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Rib Fracture/Flail Chest
Jonathan Hero Chung, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Rib fracture: Displaced or nondisplaced cortical break
              • Segmental rib fracture: ≥ 2 fractures in same rib
              • Flail chest: ≥ 3 segmental rib fractures or > 5 adjacent rib fractures
                • Flail segment shows paradoxical motion with respiration

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Kim MJ et al: Chest injury following cardiopulmonary resuscitation: a prospective computed tomography evaluation. Resuscitation. 84(3):361-4, 2013
                                          2. Mirka H et al: Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging. 3(5):433-49, 2012
                                          3. Bansal V et al: Rib and sternum fractures in the elderly and extreme elderly following motor vehicle crashes. Accid Anal Prev. 43(3):661-5, 2011
                                          4. Chung JH et al: Extrapleural hematomas: imaging appearance, classification, and clinical significance. J Thorac Imaging. 26(3):218-23, 2011
                                          5. Oikonomou A et al: CT imaging of blunt chest trauma. Insights Imaging. 2(3):281-295, 2011
                                          6. Kamath GS et al: Isolated cervical rib fracture. Ann Thorac Surg. 89(6):e41-2, 2010
                                          7. Peters S et al: Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients. Clin Radiol. 65(4):333-8, 2010
                                          8. Turk F et al: Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 17(6):473-7, 2010
                                          9. Levine BD et al: CT of rib lesions. AJR Am J Roentgenol. 193(1):5-13, 2009
                                          10. Hanak V et al: Cough-induced rib fractures. Mayo Clin Proc. 80(7):879-82, 2005
                                          11. Bulger EM et al: Epidural analgesia improves outcome after multiple rib fractures. Surgery. 136(2):426-30, 2004
                                          12. Hurley ME et al: Is ultrasound really helpful in the detection of rib fractures? Injury. 35(6):562-6, 2004
                                          13. Stawicki SP et al: Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 52(5):805-8, 2004
                                          14. Holcomb JB et al: Morbidity from rib fractures increases after age 45. J Am Coll Surg. 196(4):549-55, 2003
                                          15. Sirmali M et al: A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 24(1):133-8, 2003
                                          16. Barnea Y et al: Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 45(1):43-6, 2002
                                          17. Velmahos GC et al: Influence of flail chest on outcome among patients with severe thoracic cage trauma. Int Surg. 87(4):240-4, 2002
                                          18. Collins J: Chest wall trauma. J Thorac Imaging. 15(2):112-9, 2000
                                          19. Westcott J et al: Rib fractures. American College of Radiology. ACR Appropriateness Criteria. Radiology. 215 Suppl:637-9, 2000
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Rib fracture: Displaced or nondisplaced cortical break
                                                      • Segmental rib fracture: ≥ 2 fractures in same rib
                                                      • Flail chest: ≥ 3 segmental rib fractures or > 5 adjacent rib fractures
                                                        • Flail segment shows paradoxical motion with respiration

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • Ultrasonographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Kim MJ et al: Chest injury following cardiopulmonary resuscitation: a prospective computed tomography evaluation. Resuscitation. 84(3):361-4, 2013
                                                                                  2. Mirka H et al: Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging. 3(5):433-49, 2012
                                                                                  3. Bansal V et al: Rib and sternum fractures in the elderly and extreme elderly following motor vehicle crashes. Accid Anal Prev. 43(3):661-5, 2011
                                                                                  4. Chung JH et al: Extrapleural hematomas: imaging appearance, classification, and clinical significance. J Thorac Imaging. 26(3):218-23, 2011
                                                                                  5. Oikonomou A et al: CT imaging of blunt chest trauma. Insights Imaging. 2(3):281-295, 2011
                                                                                  6. Kamath GS et al: Isolated cervical rib fracture. Ann Thorac Surg. 89(6):e41-2, 2010
                                                                                  7. Peters S et al: Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients. Clin Radiol. 65(4):333-8, 2010
                                                                                  8. Turk F et al: Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 17(6):473-7, 2010
                                                                                  9. Levine BD et al: CT of rib lesions. AJR Am J Roentgenol. 193(1):5-13, 2009
                                                                                  10. Hanak V et al: Cough-induced rib fractures. Mayo Clin Proc. 80(7):879-82, 2005
                                                                                  11. Bulger EM et al: Epidural analgesia improves outcome after multiple rib fractures. Surgery. 136(2):426-30, 2004
                                                                                  12. Hurley ME et al: Is ultrasound really helpful in the detection of rib fractures? Injury. 35(6):562-6, 2004
                                                                                  13. Stawicki SP et al: Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 52(5):805-8, 2004
                                                                                  14. Holcomb JB et al: Morbidity from rib fractures increases after age 45. J Am Coll Surg. 196(4):549-55, 2003
                                                                                  15. Sirmali M et al: A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 24(1):133-8, 2003
                                                                                  16. Barnea Y et al: Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 45(1):43-6, 2002
                                                                                  17. Velmahos GC et al: Influence of flail chest on outcome among patients with severe thoracic cage trauma. Int Surg. 87(4):240-4, 2002
                                                                                  18. Collins J: Chest wall trauma. J Thorac Imaging. 15(2):112-9, 2000
                                                                                  19. Westcott J et al: Rib fractures. American College of Radiology. ACR Appropriateness Criteria. Radiology. 215 Suppl:637-9, 2000