TY - JOUR
T1 - Rib fracture displacement worsens over time
AU - Bauman, Zachary Mitchel
AU - Grams, Benjamin
AU - Yanala, Ujwal
AU - Shostrom, Valerie
AU - Waibel, Brett
AU - Evans, Charity Hassie
AU - Cemaj, Samuel
AU - Schlitzkus, Lisa L
N1 - Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Chest trauma
KW - Displacement
KW - Pain
KW - Rib fixation
KW - Rib fracture
UR - http://www.scopus.com/inward/record.url?scp=85082936735&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85082936735&partnerID=8YFLogxK
U2 - 10.1007/s00068-020-01353-w
DO - 10.1007/s00068-020-01353-w
M3 - Article
C2 - 32219487
AN - SCOPUS:85082936735
VL - 47
SP - 1965
EP - 1970
JO - European Journal of Trauma and Emergency Surgery
JF - European Journal of Trauma and Emergency Surgery
SN - 1863-9933
IS - 6
ER -