Digital radiography of crush thoracic trauma in the Sichuan earthquake

Abstract

Aim: To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography (CDR).

Methods: We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake. Patient age ranged from 0.5 to 103 years. CDR was performed between May 12, 2008 and June 7, 2008. We looked for injury to the thoracic cage, pulmonary parenchyma and the pleura.

Results: Antero-posterior (AP) and lateral CDR were obtained in 349 patients, the remaining 423 patients underwent only AP CDR. Thoracic cage fractures, pulmonary contusion and pleural injuries were noted in 331 (42.9%; 95% CI: 39.4%-46.4%), 67 and 135 patients, respectively. Of the 256 patients with rib fractures, the mean number of fractured ribs per patient was 3. Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib. Rib fractures had a significant positive association with non-rib thoracic fractures, pulmonary contusion and pleural injuries (P < 0.001). The number of rib fractures and pulmonary contusions were significant factors associated with patient death.

Conclusion: Earthquake-related crush thoracic trauma has the potential for multiple fractures. The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.

Keywords: Earthquake; Pleura; Pulmonary parenchyma; Radiography; Thoracic trauma.

Figure 1

An antero-posterior chest digital radiograph of patients who suffered crush injury in the Sichuan earthquake. A: Chest digital radiography (CDR) shows the right-sided 2-8 rib fractures at lateral sites (white arrow head), and non-rib thoracic fractures including clavicle (black arrow), scapula (black arrow head) and T12 vertebral body (sinistrad black curved arrow) in a 56-year-old woman after 4 d. Right-sided hemothorax (dextrad black curved arrow) and parenchymal contusion are noted; B: CDR shows thoracic cage asymmetry due to right-sided 3-7 rib fractures and severe dislocations at posterior sites (white arrow head) and lateral sites (white arrow) causing flail chest in a 51-year-old man after 3 d. Right-sided 8 and 9 rib fractures at posterior sites (white arrow head), scapula fracture (black arrow), hemothorax, pneumomediastium (black arrow head) and parenchymal contusion are shown. Note the widespread subcutaneous emphysema.

Figure 2

Bar chart shows that the number of fractured ribs per patient ranged from 1 to 17 with a median of 3. There were 1074 fractured ribs.

Figure 3

An interactive stack bar shows that most of the rib fractures were distributed from the 3rd through to the 8th ribs, and the vast majority of rib fractures were found in posterior and lateral locations.