Related Experiment Video
Updated: Oct 20, 2025

Sterile Pericarditis in Aachener Minipigs As a Model for Atrial Myopathy and Atrial Fibrillation
Published on: September 24, 2021
Fragility fracture of the fourth rib in a patient with a cardiac pacemaker: an uncommon case
Ebru Köseoğlu Tohma1, Özden Özyemişçi Taşkıran2
1Department of Physical Medicine and Rehabilitation, Muğla Sıtkı Koçman University Research and Training Hospital, Muğla, Turkey. ebru_koseoglu@hotmail.com.
Purpose:
In patients with a cardiac pacemaker, pocket-related complications such as nerve impairment or bone fractures are infrequent. We present a man with a fracture of the 4th rib several months after pacemaker implantation.
Case Presentation:
A 74-year-old man, with a left prepectoral pacemaker implanted 13 months ago, presented complaining of chest pain. The pain started after a sudden trunk rotation and right arm flexion movement with a crack. There was tenderness to palpation and crepitation over the left upper ribs. Computed tomography identified a non-displaced fracture line in the anterior aspect of the left 4th rib. After kinesiotaping and activity restriction, pain alleviated.
Conclusion:
Pacemaker implantation might have caused shoulder dysfunction and pectoral tightness resulting in reduced flexibility of the trunk. Consequently, a reaching motion of the arm with a trunk rotation might have directed rotational force vectors towards the osteopenic left 4th rib causing a fragility fracture. In elderly with a pacemaker, osteopenia and concomitant sarcopenia may create a predisposition to this atypical complication.
Related Concept Videos
Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Pericarditis IV: Nursing Management
Dysrhythmias IV: Characteristics of Bradyarrhythmias
Cardiomyopathy IV: Restrictive Cardiomyopathy
Mitral Stenosis IV: Nursing Management
Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:

