Thus, detection of rib fractures by CT may be indicated under certain circumstances (especially if severe injury is suspected). Bugaev et al [14] retrospectively reviewed 245 patients that presented to a level 1 trauma center for a number of rib fractures and degree of displacement. They found that the number of rib fractures and the degree of fracture fragment displacement accurately predicted subsequent opioid requirements. Patients with rib fractures from a high-energy mechanism or with a high clinical suspicion of intrathoracic or intra-abdominal injury may warrant further evaluation with contrast-enhanced CT, whereas a low-energy injury or normal physical examination may obviate further testing. Dubinsky and Low [17] studied 69 patients with nonthreatening trauma (stable vital signs with no evidence of cardiac injury, solid or hollow viscus rupture, or fractures associated with significant blood loss) and found that neither rib studies nor chest radiographs were of clinical benefit in this scenario, but they concluded that clinical evidence of a complicated injury, such as pneumothorax, hemothorax, or flail chest, may warrant further evaluation. Similarly, Schurink et al [18] studied patients with lower rib fractures (ribs 7 through 12) and found that the negative predictive value of a negative physical examination for abdominal injury that is due to low-energy impact was 100%, but in patients with multiple injuries, lower rib fractures were associated with abdominal organ injury in 67% of patients. Matthes et al [19] found no association between right-sided lower rib fractures in 55 Rib Fractures trauma patients with hepatic injury when matched with 55 trauma patients without hepatic injury (there was a slight negative association of hepatic laceration with left-sided fractures) but ultimately concluded that the absence of rib fractures could not rule out hepatic injury.
Rib Fractures. Thus, detection of rib fractures by CT may be indicated under certain circumstances (especially if severe injury is suspected). Bugaev et al [14] retrospectively reviewed 245 patients that presented to a level 1 trauma center for a number of rib fractures and degree of displacement. They found that the number of rib fractures and the degree of fracture fragment displacement accurately predicted subsequent opioid requirements. Patients with rib fractures from a high-energy mechanism or with a high clinical suspicion of intrathoracic or intra-abdominal injury may warrant further evaluation with contrast-enhanced CT, whereas a low-energy injury or normal physical examination may obviate further testing. Dubinsky and Low [17] studied 69 patients with nonthreatening trauma (stable vital signs with no evidence of cardiac injury, solid or hollow viscus rupture, or fractures associated with significant blood loss) and found that neither rib studies nor chest radiographs were of clinical benefit in this scenario, but they concluded that clinical evidence of a complicated injury, such as pneumothorax, hemothorax, or flail chest, may warrant further evaluation. Similarly, Schurink et al [18] studied patients with lower rib fractures (ribs 7 through 12) and found that the negative predictive value of a negative physical examination for abdominal injury that is due to low-energy impact was 100%, but in patients with multiple injuries, lower rib fractures were associated with abdominal organ injury in 67% of patients. Matthes et al [19] found no association between right-sided lower rib fractures in 55 Rib Fractures trauma patients with hepatic injury when matched with 55 trauma patients without hepatic injury (there was a slight negative association of hepatic laceration with left-sided fractures) but ultimately concluded that the absence of rib fractures could not rule out hepatic injury.