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Rib Fractures and Flail Chest
Cristina Fuss, MD; 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 non-displaced cortical break
              • Flail chest: ≥ 3 segmental (≥ 2 fractures in same rib) 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. Pieracci FM et al: A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg. 88(2):249-57, 2020
                                          2. Marini CP et al: Predictors of mortality in patients with rib fractures. Eur J Trauma Emerg Surg. ePub, 2019
                                          3. Kamath GS et al: Isolated cervical rib fracture. Ann Thorac Surg. 89(6):e41-2, 2010
                                          4. 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
                                          5. Levine BD et al: CT of rib lesions. AJR Am J Roentgenol. 193(1):5-13, 2009
                                          6. Hanak V et al: Cough-induced rib fractures. Mayo Clin Proc. 80(7):879-82, 2005
                                          7. Bulger EM et al: Epidural analgesia improves outcome after multiple rib fractures. Surgery. 136(2):426-30, 2004
                                          8. Hurley ME et al: Is ultrasound really helpful in the detection of rib fractures? Injury. 35(6):562-6, 2004
                                          9. Stawicki SP et al: Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 52(5):805-8, 2004
                                          10. Holcomb JB et al: Morbidity from rib fractures increases after age 45. J Am Coll Surg. 196(4):549-55, 2003
                                          11. Sirmali M et al: A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 24(1):133-8, 2003
                                          12. Barnea Y et al: Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 45(1):43-6, 2002
                                          13. Velmahos GC et al: Influence of flail chest on outcome among patients with severe thoracic cage trauma. Int Surg. 87(4):240-4, 2002
                                          14. Collins J: Chest wall trauma. J Thorac Imaging. 15(2):112-9, 2000
                                          15. 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 non-displaced cortical break
                                                      • Flail chest: ≥ 3 segmental (≥ 2 fractures in same rib) 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. Pieracci FM et al: A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg. 88(2):249-57, 2020
                                                                                  2. Marini CP et al: Predictors of mortality in patients with rib fractures. Eur J Trauma Emerg Surg. ePub, 2019
                                                                                  3. Kamath GS et al: Isolated cervical rib fracture. Ann Thorac Surg. 89(6):e41-2, 2010
                                                                                  4. 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
                                                                                  5. Levine BD et al: CT of rib lesions. AJR Am J Roentgenol. 193(1):5-13, 2009
                                                                                  6. Hanak V et al: Cough-induced rib fractures. Mayo Clin Proc. 80(7):879-82, 2005
                                                                                  7. Bulger EM et al: Epidural analgesia improves outcome after multiple rib fractures. Surgery. 136(2):426-30, 2004
                                                                                  8. Hurley ME et al: Is ultrasound really helpful in the detection of rib fractures? Injury. 35(6):562-6, 2004
                                                                                  9. Stawicki SP et al: Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 52(5):805-8, 2004
                                                                                  10. Holcomb JB et al: Morbidity from rib fractures increases after age 45. J Am Coll Surg. 196(4):549-55, 2003
                                                                                  11. Sirmali M et al: A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 24(1):133-8, 2003
                                                                                  12. Barnea Y et al: Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 45(1):43-6, 2002
                                                                                  13. Velmahos GC et al: Influence of flail chest on outcome among patients with severe thoracic cage trauma. Int Surg. 87(4):240-4, 2002
                                                                                  14. Collins J: Chest wall trauma. J Thorac Imaging. 15(2):112-9, 2000
                                                                                  15. Westcott J et al: Rib fractures. American College of Radiology. ACR Appropriateness Criteria. Radiology. 215 Suppl:637-9, 2000