J Chest Surg.  2023 Nov;56(6):431-434. 10.5090/jcs.23.072.

Fracture of the Second Rib: An Indirect Sign of Serious Trauma Like Fracture of the First Rib?

• Tsimpinos M
• Chrysikos D
• Demesticha T
• Piagkou M
• Troupis T

• KMID: 2547735
• DOI: http://doi.org/10.5090/jcs.23.072

Abstract

Background
The first 3 ribs are anatomically well-protected, shielded by the large thoracic muscles, the shoulder girdle, and the arm. A significant force is required to fracture these ribs; thus, such fractures suggest a high-energy trauma and are associated with injuries to vital organs of the thorax, such as the aorta, the heart, the lungs and the great vessels.
Methods
A retrospective analysis was conducted over a 10-year period at a single hospital. The study assessed patients with fractures of the second rib, including their concurrent injuries and the overall severity of their trauma.
Results
Among the 76 patients included in the study, the average age was 47.35 years, 81.5% were men, and 19.5% were women. Thirteen patients (17.1%) survived their injuries. The most common causes of injury were road traffic accidents (63%) and pedestrian injuries (22%). The patients who did not survive sustained injuries to an average of 5 additional organs, while survivors had injuries to an average of 2.07 additional organs. Left rib fractures were the most frequently observed (46%). The most serious concurrent injuries reported were to the aorta (5.26%), heart (10.52%), lung (52.36%), head (57.89%), liver (30.2%), spleen (26.31%), and kidney (17.1%).
Conclusion
As indicators of serious injury to vital endothoracic organs, isolated fractures of the second rib should be considered equal to first rib fractures in clinical importance.

Keyword

Ribs; Thorax; Aorta; Traffic accidents; Heart injuries