A proposed new mechanism of traumatic aortic rupture: the osseous pinch.

The currently accepted mechanism to explain traumatic aortic rupture from rapid deceleration involves a combination of traction, torsion, and hydrostatic forces. The authors hypothesize that aortic isthmus lacerations result from a pinch of the aorta between the spine and the anterior bony thorax (manubrium, clavicle, and first ribs) during chest compression caused by abrupt deceleration. Compression of an articulated, normally moving thoracic skeleton containing a synthetic aorta consistently caused transection of the aorta at the isthmus between the spine and anterior bony structures. Analysis of rotation of the first rib in 10 consecutive patients undergoing computed tomography of the chest demonstrated interposition of the distal aortic arch and isthmus between the vertebrae and anterior bony thorax in each instance. Aortas excised from laboratory dogs were pinched between structures simulating bones to reproduce intimal and medial lesions indistinguishable from lesions associated with naturally occurring traumatic disruptions. Although further studies in cadaveric specimens are necessary to confirm this mechanism of injury, the authors believe that their results support the osseous-pinch mechanism of aortic rupture.