HWN Suggests

Blunt Chest Trauma: Who Needs Computed Tomography Imaging?

Fractures of the thoracic spine occur in 16-30% of all trauma patients, and up to 62% are associated with neurologic deficits. Chest CT is the imaging modality of choice (acute pathology requires subsequent dedicated thoracic CT).

Sternal fractures and sternoclavicular dislocations are often missed on supine CXR. CT frequently identifies the diagnosis, frequently with concomitant retrosternal hematoma.

Scapular fractures rarely occur in the setting of blunt trauma (3% of cases) and are readily identified upon initial CXR... rib fractures are the most common finding in patients sustaining blunt thoracic injury. Supine CXR demonstrates poor sensitivity in the identification…

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Articles of Interest

Athletic Injuries of the Thoracic Cage

Athletes are susceptible to a wide range of musculoskeletal thoracic trauma. An accurate imaging diagnosis of thoracic cage injury and assessment of injury severity allow development of an adequate treatment plan.

Fractures of the Thoracic and Lumbar Spine

Most spinal fractures occur in the thoracic (midback) and lumbar spine (lower back) or at the connection of the two (thoracolumbar junction). Treatment depends on the severity of the fracture and whether the patient has other associated injuries.

Rib/Sternal Fracture

Fractures of the first 3 ribs are uncommon; they are shorter, stiffer, and are protected by the clavicle, scapula, and muscles of the upper chest wall. The presence of two or more rib fractures at any level on the thoracic cage is associated with a higher incidence of internal injuries. Ribs 4–9 are the most common ribs injured because they are exposed and relatively immobile. These ribs are attached to the sternum anteriorly and the spine posteriorly. Ribs 9–11 fx. are associated with a high risk of intra-abdominal injury, especially injuries to the liver and spleen. Sternal fracture and costochondral separation (separation of the sternum from the ribs) are often caused by anterior blunt force trauma. Because of the heart’s location directly posterior to the sternum, cardiac complications such as myocardial contusion can occur with a fractured or displaced sternum.

Thoracic Spine Fracture

Most thoracic spine fractures occur in the lower thoracic spine, with 60% to 70% of thoraco-lumbar fractures occurring in the T11 to L2 region, which is bio-mechanically weak for stress. The majority of these fractures occur without spinal cord injury. 20 to 40% of the fractures are associated with neurological injuries.

Traumatic First Rib Fractures

Due to the protected location in the upper thoracic cavity, first rib fractures are relatively rare compared with other rib fractures. It is frequently associated with high energy trauma, multisystem injuries, subclavian artery and aortic injuries.