Thoracic Trauma
Following both penetrating and blunt trauma, chest injuries are also common in multiply
injured patients.
Rib fractures
Most common injury associated with blunt chest trauma
– 4-10 % of all trauma admission
– the true incidence in probably higher since up to 50% of rib fractures may be missed on
initial CXR
Causes:
– motor vehicle crashes
– falls
– blows to the chest with blunt objects
• fractures of ribs 3 trought 8 – maximum frequency directly – at the site of force
•laterally – significant antero-posterior compression of the chest
The first rib is protected by the shoulder girdle and clavicle
– Fractures of the first rib indicate a significant amount of energy transferred to the torso
– have been associated with aortic injuries
• Posterior rib fractures are also associated with significant energy transfer to the thorax.
1
, • Associated injuries:
– 20% incidence of splenic injury is associated with fractures of ribs 9, 10, and 11 on the
left side
– similar for hepatic injuries
– 50% of patients with blunt cardiac injury have rib fractures.
Rib fractures - diagnosis
• The diagnosis of rib fractures is primarily clinical
• Pain
– Directly
– Antero-posterior compression,
• Crepitus over the possible area of fracture
• Decreased breath sounds on the side of injury
• Pain:
– Subsequent atelectasis
– Underlying pulmonary contusion
– Restriction of ventilation.
PS: radiologic confirmation of the diagnosis is not essential
Children
– pulmonary contusion is more common
– rib fractures = a sign of significant energy transfer.
Elderly
– Patients older than 65 years with 3 or more rib fractures had a 5-fold increased
mortality rate and an almost 4-fold increased incidence of pneumonia compared with
younger patients
2
Following both penetrating and blunt trauma, chest injuries are also common in multiply
injured patients.
Rib fractures
Most common injury associated with blunt chest trauma
– 4-10 % of all trauma admission
– the true incidence in probably higher since up to 50% of rib fractures may be missed on
initial CXR
Causes:
– motor vehicle crashes
– falls
– blows to the chest with blunt objects
• fractures of ribs 3 trought 8 – maximum frequency directly – at the site of force
•laterally – significant antero-posterior compression of the chest
The first rib is protected by the shoulder girdle and clavicle
– Fractures of the first rib indicate a significant amount of energy transferred to the torso
– have been associated with aortic injuries
• Posterior rib fractures are also associated with significant energy transfer to the thorax.
1
, • Associated injuries:
– 20% incidence of splenic injury is associated with fractures of ribs 9, 10, and 11 on the
left side
– similar for hepatic injuries
– 50% of patients with blunt cardiac injury have rib fractures.
Rib fractures - diagnosis
• The diagnosis of rib fractures is primarily clinical
• Pain
– Directly
– Antero-posterior compression,
• Crepitus over the possible area of fracture
• Decreased breath sounds on the side of injury
• Pain:
– Subsequent atelectasis
– Underlying pulmonary contusion
– Restriction of ventilation.
PS: radiologic confirmation of the diagnosis is not essential
Children
– pulmonary contusion is more common
– rib fractures = a sign of significant energy transfer.
Elderly
– Patients older than 65 years with 3 or more rib fractures had a 5-fold increased
mortality rate and an almost 4-fold increased incidence of pneumonia compared with
younger patients
2
