Clinical significance of rib fractures' anatomical patterns

• Published in: Injury Vol. 51; no. 8; pp. 1812 - 1816
• Main Authors: Pines, Guy, Gotler, Yakov, Lazar, Li Or, Lin, Guy
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-08-2020
• Subjects: Anatomical patterns of rib fractures; Chest CT; Complications; Delayed hemothorax; Delayed hemothorax; Chest CT; Anatomical patterns of rib fractures; Complications
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.05.023

•Rib fractures are common and carry significant morbidity. The pattern of rib fractures seems to play a role in complication development.•Among a cohort of blunt trauma patients sustaining rib fractures patients with lateral middle fractures had the highest complications rate.•A third of these patients required chest drain, and 25% developed respiratory failure.
Rib fractures are common and carry significant morbidity. Chest CT provides an accurate mapping of the fractures. The aim of this study is to propose an anatomical classification of rib fractures, and assess their relation to complication development.
The records of all blunt trauma patients between January 1st 2014 and December 31st 2017 at a university hospital were retrospectively reviewed. Wounded who were hospitalized with rib fractures (two and more) as the primary injury were included in the study. Based on the chest CT scans, the cohort was divided into five groups: upper ribs (1-4) fractures, anterior, lateral and posterior middle ribs (4-7) fractures, and lower ribs (9-12) fractures. Data regarding demographics, complications (pneumothorax, hemothorax, chest drains, pulmonary contusion atelectasis, pneumonia, respiratory failure and death), intensive care admission and hospital stay were collected.
A total of 102 wounded were included in the study, with a mean age of 46.3 years. The mean number of fractured ribs per person was 3.82±1.68, and 46 wounded had displaced fractures. Rib fracture distribution was: upper ribs – 13.7%, anterior middle ribs – 28.5%, lateral middle ribs fractures – 27.5%, posterior middle ribs – 14.7%, lower ribs fractures – 15.7%. Wounded sustaining lateral middle ribs fractures had the highest complications rates in relation to any other fracture location group, with 25% respiratory failure rate.
Lateral middle ribs fractures are associated with a higher complication rate and may require closer oabservation.