Fracture Mapping in High-Energy Chest Trauma

Abstract

Background: High-energy chest trauma often results in rib fractures and associated chest injuries. This study explored fracture distribution patterns in high-energy chest trauma, using three-dimensional (3D) fracture mapping technology. Methods: This retrospective study analyzed cases of high-energy chest trauma with rib fractures treated at a Level 1 Trauma Center, from February 2012 to January 2023. Specifically, 3D computed tomography (CT) was used to reconstruct rib fractures and create fracture-frequency heat maps, analyzing the influence of other thoracic fractures on rib fracture distribution. Results: Rib fractures were frequently found in the anterior and posterior thoracic areas. On average, patients sustained 7 ± 3.87 rib fractures, with clavicle fractures in 25.5% and scapular fractures in 19.6% of cases. Scapular fractures led to more posterior rib fractures, while sternal fractures were associated with more anterior rib fractures. Clavicle fractures were linked to fractures of the first to third ribs. Conclusions: Rib fractures in high-energy chest trauma occurred most often in the anterior and posterior regions. Fractures of the scapula and sternum influence the positioning of the fracture lines. Clavicular fractures are associated with a higher incidence of upper rib fractures. These findings can help inform surgical decisions and complication management.

Keywords: 3D fracture mapping; fracture-frequency heat maps; high-energy chest trauma; rib fractures.

Figure 1

Schematic diagram of rib fracture line measurement. The junction between the rib and spine (costovertebral joint) is marked as A, the fracture site as B, and the boundary between the rib shaft and the anterior end segment (costochondral junction) as C. The distance from A to B is denoted as D1 and the distance from B to C is denoted as D2. The percentage of rib fractures along the ribs was calculated as follows: D1/(D1 + D2) × 100. The schematic diagram illustrates that the percentage of rib fractures was 266.10/(266.10 + 36.80) × 100% = 87.85%.

Figure 2

3D Reconstruction of rib fracture heat maps. Rib fractures were reconstructed three-dimensionally with the fracture lines overlaid on a template to create 3D heat maps. These maps show a heat map of the frequency of rib fracture lines after thoracic trauma. A heat map is shown of anterior, left, posterior, and right views (from left to right). Blue indicates areas with fewer fracture lines, red indicates areas with more fracture lines, and the gradients from blue to green and yellow to red indicate an increasing frequency of fracture lines.

Figure 3

Distribution of rib fracture lines by percentage position along the rib.