Is ultrasound really helpful in the detection of rib fractures?
Introduction
Rib fractures represent the most frequent thorax injury (25%).3 They are simple or complicated (the latter when associated with soft tissue injuries, in particular, pneumothoraces and splenic lacerations).6 Clinically, rib fractures are usually suspected based on patients’ history and pain, which is accentuated at inspiration, cough and localized palpation. Nevertheless, fractures are present in only 32–42% of symptomatic patients.4 Radiologically, rib fractures are documented conventionally with a frontal chest radiograph (CXR) followed by an oblique rib view if clinically indicated. Recently, several authors have investigated the role of ultrasound (US) in the detection of rib fractures.1., 2., 5., 6., 7., 8. All found that US was more sensitive than conventional radiography for rib fracture diagnosis, ranging from marginal superiority to twice as much fracture detection by US when compared with plain film findings.1., 2., 5., 6., 7., 8.
The aim of this study was to test these findings and to evaluate their relevance to our practice.
Section snippets
Patients and methods
We included in our study over a 3-month period all patients presenting to the Accident and Emergency Department with a history of chest trauma. At initial examination a clinical assessment was made as to the likelihood of rib fracture(s) and their suspected location. All patients with a clinical suspicion of rib fracture(s) were referred for radiological work-up, which included a CXR and an oblique view of the ribs, followed immediately by a limited chest US.
The CXR was performed without grid
Results
Of the 35 patients who were examined by the Accident and Emergency team for a history of chest trauma 14 (40%) presented clinical symptoms and signs suggestive of rib fracture(s) and were referred for radiological correlation. The mean patient age of these 14 patients was 31 years (range 16–55 years) and the M:F ratio 3.7:1 (11 men and 3 women).
Radiographic work-up revealed a total of 15 broken ribs in 10 patients. One patient had three broken ribs, three patients two and four none.
Plain
Discussion
Our findings confirm that ultrasound is marginally more sensitive than plain radiography for rib fracture diagnosis. The slightly higher detection rate of rib fractures by US is mainly based on the visualization of a disruption in the cortical interface at the fracture site, best seen on longitudinal scanning. The cortex of the ribs, as of all bones, is highly echogenic on US and reflects and absorbs most of the US transmission. A fracture is visualized as a discontinuity of this echogenic
Acknowledgements
Dr. B. Richmond for his advice.
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The Diagnostic Accuracy of Ultrasonography for the Diagnosis of Rib Fractures in Patients Presenting to Emergency Department With Blunt Chest Trauma
2021, Journal of Emergency MedicineCitation Excerpt :US can detect fractures not seen on CXR studies and outperform CXR studies for the diagnosis of rib fractures (6–10). On the contrary, some studies found only marginal superiority compared with CXR study and revealed disadvantages, such as lengthened examination duration and patient discomfort from the pressure of the US probe (11). The ACR positioned US as usually not appropriate for suspected rib fractures from minor blunt trauma, rib fractures after cardiopulmonary resuscitation, and pathological rib fractures in their appropriateness criteria (12).
ACR Appropriateness Criteria <sup>®</sup> Rib Fractures
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2017, Chinese Journal of Traumatology - English EditionCitation Excerpt :Therefore, some attempts have been made to detect unknown fractures with USG. In the literature, the usefulness of ultrasonography (USG) in detecting rib fractures varies widely: from not significant2 to more sensitive than radiography.4–7 On the other hand, the advantages of USG including non-invasiveness, portability, relative inexpensiveness, lack of radiation, and repeatability, make USG a valuable diagnostic tool.8
Diagnostic accuracy of the inverted grayscale rib series for detection of rib fracture in minor chest trauma
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