Ultrasound finds rib fractures missed by x-ray

For most people, undetected rib fractures mean long-standing pain and severe potential complications. For elderly patients, the prognosis may be even worse.

These injuries, often missed with chest x-ray, can be detected with ultrasound, according to researchers in Turkey.

Rib fractures, the most serious finding in chest trauma, occur in 35% to 40% of thoracic trauma patients. The mortality rate from isolated rib fractures in elderly patients could be as high as 20%.

Physical examination can often identify rib fractures. Aside from tenderness, however, many patients with minor blunt chest trauma present without any physical or radiological findings.

When the examiner aligns the transducer in the transverse position parallel to the long axis of the rib, ultrasound usually depicts the fracture and a hypoechoic area consistent with the hematoma above the fracture line.

Dr. Murat Kara and colleagues from the University of Kirikkale's radiology and thoracic surgery departments evaluated 37 patients admitted with minor blunt chest trauma in whom x-ray had revealed no fractures. Ultrasound detected rib fractures in 15 of these patients. Their ages ranged from 16 to 85.

Investigators also found a significant correlation between the type of injured rib and the patient's age and duration of pain. Bony rib fractures are more likely to occur among elderly patients, whereas chondral rib fractures are more frequent in younger patients.

Duration of pain was significantly longer in patients with bony rib fractures as opposed to those with chondral rib fractures. Age, sex, duration of pain, and trauma type and site were not significant fracture predictors.

The study validated previous findings of sensitivity rates up to 78% for ultrasound versus 12% for chest x-rays. It appeared in the October issue of the European Journal of Cardio-Thoracic Surgery.

The technique has limitations, the authors said. The subscapular ribs and the infraclavicular portion of the first rib - though uncommon sites for fractures - may be beyond ultrasound's reach. Ultrasound may also have limited value in patients who are obese or have large breasts.

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