Rib Fracture Questions & Answers

1. Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Mar. 82 (3):618-626. [QxMD MEDLINE Link].

2. Sammy IA, Chatha H, Lecky F, Bouamra O, Fragoso-Iñiguez M, Sattout A, et al. Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database. Emerg Med J. 2017 Apr. 34 (4):205-211. [QxMD MEDLINE Link].

3. Murphy CE 4th, Raja AS, Baumann BM, Medak AJ, Langdorf MI, Nishijima DK, et al. Rib Fracture Diagnosis in the Panscan Era. Ann Emerg Med. 2017 May 27. [QxMD MEDLINE Link].

4. Yonezawa N, Nakayama Y, Takei T, Toh M, Asano M, Imamura T, et al. Fatal delayed rupture of the subclavian artery in a patient with first-rib fracture caused by blunt trauma. Clin Case Rep. 2017 Mar. 5 (3):260-263. [QxMD MEDLINE Link].

5. Ochi K, Furuya T, Ikari K, Taniguchi A, Yamanaka H, Momohara S. Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan. Arch Osteoporos. 2013. 8(1-2):130. [QxMD MEDLINE Link].

6. Colosimo AJ, Byrne E, Heidt RS Jr, Carlonas RL, Wyatt H. Acute traumatic first-rib fracture in the contact athlete: a case report. Am J Sports Med. 2004 Jul-Aug. 32(5):1310-2. [QxMD MEDLINE Link].

7. Lee SJ, Chu SJ, Tsai SH. Isolated Bilateral First-rib Fractures. J Emerg Med. 2008 Jul 21. [QxMD MEDLINE Link].

8. Recinos G, Inaba K, Dubose J, et al. Epidemiology of sternal fractures. Am Surg. 2009 May. 75(5):401-4. [QxMD MEDLINE Link].

9. Peters ML, Starling SP, Barnes-Eley ML, Heisler KW. The presence of bruising associated with fractures. Arch Pediatr Adolesc Med. 2008 Sep. 162(9):877-81. [QxMD MEDLINE Link].

10. Expert Panel on Pediatric Imaging:., Wootton-Gorges SL, Soares BP, Alazraki AL, Anupindi SA, Blount JP, et al. ACR Appropriateness Criteria^® Suspected Physical Abuse-Child. J Am Coll Radiol. 2017 May. 14 (5S):S338-S349. [QxMD MEDLINE Link].

11. Boele van Hensbroek P, Mulder S, Luitse JS, van Ooijen MR, Goslings JC. Staircase falls: high-risk groups and injury characteristics in 464 patients. Injury. 2009 Aug. 40(8):884-9. [QxMD MEDLINE Link].

12. Maxwell CA, Mion LC, Dietrich MS. Hospitalized injured older adults: clinical utility of a rib fracture scoring system. J Trauma Nurs. 2012 Jul. 19(3):168-74. [QxMD MEDLINE Link].

13. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994 Dec. 37(6):975-9. [QxMD MEDLINE Link].

14. Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009 May. 10(2):79-84. [QxMD MEDLINE Link].

15. Rosenberg G, Bryant AK, Davis KA, Schuster KM. No breakpoint for mortality in pediatric rib fractures. J Trauma Acute Care Surg. 2016 Mar. 80 (3):427-32. [QxMD MEDLINE Link].

16. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000 Jun. 48(6):1040-6; discussion 1046-7. [QxMD MEDLINE Link].

17. Shorr RM, Rodriguez A, Indeck MC, Crittenden MD, Hartunian S, Cowley RA. Blunt chest trauma in the elderly. J Trauma. 1989 Feb. 29(2):234-7. [QxMD MEDLINE Link].

18. Wang HW, Xiang Q, Li CQ, Zhou Y. Traumatic vertebral fractures with concomitant fractures of the first rib. Orthop Surg. 2013 May. 5(2):100-4. [QxMD MEDLINE Link].

19. Richardson JD, McElvein RB, Trinkle JK. First rib fracture: a hallmark of severe trauma. Ann Surg. 1975 Mar. 181(3):251-4. [QxMD MEDLINE Link].

20. Logan PM. Is there an association between fractures of the cervical spine and first- and second-rib fractures?. Can Assoc Radiol J. 1999 Feb. 50(1):41-3. [QxMD MEDLINE Link].

21. Hassan AN, Ballester J, Slater N. Bilateral first rib fractures associated with Horner's syndrome. Injury. 2000 May. 31(4):273-4. [QxMD MEDLINE Link].

22. Al-Hassani A, Afifi I, Abdelrahman H, El-Menyar A, Almadani A, Recicar J, et al. Concurrent rib and pelvic fractures as an indicator of solid abdominal organ injury. Int J Surg. 2013. 11(6):483-6. [QxMD MEDLINE Link].

23. Kristine A Karlson, MD, Section EditorsPatrice Eiff, MD & John A Marx, MDDeputy Editor Jonathan Grayzel, MD, et al. Rib fractures. UpToDate. Available at http://www.uptodate.com/ribfractures. Accessed: April 3, 2012.

24. Coris EE, Higgins HW 2nd. First rib stress fractures in throwing athletes. Am J Sports Med. 2005 Sep. 33(9):1400-4. [QxMD MEDLINE Link].

25. Holmes JF, Wisner DH, McGahan JP, Mower WR, Kuppermann N. Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2009 Oct. 54(4):575-84. [QxMD MEDLINE Link].

26. Park S. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture. Korean J Thorac Cardiovasc Surg. 2012 Aug. 45(4):246-50. [QxMD MEDLINE Link]. [Full Text].

27. Leport T, Baudrit P, Potier P, Trosseille X, Lecuyer E, Vallancien G. Study of rib fracture mechanisms based on the rib strain profiles in side and forward oblique impact. Stapp Car Crash J. 2011 Nov. 55:199-250. [QxMD MEDLINE Link].

28. Murphy J, Nyland J, Lantry J, Roberts C. Motorcyclist "biker couples": a descriptive analysis of orthopaedic and non-orthopaedic injuries. Injury. 2009 Nov. 40(11):1195-9. [QxMD MEDLINE Link].

29. Connolly LP, Connolly SA. Rib stress fractures. Clin Nucl Med. 2004.

30. Chan SS. Emergency bedside ultrasound for the diagnosis of rib fractures. Am J Emerg Med. 2009 Jun. 27(5):617-20. [QxMD MEDLINE Link].

31. Griffith JF, Rainer TH, Ching AS, Law KL, Cocks RA, Metreweli C. Sonography compared with radiography in revealing acute rib fracture. AJR Am J Roentgenol. 1999 Dec. 173(6):1603-9. [QxMD MEDLINE Link].

32. Kara M, Dikmen E, Erdal HH, Simsir I, Kara SA. Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma. Eur J Cardiothorac Surg. 2003 Oct. 24(4):608-13. [QxMD MEDLINE Link].

33. Rainer TH, Griffith JF, Lam E, Lam PK, Metreweli C. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma. 2004 Jun. 56(6):1211-3. [QxMD MEDLINE Link].

34. Hurley ME, Keye GD, Hamilton S. Is ultrasound really helpful in the detection of rib fractures?. Injury. 2004 Jun. 35(6):562-6. [QxMD MEDLINE Link].

35. Magu S, Yadav A, Agarwal S. Computed tomography in blunt chest trauma. Indian J Chest Dis Allied Sci. 2009 Apr-Jun. 51(2):75-81. [QxMD MEDLINE Link].

36. Jeroukhimov I, Hershkovitz Y, Wiser I, Kessel B, Ayyad M, Gatot I, et al. When Should Abdominal Computed Tomography Be Considered in Patients with Lower Rib Fractures?. J Emerg Med. 2017 May. 52 (5):609-614. [QxMD MEDLINE Link].

37. Sanchez TR, Grasparil AD, Chaudhari R, Coulter KP, Wootton-Gorges SL. Characteristics of Rib Fractures in Child Abuse-The Role of Low-Dose Chest Computed Tomography. Pediatr Emerg Care. 2016 Jan 12. [QxMD MEDLINE Link].

38. Ingalls NK, Horton ZA, Bettendorf M, Frye I, Rodriguez C. Randomized, double-blind, placebo-controlled trial using lidocaine patch 5% in traumatic rib fractures. J Am Coll Surg. 2010 Feb. 210(2):205-9. [QxMD MEDLINE Link].

39. Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001.

40. Malekpour M, Hashmi A, Dove J, Torres D, Wild J. Analgesic Choice in Management of Rib Fractures: Paravertebral Block or Epidural Analgesia?. Anesth Analg. 2017 Jun. 124 (6):1906-1911. [QxMD MEDLINE Link].

41. Shields JF, Emond M, Guimont C, Pigeon D. Acute minor thoracic injuries: evaluation of practice and follow-up in the emergency department. Can Fam Physician. 2010 Mar. 56(3):e117-24. [QxMD MEDLINE Link]. [Full Text].

42. Misthos P, Kakaris S, Sepsas E, Athanassiadi K, Skottis I. A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma. Eur J Cardiothorac Surg. 2004 May. 25(5):859-64. [QxMD MEDLINE Link].

43. Bansidhar BJ, Lagares-Garcia JA, Miller SL. Clinical rib fractures: are follow-up chest X-rays a waste of resources?. Am Surg. 2002.

44. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003 Mar. 54(3):615-25. [QxMD MEDLINE Link].

45. Mohta M, Verma P, Saxena AK, Sethi AK, Tyagi A, Girotra G. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study. Journal of Trauma. 2009.

46. Hwang EG, Lee Y. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 2014 Aug. 10 (4):241-4. [QxMD MEDLINE Link].

47. Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009 Mar. 56(3):230-42. [QxMD MEDLINE Link].

48. Short K, Scheeres D, Mlakar J, Dean R. Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial. Am Surgery. 1996.

49. [Guideline] Brasel KJ, Guse CE, Layde P, Weigelt JA. Rib fractures: relationship with pneumonia and mortality. Crit Care Med 2006. 2006. 34(6):1642:[Full Text].

50. Karmy-Jones R, Holevar M, Sullivan RJ, et al. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Respir J. 2008.

51. Bruno VD, Batchelor TJ. Late aortic injury: a rare complication of a posterior rib fracture. Ann Thorac Surg. 2009 Jan. 87(1):301-3. [QxMD MEDLINE Link].

52. Carver TW, Milia DJ, Somberg C, Brasel K, Paul J. Vital capacity helps predict pulmonary complications after rib fractures. J Trauma Acute Care Surg. 2015 Sep. 79 (3):413-6. [QxMD MEDLINE Link].

53. Henry TS, Kirsch J, Kanne JP, et al. ACR Appropriateness Criteria rib fractures. National Guideline Clearinghouse. Available at http://www.guideline.gov/content.aspx?id=48290&search=rib+fracture. 2014; Accessed: May 11, 2016.

54. Carrier FM, Turgeon AF, Nicole PC, Trépanier CA, Fergusson DA, Thauvette D, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009.

55. Colosimo AJ, Byrne E, Heidt RS Jr, Carlonas RL, Wyatt H. Acute traumatic first-rib fracture in the contact athlete: a case report. Am J Sports Med. 2004 Jul-Aug. 32(5):1310-2. [QxMD MEDLINE Link].

56. Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005 Oct. 138(4):717-23; discussion 723-5. [QxMD MEDLINE Link].

57. Fulda GJ, Giberson F, Fagraeus L. A prospective randomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the management of acute thoracic pain. J Trauma. 2005 Aug. 59(2):383-8; discussion 389-90. [QxMD MEDLINE Link].

58. Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. J Trauma. 1990 Jun. 30(6):695-700. [QxMD MEDLINE Link].

59. Hurley ME, Keye GD, Hamilton S. Is ultrasound really helpful in the detection of rib fractures?. Injury. 2004 Jun. 35(6):562-6. [QxMD MEDLINE Link].

60. Lee RB, Bass SM, Morris JA Jr, MacKenzie EJ. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma. 1990 Jun. 30(6):689-94. [QxMD MEDLINE Link].

61. Love JC, Symes SA. Understanding rib fracture patterns: incomplete and buckle fractures. J Forensic Sci. 2004 Nov. 49(6):1153-8. [QxMD MEDLINE Link].

62. Ruddy RM. Trauma and the paediatric lung. Paediatr Respir Rev. 2005 Mar. 6(1):61-7. [QxMD MEDLINE Link].

63. Stawicki SP, Grossman MD, Hoey BA, Miller DL, Reed JF 3rd. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 2004 May. 52(5):805-8. [QxMD MEDLINE Link].

Sarah L Melendez, MD Fellow in Pediatric Emergency Medicine, Department of Emergency Medicine, Arnold Palmer Hospital for Children

Sarah L Melendez, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Christopher I Doty, MD, MAAEM, FAAEM, FACEP Tenured Professor of Emergency Medicine, University of Kentucky College of Medicine; Vice Chair of Education, Department of Emergency Medicine, University of Kentucky Chandler Medical Center

Christopher I Doty, MD, MAAEM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Residency Directors in Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Michelle Ervin, MD Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Laurie K Mahoney, MD, FAAEM Attending Physician, Department of Emergency Medicine, Long Island College Hospital, Brooklyn

Laurie K Mahoney, MD, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, and American College of Emergency Physicians

Disclosure: Nothing to disclose.

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