title: [The elderly patient with multiple rib fractures].
abstract: Rib fractures resulting from blunt thoracic trauma occur frequently in the elderly. Even though these are usually due to a low impact trauma mechanism (e.g. a fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient. This unfavourable clinical course is most often caused by respiratory insufficiency due to lung oedema or pneumonia. This cases series presents three elderly patients who sustained multiple rib fractures and were subsequently admitted to a level I trauma centre for treatment and discusses diagnostic challenges and different treatment approaches for this population. More specifically, age-specific indications and contra-indications for intravenous or epidural analgesia and operative rib fixation are discussed. In addition, we show that a multidisciplinary approach, involving a trauma surgeon, anaesthetist, intensive care physician and physiotherapist, is paramount for the prevention of potentially lethal complications.
authors.affiliation: Erasmus MC, afd. Heelkunde, Trauma Research Unit, Rotterdam.
authors.forename: Mark G
authors.initials: MG
authors.lastname: van Vledder
authors.forename: Tjebbe
authors.initials: T
authors.lastname: Hagenaars
authors.forename: Michiel H J
authors.initials: MH
authors.lastname: Verhofstad
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D003422:Critical Care; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009104:Multiple Trauma; D011014:Pneumonia / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology*; D012253:Rib Fractures / Q000150:complications* / Q000401:mortality; D013898:Thoracic Injuries / Q000150:complications* / Q000401:mortality; D014193:Trauma Centers