Brewer Jennifer M, Karsmarski Owen P, Fridling Jeremy, Hill T Russell, Greig Chasen J, Posillico Sarah E, McGuiness Carol, McLaughlin Erin, Montgomery Stephanie C, Moutinho Manuel, Gross Ronald, Eriksson Evert A, Doben Andrew R
Department of General Surgery, University of Connecticut School of Medicine, Farmington, CT, USA.
Department of Surgery, Saint Francis Hospital and Medical Center, Hartford, CT, USA.
J Trauma Inj. 2024 Mar;37(1):48-59. doi: 10.20408/jti.2023.0065. Epub 2024 Feb 23.
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.
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.
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.
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.
关于肋骨骨折治疗的研究呈指数级增长。基于损伤机制（MOI）及其他可能的相关性来预测骨折模式，可能会改善资源分配和损伤预防策略。胸部损伤国际数据库（CIID）是最大的关于严重胸壁创伤患者手术及非手术治疗的前瞻性资料库。本研究的目的是确定MOI是否与所产生的肋骨骨折模式相关。我们假设特定的MOI会与不同的肋骨骨折模式相关。
查询CIID以基于MOI分析骨折模式。患者按MOI分层：跌倒、机动车碰撞（MVC）、摩托车碰撞（MCC）、汽车与行人碰撞以及自行车碰撞。记录骨折位置、相关损伤及患者特定变量。绘制热图以显示各肋骨位置的骨折发生率。
研究队列包括1121例患者，中位肋骨评分2分（范围0 - 3分），共9353处骨折。平均年龄为57±20岁，64%的患者为男性。按MOI划分，患者及骨折数量如下：跌倒（474例患者，3360处骨折）、MVC（353例患者，3268处骨折）、MCC（165例患者，1505处骨折）、汽车与行人碰撞（70例患者，713处骨折）以及自行车碰撞（59例患者，507处骨折）。最常受伤的肋骨是第6肋，最常见的骨折位置是外侧。除MCC与自行车碰撞外，比较每种MOI时，骨折位置和模式存在统计学显著差异。
不同的损伤机制导致不同的肋骨骨折模式。在胸部损伤患者的检查和治疗中应考虑这些不同模式。鉴于这些显著差异，未来研究应兼顾骨折位置和MOI，以更好地确定哪些人群从手术治疗与非手术治疗中获益。
