US Chest Several articles have noted that ultrasound (US) can detect fractures not seen on conventional radiographs [26- 28]. Griffith et al [28] compared US and radiography (chest radiography plus one oblique rib radiograph) in 50 patients and found that radiographs detected only 8 of 83 (10%) sonographically detected rib fractures and were positive in only 6 of the 39 patients who had demonstrated fractures. In this study, US allowed evaluation of the costochondral junction, the costal cartilage, and the ribs and was able to show nondisplaced fractures. Kara et al [26] found rib fractures in 40.5% of 37 patients with minor blunt chest trauma and negative radiographs by using US; osseous fractures were more common in the elderly, and duration of pain was significantly longer in these patients compared to those with chondral injuries [26-28]. However, Hurley et al [29] found US to be only marginally superior to conventional radiographs, and its routine use was not indicated because of the lengthy time of the examination, averaging 13 minutes in this series, and patient discomfort from the pressure of the US probe, particularly since identification of the fracture was unlikely to impact patient care. Bone Scan Whole Body Nuclear medicine bone scans are sensitive but not specific for detection of rib fracture [30]. Bone scans are most commonly used for detection of osseous involvement in systemic processes (eg, metastatic disease) and may result in false-positive diagnosis of malignancy in a patient with rib fractures, although the pattern of tracer uptake can often help differentiate the two processes [30]. Bone scans have limited use in distinguishing acute and subacute or chronic rib fractures as they will usually be positive within 24 hours after an injury, but the return to normal can be slow (79% by 1 year, 93% by 2 years, and 100% in 3 years) [31].
Rib Fractures. US Chest Several articles have noted that ultrasound (US) can detect fractures not seen on conventional radiographs [26- 28]. Griffith et al [28] compared US and radiography (chest radiography plus one oblique rib radiograph) in 50 patients and found that radiographs detected only 8 of 83 (10%) sonographically detected rib fractures and were positive in only 6 of the 39 patients who had demonstrated fractures. In this study, US allowed evaluation of the costochondral junction, the costal cartilage, and the ribs and was able to show nondisplaced fractures. Kara et al [26] found rib fractures in 40.5% of 37 patients with minor blunt chest trauma and negative radiographs by using US; osseous fractures were more common in the elderly, and duration of pain was significantly longer in these patients compared to those with chondral injuries [26-28]. However, Hurley et al [29] found US to be only marginally superior to conventional radiographs, and its routine use was not indicated because of the lengthy time of the examination, averaging 13 minutes in this series, and patient discomfort from the pressure of the US probe, particularly since identification of the fracture was unlikely to impact patient care. Bone Scan Whole Body Nuclear medicine bone scans are sensitive but not specific for detection of rib fracture [30]. Bone scans are most commonly used for detection of osseous involvement in systemic processes (eg, metastatic disease) and may result in false-positive diagnosis of malignancy in a patient with rib fractures, although the pattern of tracer uptake can often help differentiate the two processes [30]. Bone scans have limited use in distinguishing acute and subacute or chronic rib fractures as they will usually be positive within 24 hours after an injury, but the return to normal can be slow (79% by 1 year, 93% by 2 years, and 100% in 3 years) [31].