Chest Wall Trauma

Question 1

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

Answer 1

Rib fractures

Question 2

What ribs are most commonly fractured?

Answer 2

4-10 ribs

Question 3

Ribs __-__ are associated with high-energy trauma and potential serious complications including vascular, neurological and pulmonary damage

Answer 3

1-3 rib

Question 4

When the rib is fractured twice what term is used to describe the free fracture fragment?

Answer 4

floating rib

Question 5

What three or more contiguous floating ribs are present this is called _____

Answer 5

Flail chest

Question 6

___% of cases are due to MVA, falls, assaults… all blunt trauma

Answer 6

50%

Question 7

What are some other ways that a rib can be fractured?

Answer 7

• Pathologic (mets, myeloma, radiation)
• Stress fractures (high level athletes)
• Non-accidental injuries (children - posterior rib most frequently)
• Cardiopulmonary resuscitation (CPR) (1-3 cases)

Question 8

1-3 rib fractures most commonly involve what vessels/nerves?

Answer 8

Brachial plexus/subclavian A.&V.

Question 9

10-12 rib fractures most commonly involve what organs?

Answer 9

Liver, Kidney, and spleen

Question 10

What is the most frequent condition to occur in relation to the lungs with rib fracture?

Answer 10

Pneumothorax/Hemothorax

Question 11

Plain film x-rays will miss up to ____% of rib fractures even with dedicated oblique rib projections.

Answer 11

50%

Question 12

What imaging modality is most sensitive to rib fractures?

Answer 12

CT

Question 13

What are the radiographic views performed in a rib series?

Answer 13

AP upper/lower
Oblique upper/lower
PA CHEST

Question 14

Many researchers and radiologists say to get rid of dedicated rib series and to just perform __ and ___ chest radiographs to evaluate what 2 complications?

Answer 14

• Pneumothorax/hemothorax

- Intrathoracic/Pulmonary

Question 15

In cases of severe trauma CT scanning is required to evaluate ______ complications

Answer 15

intrathoracic/abdominal complications

Question 16

In flail chest, during inspiration, the floating ribs will move where?

Answer 16

Posteriorly [into the lung region]

Question 17

In flail chest, during expiration, the floating ribs will move where?

Answer 17

Anteriorly [away from the lung region]

Question 18

Clavicular fractures are common and account for ____% of all fractures

Answer 18

2.6-10%

Question 19

The vast majority of clavicle fractures occur in the _____

Answer 19

Midshaft [69-82%]

Question 20

Why do the majority of clavicle fractures occur in the midshaft?

Answer 20

Thinnest part of the bone [not reinforced by muscle or ligaments]

Question 21

What common carpal fracture mechanism also causes clavicular fractures?

Answer 21

FOOSH

Question 22

What radiograph views are required to view a clavicular fracture? Are they easy to identify?

Answer 22

AP with Cephalad tilt (15-30 degrees)

Easy to identify

Question 23

Why does the limb sometimes appear displaced?

Answer 23

Upper limb weight pulling down, SCM pulling up

Question 24

Comminuted clavicular fractures require what imaging modality?

Answer 24

CT

Question 25

Traditionally, midshaft fractures of the clavicle have been treated with what?

Answer 25

Immobilization, sling, figure 8 dressing

Question 26

What is the record of non-union rates for clavicular fractures?

Answer 26

Low

Question 27

If there is displacement, angulation, shortening (>2cm) or comminution what is the method of treatment?

Answer 27

ORIF [for increased union rates]

Question 28

How often to scapular fractures occur?

Answer 28

3% of all shoulder fractures

Question 29

What is the usual mechanism of action to develop a scapular fracture?

Answer 29

MVA [50%]

Question 30

Where are most scapular fractures located?

Answer 30

Through the body [HORIZONTALLY]

Question 31

Due to the high energy trauma that usually causes scapular fractures, what complications may result?

Answer 31

Pneumothorax

Question 32

What views are used to assess and identify these fractures?

Answer 32

AP, Axillary view, True lateral [lateral is taken to view the glenoid fossa, IMPORTANT]

Question 33

If there is chest involvement from a scapular fracture, what is the imaging modality of choice?

Answer 33

CT

Question 34

In approximately 5% of blunt chest trauma, what bony structure is involved?

Answer 34

Sternum, manubrium is most common

Question 35

What is a common mechanism of injury?

Answer 35

MVA [steering wheel]

Question 36

What view is this best viewed on?

Answer 36

Lateral sternal

Question 37

What is the modality of choice for this type of injury? (sternal fx)

Answer 37

CT - sagittal is most sensitive for anterior cortical breach and posterior cortical breach.

Question 38

Posterior cortical breach [where the fx site has been displaced posteriorly into the chest cavity] is associated with what types of injuries?

Answer 38

Neurovascular and intrathoracic

Question 39

If the sternal fx is severe one would expect what mortality rate?

Answer 39

High, due to visceral involvment

Question 40

What is found in 5% of the population that can be confused with a sternal fracture that is a NORMAL ANATOMICAL VARIANT

Answer 40

Sternal foramen (perforated sternum) [this is commonly found in the inferior aspect of the sternal body and can LITERALLY be mistaken for sternal fx]