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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 6/2021

01-12-2021 | Thoracic Trauma | Original Article

Rib fracture displacement worsens over time

Authors: Zachary Mitchel Bauman, Benjamin Grams, Ujwal Yanala, Valerie Shostrom, Brett Waibel, Charity Hassie Evans, Samuel Cemaj, Lisa Lynn Schlitzkus

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2021

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Abstract

Purpose

Rib fractures (RF) occur in 10% of trauma patients; associated with significant morbidity and mortality. Despite advancing technology of surgical stabilization of rib fractures (SSRF), treatment and indications remain controversial. Lack of displacement is often cited as a reason for non-operative management. The purpose was to examine RF patterns hypothesizing RF become more displaced over time.

Methods

Retrospective review of all RF patients from 2016–2017 at our institution. Patients with initial chest CT (CT1) followed by repeat CT (CT2) within 84 days were included. Basic demographics were obtained. Primary outcomes included RF displacement in millimeters (mm) between CT1 and CT2 in three planes (AP = anterior/posterior, O = overlap/gap, and SI = superior/inferior). Displacement was calculated by subtracting CT1 fracture displacement from CT2 displacement for each rib. Given anatomic and clinical characteristics, ribs were grouped (1–2, 3–6, 7–10, 11–12), averaged, and analyzed for displacement. Secondary outcome included number of missed RF on CT1. Non-parametric sign test and paired t test were used for analysis. Significance was set at p < 0.002.

Results

78 of 477 patients with RF on CT1 had CT2 during the study period: primarily male (76%) and age 55.8 ± 20.1 with blunt mechanism of injury (99%). Median Injury Severity Score was 21 (IQR, 13–27) with Chest Abbreviated Injury Score of 3 (IQR, 3–4). Median time between CT1 and CT2 was 6 days (IQR, 3–12). Missed RF rate for CT1 was 10.1% (p = 0.11). Average fracture displacement was significantly increased for all rib groupings except 11–12 in all planes (p < 0.002).

Conclusion

RF become more displaced over time. Pain regimens and SSRF considerations should be adjusted accordingly.
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Metadata
Title
Rib fracture displacement worsens over time
Authors
Zachary Mitchel Bauman
Benjamin Grams
Ujwal Yanala
Valerie Shostrom
Brett Waibel
Charity Hassie Evans
Samuel Cemaj
Lisa Lynn Schlitzkus
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01353-w

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