MCACS Home
Annual Meeting Home
Final Program
Past Meetings

Back to Annual Meeting Posters


Morphology of Displaced Blunt Rib Fractures Predicts Thoracic Co-Injuries
Nikolay Bugaev, MD1; Janis Breeze, MPH2, Majid Alhazmi, MD3, Hassan Najm, MD4,
Sandra Strack Arabian, CSTR5, Reuven Rabinovici, MD6
1Tufts Medical Center, Boston, MA, 2Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, 3Tufts Medical Center, Boston, MA, 4Tufts Medical Center, Boston, MA, 5Tufts Medical Center, Boston, MA, 6Tufts Medical Center, Boston, MA

Background: Although blunt rib fractures (RF) are common, the association between
fracture displacement and chest co-injuries is still obscure.

Methods: A retrospective review of all adult patients with blunt RF treated at an urban
Level I trauma center between 2007-2012. 3D measurements of RF displacement were performed using axial, coronal, and sagittal chest computed tomography images, and correlated with the presence of other chest injuries. Characteristics of patients with non-displaced RF (NDRF) and displaced RF (DRF) were compared. An analysis of receiver operating characteristic (ROC) curves for sensitivity and specificity was performed to identify displacement thresholds in each plane most strongly associated with chest co-injuries, based on each patientís maximal RF displacement value.

Results: 245 patients with 1003 fractured ribs and 1127 RF were identified. DRF were observed in 69% of patients. DRF compared to NDRF patients were older (61.0 vs. 54 yrs, p=0.008), had a higher Injury Severity Score (17.4 vs. 14.4, p=0.03), and a higher prevalence of hemothorax (HTX; 25 vs 8%, p=0.0016), pneumothorax (33 vs. 16%, p<0.004), hemopneumothorax (HPTX; 13% vs. 1%, p<0.0033), flail chest (19% vs. 1%, p=0.0019), and chest tube (CT) placement (23 vs. 7%, p=0.0021). Only absolute maximal axial displacement thresholds of ~3 mm performed well at classifying patients with or without HTX (threshold=2.8 mm, ROC=0.74), PTX (2.6 mm, ROC=0.70), HPTX (3.1 mm, ROC=0.77), and CT (2.8 mm, ROC=0.75) placement.

Conclusion: DRF are associated with a greater prevalence of HTX, PTX, HPTX, and CT placement. Axial displacement of RF may be an important predictor of these injuries.


Back to Annual Meeting Posters

 



© 2019 Massachusetts Chapter of the American College of Surgeons. All Rights Reserved. Privacy Policy.