Fatal blunt chest trauma: an evaluation of rib fracture patterns and age

International Journal of Legal Medicine - The following study was undertaken to determine if any specific occupant characteristics, crash factors, or associated injuries identified at autopsy could...     

Nonunion of a first rib fracture in a gymnast

Isolated fracture of the first rib is uncommon, but has been reported to occur in sports such as basketball, baseball, and dancing. It has not been reported to occur in gymnasts. Usually, these fractures heal with an adequate period of rest. Rarely do first rib fractures become nonunions. They have been felt to be asymptomatic and are usually found incidentally on routine chest roentgenograms. Symptomatic nonunion of a first rib fracture has not been reported previously. Our patient did not respond to nonoperative treatment and required surgical intervention to alleviate her symptoms. We agree that most fractures of this type heal without complications. However, if a persistently symptomatic nonunion ensues, we suggest transaxillary resection of 90% or more of the first rib.     

Stress fracture of the first rib in a weightlifter

A 20-year-old woman elite weightlifter presented with acute onset debilitating right shoulder pain while attempting the "clean and jerk." There was no previous relevant history, including no prior fracture in the region. Examination confirmed vague tenderness in the right supraclavicular fossa with no discernible neurologic or vascular deficit within the right arm. X-ray was normal. The patient had a bone scan, including SPECT, suggesting a fracture of the right first rib, subsequently confirmed on CT examination.     

Isolated first rib fracture in athletes

Isolated fractures of the first rib are uncommon. They are caused by major blunt trauma, a violent muscular pull, or fatigue. Diagnosis is usually made by chest radiography and computed tomography. Angiography is justified when certain criteria are met. Treatment is rest and mild analgesia. Early and late complications have been reported and are treated accordingly. The purpose of this article is to report a case of first rib stress fracture in a kick boxer and review the pertinent literature.     

Radiology of trauma to the wrist: Dislocations,fracture dislocations,and instability patterns

Radiologic changes from trauma to the carpus are described. Emphasis is placed upon pathomechanics and characterization of greater and lesser arc injury patterns. Finally, the various posttraumatic instability patterns of the wrist are discussed.     

肋骨骨折的诊疗进展

随着意外伤害特别是交通事故的逐渐增多,胸部创伤的发生率也逐年增高.胸部创伤中以肋骨骨折最为常见,约占所有胸部创伤的50%～80%.而肋骨骨折又以单根肋骨骨折最为常见,对于此类肋骨骨折如无并发症一般不需特殊处理.     

Stress fracture of the ipsilateral first rib in a pitcher

This stress fracture of the left first rib in a 17-year-old, left-handed high school baseball pitcher represents the first of its type reported in the literature. Two similar cases have been reported in pitchers, but the fracture was on the nondominant side in both cases. In contrast to most cases of this rare lesion, the stress fracture we report occurred acutely and was documented roentgenographically from onset to complete healing 9 months later.     

肋骨骨折的诊疗进展

随着意外伤害特别是交通事故的逐渐增多,胸部创伤的发生率也逐年增高.胸部创伤中以肋骨骨折最为常见,约占所有胸部创伤的50%～80%.而肋骨骨折又以单根肋骨骨折最为常见,对于此类肋骨骨折如无并发症一般不需特殊处理.     

肋骨骨折的诊疗进展

随着意外伤害特别是交通事故的逐渐增多,胸部创伤的发生率也逐年增高.胸部创伤中以肋骨骨折最为常见,约占所有胸部创伤的50%～80%.而肋骨骨折又以单根肋骨骨折最为常见,对于此类肋骨骨折如无并发症一般不需特殊处理.     

钝性损伤致下胸部肋骨骨折合并腹腔脏器损伤的危险因素分析

目的分析钝性损伤致下胸部肋骨骨折合并腹腔脏器损伤的危险因素和早期预测因子。方法回顾性分析2015年1月—2017年12月厦门大学附属东南医院收治的183例钝性损伤致下胸部肋骨(8~12肋)骨折患者,其中经CT影像学或剖腹探查诊断合并腹腔脏器损伤34例(腹腔脏器损伤组),无腹腔脏器损伤149例(无腹腔脏器损伤组),收集患者人口学特征(性别、年龄)、致伤原因(交通事故、高处坠落、意外跌倒、暴力击打)、肋骨骨折部位(单侧、双侧)和数目、入院时生命体征(收缩压、心率)、腹部体征、实验室指标(红细胞压积),通过单因素和多因素Logiistic回归分析合并腹腔脏器损伤的相关因素。结果本组183例钝性损伤致下胸部肋骨骨折患者中左侧肋骨骨折91例,右侧肋骨骨折79例,双侧肋骨骨折13例。本组合并腹腔脏器损伤比例为18.6%(34/183),共计发生57处脏器损伤,其中脾脏损伤27例、肝脏损伤18例、肾脏损伤6例、肾上腺损伤3例、胰腺损伤2例、十二指肠损伤1例。单因素分析发现,性别和肋骨骨折数目与合并腹腔脏器损伤无关联,而年龄(χ~2=6.349,P=0.012)、是否机动车事故(χ~2=7.133,P=0.008)、肋骨骨折部位(χ~2=11.506,P=0.001)、入院时收缩压(χ~2=18.531,P0.001)、心率(χ~2=5.932,P=0.015)、腹部体征(χ~2=6.416,P=0.011)和红细胞压积(χ~2=6.685,P=0.010)与合并腹腔脏器损伤存在关联。多因素Logistic回归分析发现,机动车事故(OR=5.64,95%CI:2.57~11.61,P=0.008)、双侧肋骨骨折(OR=4.25,95%CI:1.63~12.87,P=0.025)、入院时红细胞压积40%(OR=2.16,95%CI:1.98~5.29,P=0.017)是同时合并腹腔脏器损伤的独立危险因素。结论对于钝性损伤致下胸部肋骨骨折,尤其是机动车事故、双侧肋骨骨折、存在明显失血指征者,要高度警惕合并腹腔脏器损伤的可能。     

两种不同类型的肋骨接骨板在肋骨骨折固定手术中的应用研究

目的 探讨两种不同类型的肋骨接骨板治疗多发性肋骨骨折的临床疗效.方法 回顾性分析2019年3月—2020年9月上海交通大学医学院附属第九人民医院胸外科收治的92例切开复位内固定术的多发性肋骨骨折患者资料,按照不同的内固定手术方式分为观察组和对照组,每组46例.观察组采用形状记忆环抱接骨板治疗,男性28例,女性18例;年...     

Pseudo-gunshot wound injury from perforating rib fracture: a cautionary case report

We report a case of a young woman who was found unresponsive in a garbage dumpster beneath the balcony of her 9th floor apartment residence. Initial investigations by the police and coroner raised concerns regarding the circumstances of the death. Initial examination of the body, revealed a single penetrating injury on the chest with a wide abrasion collar––the injury pattern was similar to a gunshot entry wound or a shored exit wound. Autopsy revealed the abraded skin perforation along with major chest injuries with bruising of the chest wall, extensive comminuted rib fractures, and pleural and lung lacerations. These injuries were consistent with the effects of a fatal descent from height. The penetrating injury with the abrasion collar was due to a fractured end of a rib protruding through the skin mimicking a gunshot wound. The involvement of a firearm was further excluded by postmortem radiography (no projectile in situ), detailed external examination of the clothing, and scene investigation revealing that the decedent had descended from a balcony into the dumpster. This case underscores the concept that all round penetrating wounds with abrasion collars are not gunshot injuries.     

早期胸腔镜探查同期肋骨骨折内固定治疗多发肋骨骨折并血气胸

目的探讨早期胸腔镜探查同期行肋骨骨折内固定手术治疗多发肋骨骨折并血气胸的临床疗效。方法总结2014年2月~2015年6月收治的25例多发肋骨骨折并血气胸患者,男性19例,女性6例,年龄19~66岁,平均43岁。13例作为对照组,只行肋骨骨折内固定和胸腔闭式引流术;12例行早期胸腔镜探查同期肋骨骨折内固定为观察组,评价早期胸腔镜探查同期肋骨骨折内固定的临床效果。结果观察组患者术后引流管拔除时间、血氧饱和度、胸腔感染、肺完全复张情况、凝固性血胸与再次手术及住院天数比较均优于对照组患者。结论早期胸腔镜探查同期肋骨骨折内固定手术治疗多发肋骨骨折并血气胸是一种安全、有效的手术方式,值得推广。     

Spinopelvic dissociation: multidetector computed tomographic evaluation of fracture patterns and associated injuries at a single level 1 trauma center

The objective of the present study is to evaluate multidetector computed tomographic (MDCT) fracture patterns and associated injuries in patients with spinopelvic dissociation (SPD). Our institutional trauma registry database was reviewed from Jan. 1, 2006, to Sept. 30, 2012, specifically evaluating patients with sacral fractures. MDCT scans of patients with sacral fractures were reviewed to determine the presence of SPD. SPD cases were characterized into the following fracture patterns: U-shaped, Y-shaped, T-shaped, H-shaped, and burst. The following MDCT features were recorded: level of the horizontal fracture, location of vertical fracture, kyphosis between major fracture fragments, displacement of fracture fragment, narrowing of central spinal canal, narrowing of neural foramina, and extension into sacroiliac joints. Quantitative evaluation of the sacral fractures was performed in accordance with the consensus statement by the Spine Trauma Study Group. Medical records were reviewed to determine associated pelvic and non-pelvic fractures, bladder and bowel injuries, nerve injuries, and type of surgical intervention. Twenty-one patients had SPD, of whom 13 were men and eight were women. Mean age was 41.8 years (range 18.8 to 87.7). Five fractures (24 %) were U-shaped, six (29 %) H-shaped, four (19 %) Y-shaped, and six (29 %) burst. Nine patients (43 %) had central canal narrowing, and 19 (90 %) had neural foramina narrowing. Eleven patients (52 %) had kyphotic angulation between major fracture fragments, and seven patients (33 %) had either anterior (24 %) or posterior (10 %) displacement of the proximal fracture fragment. Fourteen patients (67 %) had associated pelvic fractures, and 20 (95 %) had associated non-pelvic fractures. Two patients (10 %) had associated urethral injuries, and one (5 %) had an associated colon injury. Seven patients (33 %) had associated nerve injuries. Six patients (29 %) had surgical fixation while 15 (71 %) were managed non-operatively. On trauma MDCT examinations, patients with SPD have characteristic fracture patterns. It is important to differentiate SPD from other pelvic ring injuries due to high rate of associated injuries. Although all SPD injuries are unstable and need fixation, the decision for operative management in an individual patient depends on the systemic injury pattern, specific fracture pattern, and the ability to attain stable screw fixation.     

Unusually extensive head trauma in a hydraulic elevator accident: post-mortem MSCT findings, autopsy results and scene reconstruction

Accidental or intentional falls from a height are a form of blunt trauma and occur frequently in forensic medicine. Reports describing elevator accidents as a small subcategory of falls from heights are rare in the medical literature and no report on injury patterns or scene reconstruction of such an accident was found. A case of an accident in a hydraulic elevator with a man falling 3m was examined using post-mortem multi-slice computed tomography (MSCT) and autopsy. The man suffered an unusually extensive trauma and died at the scene. Post-mortem MSCT examination showed a comminute fracture of the skull, the right femur and the first lumbar vertebra. Severe lacerations of the brain with epidural, subdural and subarachnoidal haemorrhages over both hemispheres were diagnosed. Autopsy confirmed these findings. To reconstruct the accident we used radiological and autopsy results as well as findings at the scene.     

Validation of a post-mortem computed tomography method for age estimation based on the 4th rib in a French population

International Journal of Legal Medicine - Age estimation is a key factor for identification procedure in forensic context. Based on anthropological findings, degenerative changes of the sternal...