An analysis of 214 cases of rib fractures

INTRODUCTION: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs. MATERIALS AND METHODS: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4 percent), 2) patients with two rib fractures (RF2) (n = 53, 24.8 percent), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9 percent). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems. FINDINGS: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30 percent in group RF1, 24.6 percent in group RF2, and 75.6 percent in group RF3 (p<0.05). Co-existing injuries to other systems were 24 percent in group RF1, 23.2 percent in group RF2, and 52.6 percent in group RF3 (p<0.05). Two patients (4 percent) in group RF1, 2 patients (3.8 percent) in group RF2, and 5 patients (4.5 percent) in group RF3 (total n = 9; 4.2 percent) died. CONCLUSION: Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.

continuous positive airway pressure [CPAP] for ventilation for patients with multiple fracture ribs

The role of non-invasive positive pressure ventilation delivered through a face mask in patients with multiple fracture ribs is uncertain. We conducted a prospective, randomized study of continuous positive airway pressure [CPAP] given via a face mask for spontaneously breathing patients compared with intermittent positive pressure ventilation [IPPV] with endotracheal intubation [ETI] in 52 patients with multiple fracture ribs who required mechanical ventilation. The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group [n=27] received mechanical ventilation with ETI, whereas patients in the CPAP group [n=25] received CPAP via a face mask with patient controlled analgesia [PCA]. Major complications, arterial blood gas levels, length of intensive care unit [ICU] stay and ICU survival rate were recorded Nosocomial infection was diagnosed in 10 to 21 patients in the ET group, but only in 4 of 22 in the CPAP group [P=0.001]. Mean PaO 2 was significantly higher in the ET group in the first 2 days [P < 0.05]. There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received 1PPV [P < 0.01]. Non invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. This study supports the application of CPAP at least as a first line of treatment for multiple fractured ribs caused by blunt thoracic trauma