Rib fracture displacement worsens over time

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

Research output: Contribution to journalArticle

1 Scopus citations

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.

Original languageEnglish (US)
JournalEuropean Journal of Trauma and Emergency Surgery
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Chest trauma
  • Displacement
  • Pain
  • Rib fixation
  • Rib fracture

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Rib fracture displacement worsens over time'. Together they form a unique fingerprint.

  • Cite this

    Bauman, Z. M., Grams, B., Yanala, U., Shostrom, V., Waibel, B., Evans, C. H., Cemaj, S., & Schlitzkus, L. L. (Accepted/In press). Rib fracture displacement worsens over time. European Journal of Trauma and Emergency Surgery. https://doi.org/10.1007/s00068-020-01353-w