Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Thoracic Cage Fractures

Katie Sprinkel, M.D.

  • Rib fractures are a marker of injury severity, having a single fracture on CXR confers a four fold increase in mortality. They should prompt you to look for other injuries.
  • Pediatric rib fractures, especially under 3 years old, should prompt investigation into child abuse.
  • Elderly patients do poorly (they have more rib fractures w/ low mechanisms and have increased rates of pneumonia/ARDS) so expect this and escalate their care accordingly.
  • The cornerstone of treatment for rib fractures is pain control sufficient to allow patients to continue to breathe deeply.
  • Sternal fractures when isolated are relatively benign but should prompt consideration of other injuries, especially T spine fractures and cardiac complications.
  • Not all clavicle fractures should be managed conservatively. Get ortho involved for skin tenting, 1.5-2 cm shortening, visible deformity, type 2 lateral fx, neurovascular injury.

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