Investigation of the relationship of the number, localization, and displacement of rib fractures with intrathoracic stru
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ORIGINAL ARTICLE
Investigation of the relationship of the number, localization, and displacement of rib fractures with intrathoracic structures and abdominal solid organ complications using computed tomography Selçuk Parlak1 · Muhammed Said Beşler1 Received: 16 May 2020 / Accepted: 2 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aimed at evaluating the fracture properties, intrathoracic structures, and abdominal solid organ complications in patients with traumatic rib fractures. Methods Chest CT images of 305 patients were retrospectively evaluated to determine the number and level of rib fractures and measure the magnitude of displacement. The relationship of rib fractures and displacement patterns with intrathoracic structures and abdominal solid organ complications was investigated. Results The fractures were most located in the fifth, sixth, and seventh ribs. The mean age of the patients with displaced fractures was statistically significantly higher than the non-displaced fracture group with pneumothorax, hemothorax or lung injury. RibScore was statistically significantly higher in patients with pneumothorax, hemothorax, and lung parenchyma injury, as well as those with liver, spleen, and kidney injury. Hepatic, splenic, and renal injuries were markedly higher in patients with displaced fractures, but this was not statistically significant. Spleen and kidney injuries were statistically significantly more frequent among the patients with the fractures of the 10th to 12th ribs. The rib fracture displacement cut-off values for pneumothorax, hemothorax, and lung injury were found to be 2.18 mm, 2.32 mm, and 2.82 mm, respectively. Conclusion The presence of a displaced rib fracture is a strong predictor of intrathoracic complications. A more careful intrathoracic evaluation of rib fractures with more than 2 mm displacement will contribute to patient management. Keywords Computed tomography · Rib fracture · Pneumothorax · Hemothorax
Introduction Ribs are important components of the thoracic wall and play an essential role in the protection of lungs, mediastinal structures, and other vital thoracoabdominal organs with risk of injury in trauma. Although thorax traumas are mostly blunt, penetrating injuries can also be seen [1, 2]. In blunt traumas, the most frequently affected structures are ribs, which appear in the form of a fracture in approximately half of the cases [1–4]. The number of fractures, affected ribs, type of fracture, and whether there is displacement are important in determining the severity of trauma and clinical state. * Muhammed Said Beşler [email protected] 1
Department of Radiology, Ankara City Hospital, Ankara, Turkey
Morbidity and mortality increase as the number of broken ribs increases [1–3, 5–7]. In a displaced fracture (DF), there is no cortical contact between the ends of the fracture due to overlapping or distraction [8]. Depending on the severity of trauma, the fracture ends may separate from each other and displac
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