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The significance of first rib fractures in children
Nicholas A Hamilton1, Brian T Bucher, Martin S Keller
1Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Insights
First rib fractures in children do not indicate a high risk for thoracic vascular injury. If a chest X-ray shows no mediastinal abnormalities, further imaging is unnecessary.
Area of Science:
- Pediatric Traumatology
- Thoracic Imaging
- Vascular Injury Assessment
Background:
- First rib fractures are rare in pediatric blunt trauma.
- Thoracic vascular injuries require prompt diagnosis and management.
- The association between first rib fractures and thoracic vascular injury in children is not well-established.
Purpose of the Study:
- To investigate the incidence of thoracic vascular injury in pediatric patients with first rib fractures.
- To determine if first rib fractures are a reliable indicator of associated thoracic vascular injury in children.
Main Methods:
- Retrospective review of medical records of pediatric patients (2000-2009) with first rib fracture or central vascular injury.
- Analysis of imaging findings, including chest radiographs and computed tomography scans.
- Correlation of fracture patterns with vascular injury outcomes.
Main Results:
- Thirty-three children with first rib fracture or thoracic vascular injury were identified.
- Only one child (3%) sustained a significant thoracic vascular injury.
- Children with first rib fractures and normal mediastinum on chest X-ray had a 100% negative predictive value for thoracic vascular injury.
Conclusions:
- Pediatric patients with first rib fractures and normal chest radiograph findings do not require further evaluation for thoracic vascular injury.
- Normal mediastinum on initial chest X-ray effectively rules out significant intrathoracic vascular injury in this cohort.
- This finding can help streamline diagnostic workup and avoid unnecessary imaging in pediatric trauma.
Purpose:
The purpose of the study was to determine if first rib fractures are associated with an increased incidence of thoracic vascular injury in pediatric patients.
Methods:
The medical records of all children diagnosed with a first rib fracture or a central vascular injury after blunt trauma treated at a state-designated level 1 pediatric trauma center from 2000 to 2009 were reviewed.
Results:
Thirty-three children (0.27% of patients; mean age, 10.9 ± 0.9 years) were identified with either a first rib fracture or thoracic vascular injury owing to blunt trauma. Thirty-two children had a first rib fracture, and only 1 child (3%) had significant thoracic vascular injury. Mediastinal abnormalities (indistinct aortic knob) were identified in 3 children, 2 with first rib fracture on initial chest radiograph. Despite a normal cardiovascular examination result, 25 (74%) children with a normal mediastinum on screening chest radiograph underwent computed tomography. No child with a normal mediastinum on initial chest radiograph was found to have associated intrathoracic injuries requiring further intervention. In children with first rib fractures and a normal mediastinum by screening chest x-ray, the negative predictive value for thoracic vascular injury was 100%.
Conclusions:
Children with first rib fractures without mediastinal abnormality on chest radiograph require no further workup for thoracic vascular injury.
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