@article{ref1,
title="Is first rib fracture a culprit or a sign of injury severity? It is both",
journal="Journal of Orthopaedic Trauma",
year="2018",
author="Fokin, Alexander and Wycech, Joanna and Picard, Eric and Weisz, Russell and Puente, Ivan",
volume="32",
number="8",
pages="391-396",
abstract="OBJECTIVES: First rib fractures (1 RFX) have been correlated with increased morbidity and mortality. Whether this is due to the fracture of the rib itself or due to an increased number of associated injuries remains debatable. <br><br>DESIGN: Retrospective cohort study SETTING:: Level 1 trauma center PATIENTS:: 1089 patients with rib fractures divided into 3 groups: Group A (n=44) with isolated 1 RFX, Group B (n=116) with 1 RFX combined with other rib fractures, and Group C (n=929) with rib fractures without 1 RFX. INTERVENTION: None OUTCOME MEASUREMENTS:: Age, gender, injury severity score (ISS), mortality, number of ribs fractured (RFX), incidences of flail chest, multiple co-injuries, hospital and intensive care unit lengths of stay (HLOS, ICULOS) and duration of mechanical ventilation (DMV). <br><br>RESULTS: Group A when compared to Group B, had significantly lower ISS, RFX, rates of flail chest, pulmonary co-injuries, shorter HLOS and ICULOS. Group A compared to Group C, had significantly lower age, RFX, rates of flail chest, and hemopneumothorax. In Group B, all outcome measurements were significantly higher than in Group C. Incidence of subclavian artery, brachial plexus and 1 thoracic vertebra injuries were significantly higher in Group A. Frequency of traumatic brain and orthopaedic co-injuries were comparable in both groups with 1 RFX. <br><br>CONCLUSIONS: Isolated 1 RFX alone are associated with higher incidence of injuries to subclavian structures and the 1 thoracic vertebrae. When they are combined with fractures of other ribs, the overall severity of trauma expands significantly. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<p /> <p>Language: en</p>",
language="en",
issn="0890-5339",
doi="10.1097/BOT.0000000000001189",
url="http://dx.doi.org/10.1097/BOT.0000000000001189"
}