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Thứ Sáu, 21 tháng 12, 2012

SIÊU ÂM CHẨN ĐOÁN GÃY SƯỜN và SỤN SƯỜN


Abstract


Introduction


Rib fractures are the most common injuries resulting from blunt chest trauma. However, costal cartilage fractures are almost invisible on chest X-rays unless they involve calcified cartilage. The sensitivity of conventional radiography and computed tomography for detecting rib fractures is limited, especially in cases where rib cartilage is involved. Therefore, this study was designed to evaluate the sensitivities of chest wall ultrasonography, clinical findings, and radiography in the detection of costal cartilage fractures.

Materials and methods


A total of 93 patients presenting with a high clinical suspicion of rib or sternal fractures were recruited for radiological workup with posterior–anterior (PA) chest radiographs, oblique rib views, sternal views, computed tomography, and chest ultrasound between April 2008 and May 2010. There were 47 men and 46 women, and the mean age of the patients was 51.8 ± 15.9 years (range 17–78 years). These patients with minor blunt chest trauma showed no evidence of rib fractures on conventional radiography and computed tomography, and no evidence of other major fractures. Chondral rib fractures were detected by using ultrasonography on a 7.5-MHz linear transducer.

Results


Of the total 93 patients, 64 (68.8%) showed chondral rib fractures, whereas 29 (31.2%) did not. The mean number of chondral rib fracture sites detected in 64 patients was 1.8 ± 0.8 (range 1–5). Subperiosteal hematoma was the most common finding associated with costal cartilage fractures (n = 14, 15.0%), followed by sternal fracture (n = 9, 9.7%). However, subperiosteal hematoma was also noticed in 1 (1.1%) of the patients without costal cartilage fractures, and sternal fractures in 7 patients (7.5%).

Discussion


The results of this study suggest that ultrasonography may be a useful imaging method for detecting costal cartilage fractures overlooked on conventional radiographs and computed tomography in patients with minor blunt chest trauma. Early ultrasonographic evaluation can give more accurate information than clinical and radiologic evaluation in detecting costal cartilage fractures and sternal fractures that are overlooked on conventional radiography and computed tomography after minor blunt chest trauma.

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Ultrasound in revelation of chondral rib fracture and  bony rib fracture at an outpatient clinic : A Vietnamese experience

Le Thanh Liem, Nguyen Thien Hung, Le van Tai, Lu Minh Tan, Le Tu Phuc, Phan Thanh Hai

MEDIC MEDICAL CENTER, HCMC, Vietnam

Abstract:

OBJECTIVE:


To disclose chondral or bony rib fracture by ultrasound which are negative on X-ray film of minor blunt chest trauma patients.

METHODS:


A total of 42 patients suffering from minor blunt chest trauma without evidence of a rib fracture on chest X-ray film, were examined with a 9L4 MHz or 7.5 MHz linear transducer of ultrasound system (Siemens, Aloka). Statistical analysis was done to outline the ultrasound findings of these rib fractures.

RESULTS:


There were 50 (100.0%) patients showed chondral and bony rib lesions, whereas these 50 patients had no evidence of rib lesions on X-ray film. Fracture of the rib with a disruption of continuity of bony cortex near junction of chrondral and bony rib was the most common finding in 45 (90,0%) patients. Chondral rib fractures were in five (10,0% )patients. Chondral rib fracture appeared as disruption of cortex, small echogenic lines in chondral rib, and bruised chondral rib was a small deformation of chondral cortex and echogenic area at trauma site which was painful site. Bony rib fractures significantly occurred in trauma patients, and the duration of pain in patients with chondral rib fractures was significantly longer than that of patients with bony rib fractures.


CONCLUSIONS:


Ultrasonography is a useful imaging method in disclosing the rib fractures (chondral and bony rib fractures) which were negative on chest X-ray film in minor blunt chest trauma. However, chondral rib fractures significantly occur less than bony rib fractures and result in a longer duration of pain.


Chondral rib fracture by ox kicking for 4 days.



2 cases of bruised chondral rib by hitting with echogenic line.


A case of calcified chondral rib for 4 years by beating.



A bruised of chondral rib with echogenic area in costal cartilage (below image), but ARFI velocity value in out of  range (above image).


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Tại MEDIC, trong 6 tháng cuối năm 2012, có 5 ca gãy dập sụn sườn trong số 50 ca chấn thương nhẹ lồng ngực với gãy xương sườn (và thân xương ức). Ca gãy sụn sườn gần với lúc khám siêu âm là 4 ngày do bị bò đá, ca xa nhất, 4 năm. X-quang không thấy tổn thương ở 2 ca này và các ca còn lại (45 ca). Gãy xương sườn là tổn thương không liên tục của vỏ xương, thường gần chỗ nối sụn và xương, và có kèm theo máu tụ khu trú thành ngực quanh ổ gãy. Gãy sụn sườn ít gặp hơn với  đường viền sụn gián đoạn, hay các đường echo dày trong sụn sườn, trong khi dập sụn sườn có các vùng echo dày trong sụn và bao sụn biến dạng lỏm ở nơi va chạm.




Siêu âm phần mềm thành ngực là phương tiện khám có hiệu quả và phát hiện sớm các trường hợp gãy sụn sườn, xương sườn (và xương ức), góp phần chẩn đoán đầy đủ các trường hợp chấn thương ngực kín nghi có tổn thương xương và sụn sườn, mà các phương tiện khác như X-quang và CT có thể bỏ sót.
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