Delayed Traumatic Aortic Injury Caused by a Displaced Rib Fracture in an Elderly Patient: A Case Report

Rib fractures are common injuries in elderly trauma patients and are typically managed conservatively with favorable outcomes. However, recurrent falls can cause displacement of initially stable rib fragments, leading to catastrophic internal organ injuries. We present a case of a male in his late 70s with a history of total aortic arch replacement who initially sustained an undisplaced left 10th rib fracture from a fall. Fifteen days later, a secondary fall at home resulted in severe displacement of the rib fragment, which directly penetrated the descending aorta. The patient presented in profound obstructive and hemorrhagic shock due to a tension hemothorax. Rapid stabilization was achieved using an intra-aortic balloon occlusion (IABO) catheter, followed by emergency thoracic endovascular aortic repair (TEVAR). Despite a complicated course with acute consumptive coagulopathy, the patient was successfully managed with a massive transfusion protocol and extubated on postoperative day 11. This case highlights the critical importance of recognizing the potential for delayed, fatal vascular complications from displaced rib fractures in elderly patients prone to recurrent falls.