improvement in the same group regarding co-morbidities and opioid analgesic consumption. […] Similarly, an Australian study investigating the quality of life after rib fractures suggests that patients who underwent rib osteosynthesis (rib-fixation surgery) had less post-operative pain and also less long-term pain and disability issues. […] 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.

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

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

  Therefore, an early interventional approach to reduce acute pain after rib fractures might improve the outcomes for these patients. […] The rationale behind this hypothesis is that costal fixation could lead to reduced inflammation and nerve injury by restricting and preventing further fracture movement and thus reducing pain. […] 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. […] Although there are many challenges when it comes to the treatment of rib fractures, including the lack of clinical research and evidence, it is quite obvious that the current conservative treatment of rib fractures does not efficiently facilitate pain relief or even a prompt return to everyday activities.

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