kindliche Rippenfrakturen

Infant with
cough who had experienced a traumatic delivery 4 months agoCXR AP shows clear lungs and an area of callus surrounding the right 7th rib posteriorly.The diagnosis was chronic right 7th posterior rib fracture caused by a traumatic birth.
pediatricimaging.org • CC-by-nc-sa 4.0
Febrile
newborn who had a traumatic delivery due to shoulder dystocia 3 days agoCXR AP shows lucent lines without surrounding periosteal reaction through the left 5th-7th ribs posteriorly.The diagnosis was acute left 5th-7th posterior rib fractures caused by birth trauma.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with a
large burn on the scalp3D CT reconstruction with contrast of the chest shows callus formation around the right 4th-8th ribs and left 4th-9th ribs anteriorly.The diagnosis was chronic right 4th-8th and chronic left 4-9th anterior rib fractures in a child abuse patient.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
respiratory distressCXR AP shows poorly expanded but grossly clear lungs bilaterally. There is dense periosteal reaction / callus formation around the posterior aspect of the left 8th and 9th ribs.The diagnosis was chronic left 8th-9th posterior rib fractures in a child abuse patient.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
right hip painAP and lateral radiographs of the right femur (above) show a linear lucency through the diaphysis of the right femur with no associated periosteal reaction. CXR AP shows callus formation around the lateral aspect of the right 5th-6th ribs.The diagnosis was an acute nondisplaced fracture of the right femur and chronic right 5th-6th lateral rib fractures in a child abuse patient.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
swollen right legAP radiograph of the right femur shows a lucency through the diaphysis of the right femur with no associated periosteal reaction. CXR AP shows callus formation around the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly.The diagnosis was an acute displaced fracture of the right femur and chronic rib fractures of the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly in a child abuse patient.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant who
had been abusedCXR (above) and complete skeletal survey showed no evidence of rib fractures. Gross pathological image (below) shows callus formation along the posterior aspect of the left 4th-8th ribs.The diagnosis was left 4th-8th chronic posterior rib fractures which were not detected on the skeletal survey in a child abuse patient.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant post
unexplained cardiac arrest. CXR AP shows acute fractures of the left 5th through 8th ribs laterally.The diagnosis was lateral rib fractures in child abuse.
pediatricimaging.org • CC-by-nc-sa 4.0
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kindliche Rippenfrakturen

Rippenfraktur Radiopaedia • CC-by-nc-sa 3.0 • de

Rib fractures are a common consequence of trauma and can cause life-threatening complications.

Epidemiology

Associations

Rib fractures are often associated with other injuries and the greater the number of rib fractures the more likely are associated injuries :

Pathology

The 4-10 ribs are the most commonly fractured . Fractures of the 1-3 ribs are associated with high-energy trauma .

When the rib is fractured twice, the term floating rib is used to describe the free fracture fragment, and when three or more contiguous floating ribs are present this is called a flail chest.

Buckle rib fractures can also occur.

Etiology

Radiographic features

Plain radiograph
  • may miss up to 50% of rib fractures even with dedicated oblique rib projections
CT
  • more sensitive than plain radiography for the detection of rib fractures
  • Displacement on CT may be defined as greater than half a rib shaft width
Ultrasound

Common application of point of care ultrasonography, used in a complementary manner to conventional radiography in the workup of blunt chest wall trauma and localized chest pain. Ultrasonography is more sensitive and specific than conventional radiography for rib fracture detection in blunt trauma when performed by a trained clinician .

Moreover, the use of sonography allows the detection of radiographically occult costal cartilage fractures, as well as assessment of the underlying lung for associated traumatic pathology, including;

B-mode
  • cardinal sonographic feature is a discontinuity of the otherwise smooth, linear echogenicity corresponding to the anterior bony cortex
  • if accompanied by cortical displacement, may be further characterized by the axial distance between the cortical margins
    • ​separation by less than 1 mm defines mild displacement
    • considered severe when >4 mm
      • often associated with comet tail artifacts extending from the fracture site into the far field
  • if initially occult, obvious interruption of the bony cortex may be elicited with sonopalpation (applying local transducer pressure​)
    • appropriate analgesia may be necessary before attempting this maneuver
  • suggestive findings include a circumscribed, hypoechoic fluid collection adjacent to the putative fracture site
    • represents a fracture hematoma, fluid nature may be ascertained through careful adjustment of gain settings and dynamic variation of the observed shape with pressure
    • associated periosteal elevation appears as a delicate, raised hyperechoic linear stripe 
Nuclear medicine
  • Tc-99m bone scan is sensitive but not specific for rib fractures and demonstrates focal areas of high-uptake, which need to be correlated with SPECT or radiographic imaging

Treatment and prognosis

Rib fractures themselves are treated symptomatically and have a good prognostic outcome. Rarely, severe rib injuries (e.g. flail chest) may be treated with ORIF, often in the setting of other severe traumatic injuries and in the hope that respiratory function will improve facilitating a shorter ICU stay and quicker recovery.

Complications

Aside from immediate traumatic complications outlined above atelectasis and pneumonia may develop, mainly due to poor respiratory effort secondary to pain, and this increases the morbidity and mortality due to rib fractures .

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu kindliche Rippenfrakturen:
Battered-Child-Syndrom
 
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Rippenfraktur
 
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