title: Ultrasonographic evaluation of costal cartilage fractures unnoticed by the conventional radiographic study and multidetector computed tomography.
abstract: BACKGROUND
  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.
  
  
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University Chungju Hospital, Kyohyun-dong, Chungju-si, Chungbuk, 380-704, Republic of Korea.
authors.forename: W S
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University Chungju Hospital, Kyohyun-dong, Chungju-si, Chungbuk, 380-704, Republic of Korea. drhousehouse@naver.com.
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University Seoul Hospital, Seoul, Republic of Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Chee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University Seoul Hospital, Seoul, Republic of Korea.
authors.forename: S A
authors.initials: SA
authors.lastname: Lee
keywords: Rib fracture; Sternum fracture; Thoracic trauma; Ultrasonography
references.citation: Am Surg. 2002 May;68(5):449-53
references.pmid: 12013289
references.citation: J Radiol. 1993 Aug-Sep;74(8-9):409-12
references.pmid: 8410773
references.citation: AJR Am J Roentgenol. 2000 Apr;174(4):1115-7
references.pmid: 10749262
references.citation: Ultraschall Med. 1997 Aug;18(4):158-61
references.pmid: 9381122
references.citation: Can J Surg. 2002 Feb;45(1):43-6
references.pmid: 11837920
references.citation: J Bone Joint Surg Am. 1994 Dec;76(12 ):1804-13
references.pmid: 7989385
references.citation: AJR Am J Roentgenol. 2001 Feb;176(2):429-32
references.pmid: 11159088
references.citation: Eur J Cardiothorac Surg. 2003 Oct;24(4):608-13
references.pmid: 14500082
references.citation: Injury. 2004 Jun;35(6):562-6
references.pmid: 15135274
references.citation: AJR Am J Roentgenol. 1992 Oct;159(4):829-33
references.pmid: 1529851
references.citation: Aust N Z J Surg. 1996 Aug;66(8):530-4
references.pmid: 8712986
references.citation: AJR Am J Roentgenol. 1999 Dec;173(6):1603-9
references.pmid: 10584808
references.citation: Semin Ultrasound CT MR. 1996 Apr;17 (2):119-41
references.pmid: 8845197
references.citation: Radiographics. 2002 Jan-Feb;22(1):e1
references.pmid: 11796913
references.citation: Radiol Med. 1997 Sep;94(3):166-9
references.pmid: 9446119
references.citation: Br Med J (Clin Res Ed). 1984 Nov 10;289(6454):1271
references.pmid: 6437515
references.citation: Ultrasound Med Biol. 1997;23 (8):1131-9
references.pmid: 9372561
references.citation: Unfallchirurg. 1995 May;98 (5):296-300
references.pmid: 7610392
references.citation: J Trauma. 1989 May;29(5):623-9
references.pmid: 2657085
references.citation: Chest Surg Clin N Am. 1997 May;7(2):239-61
references.pmid: 9156291