Journal of Trauma and Injury

  • 제37권1호
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  • Pages.48-59
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  • 2024
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  • 2799-4317(pISSN)
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  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
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Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States

  • Jennifer M. Brewer (Department of General Surgery, University of Connecticut School of Medicine) ;
  • Owen P. Karsmarski (Department of General Surgery, University of Connecticut School of Medicine) ;
  • Jeremy Fridling (Department of General Surgery, University of Connecticut School of Medicine) ;
  • T. Russell Hill (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Chasen J. Greig (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Sarah E. Posillico (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Carol McGuiness (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Erin McLaughlin (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Stephanie C. Montgomery (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Manuel Moutinho (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Ronald Gross (Department of Surgery, Saint Francis Hospital and Medical Center) ;
  • Evert A. Eriksson (Department of Surgery, Medial University of South Carolina) ;
  • Andrew R. Doben (Department of Surgery, Saint Francis Hospital and Medical Center)
  • 투고 : 2023.09.10
  • 심사 : 2023.10.18
  • 발행 : 2024.03.31
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초록

Purpose: Research on rib fracture management has exponentially increased. Predicting fracture patterns based on the mechanism of injury (MOI) and other possible correlations may improve resource allocation and injury prevention strategies. The Chest Injury International Database (CIID) is the largest prospective repository of the operative and nonoperative management of patients with severe chest wall trauma. The purpose of this study was to determine whether the MOI is associated with the resulting rib fracture patterns. We hypothesized that specific MOIs would be associated with distinct rib fracture patterns. Methods: The CIID was queried to analyze fracture patterns based on the MOI. Patients were stratified by MOI: falls, motor vehicle collisions (MVCs), motorcycle collisions (MCCs), automobile-pedestrian collisions, and bicycle collisions. Fracture locations, associated injuries, and patient-specific variables were recorded. Heat maps were created to display the fracture incidence by rib location. Results: The study cohort consisted of 1,121 patients with a median RibScore of 2 (range, 0-3) and 9,353 fractures. The average age was 57±20 years, and 64% of patients were male. By MOI, the number of patients and fractures were as follows: falls (474 patients, 3,360 fractures), MVCs (353 patients, 3,268 fractures), MCCs (165 patients, 1,505 fractures), automobile-pedestrian collisions (70 patients, 713 fractures), and bicycle collisions (59 patients, 507 fractures). The most commonly injured rib was the sixth rib, and the most common fracture location was lateral. Statistically significant differences in the location and patterns of fractures were identified comparing each MOI, except for MCCs versus bicycle collisions. Conclusions: Different mechanisms of injury result in distinct rib fracture patterns. These different patterns should be considered in the workup and management of patients with thoracic injuries. Given these significant differences, future studies should account for both fracture location and the MOI to better define what populations benefit from surgical versus nonoperative management.

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참고문헌

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