DOI: http://dx.doi.org/10.18203/2349-2902.isj20191251

First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

Majed Al-Mourgi

Abstract


Background: First-rib fractures are relatively rare compared with fractures of other ribs because of the broad structure deeply placed and protected location of the first rib. A high amount of energy is needed to cause a first-rib fracture; violent trauma, such as that involving motor vehicle accident, is a frequent cause of these fractures, as well as other serious intra-thoracic, head, cervical spine, and intra-abdominal injuries. First-rib fractures have traditionally been considered indicators of increased injury severity and mortality in major trauma patients. The aim was to study the significance of first-rib fractures as indicators of serious intra-thoracic and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality in a high-altitude area in Al-Taif, Saudi Arabia.

Methods: This is a retrospective study conducted in King Abdul-Aziz Specialist Hospital (KASH), Taif City, KSA. Patients with chest injuries who presented to the emergency department and were admitted to the hospital between November 2013 and March 2016 were included in the study. Data regarding first-rib fracture were collected, and the relationship between first-rib injuries and associated intra-thoracic and extra-thoracic injuries was analyzed.

Results: There was a high incidence of first-rib fracture (23.45%), and 35.8% were bilateral. The most common associated chest injury was a pulmonary contusion (58.5%), followed by pneumothorax (32.1%), hemopneumothorax (20.7%), and surgical emphysema (20.7%). The most common associated extra-thoracic injuries in our study were skeletal injuries (47.4%), cervical spine injuries (11.3%), and head trauma (24.5%).

Conclusions: Fractures of the first-rib are associated with serious thoracic and extra-thoracic injuries; they are associated only with increased morbidity in patients with polytrauma and have no independent impact on mortality.


Keywords


First-rib, Chest injuries, Rib fracture, Trauma, Multiple trauma, Saudi Arabia

Full Text:

PDF

References


Sirmali M, Turut H, Topcu S, Gülhan E, Yazici U, Kaya S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24:133-8.

Khosla A, Ocel J, Rad AE, Kallmes DF. Correlating first and second rib fractures noted on spine computed tomography with major vessel injury. Emerg Radiol. 2010;17:461-4.

Jaiswal A, Tanwar YS, Habib M, Jain V. First rib fractures: not always a hallmark of severe trauma a report of three cases. Chin J Traumatol. 2013;16:251-3.

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;34:205-11.

Chatterjee S, Dey R, Guha P, Ray R, Sinha S. Isolated traumatic bilateral first rib fracture: a rare entity. Tanaffos. 2011;10:60-3.

Ismail I, Looi CSK, Hakim AB, Roohi SA. Bilateral first rib and associated lower cervical spine fractures. MOJ Orthop Rheumatol. 2007;7:00287.

Karuppal R, Kumaran CM, Marthya A, Raman RV. Isolated bilateral first rib fracture associated with congenital cervical block vertebra—a case report. J Orthop. 2013;10:149-51.

Sinha S, Mummidi S, Londhe S, Campbell AC. Isolated fracture of the first rib without associated injuries: a case report. Emerg Med J. 2001;18:315.

Qureshi T, Mander BJ, Wishart GC. Isolated bilateral first rib fractures - an unusual sequel of whiplash injury. Injury. 1998;29:397–8.

Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in elderly. J Trauma. 2000;48:1040-6.

Kochar MP, Singh SP. A prospective randomized trial on trauma thoracic cage with rib fracture especially first rib fracture and associated complications. Int Surg J. 2016;3:1278-82.

Legaye J, Lenfant P, Charlier H. First rib fracture with compression of the distal roots of the brachial plexus. Eur J Orthop Surg Traumatol. 2006;16:357-9.

Gupta A, Jamshidi M, Rubin JR. Traumatic first rib fracture:is angiography necessary? A review of 730 cases. Cardiovasc Surg. 1997;5:48-53.

Steele D, Bergman J. Non-traumatic fracture of the first rib. Emergency Med. 1998;10:169-72.

Yazkan R. First Rib Fractures. JAEM. 2012:27-30.

Phillips EH, Rogers WF, Gaspar MR. Incidence of vascular injury and indications for angiography. Surgery. 1981;89:42-7.

Poole GV, Myers RT. Morbidity and mortality rates in major blunt trauma to the upper chest. Ann Surg. 1981;193:70-5.