GÃY XƯƠNG SƯỜN, SỤN SƯỜN BS Lê Văn Tài Trung Tâm Y Khoa MEDIC • A bone fracture is a medical condition in which there is a damage in the continuity of the bone • A bone fracture can be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture GẢY XƯƠNG SƯỜN • High-resolution sonography was performed with a 5-12– MHz linear array sonography unit • The high-resolution sonography of the ribs and costal cartilage in the most painful area was performed with the transducer aligned transversely (i.e., parallel to the long axis of the rib) • The patients were then turned to a lateral decubitus position Thereafter, the entire length of each rib in the affected area and above and below the rib was scanned from the costosternal to the costovertebral junction • The high-resolution sonograms were reviewed for the presence of representative findings: cortical disruption (focal interruption of the echogenic cortical line), callus formation (echogenic dump with posterior shadow), cortical deformity (changed shape of echogenic cortical line such as angulation or stepping 43-year-old man with trauma 10 days previously and confirmed traumatic rib fracture Radiograph shows cortical disruption with soft-tissue swelling (arrows) 43-year-old man with trauma 10 days previously and confirmed traumatic rib fracture Sonogram shows cortical disruption (arrow) and hematoma formation (arrowheads) on transverse and longitudinal scans GÃY SỤN SƯỜN • Costal cartilage fractures are fractures of the cartilage connecting the ribs anteriorly to the sternum • There is little published data on costal cartilage fractures Most reported cases are in males and resulted from blunt trauma or a fall • In young children a costal cartilage fracture can present as a chest wall mass associated with pain (differentials include neoplasm and posttraumatic haematoma) In older patients pain is the primary complaint • Costal cartilages can fracture due to blunt trauma sustained in high-energy trauma or a fall While the more immobile first and second ribs seem to be more prone to costochondral separation, the lower ribs can suffer costal cartilage fracturing more easily • Disruptions or fractures of costal cartilage might result in an unstable rib cage and may expose thoracic contents, such as the heart, to injury • Plain film: Fractures of the costal cartilage are challenging to establish on physical examination and not visible on plain radiographs, unless there is severe calcification of the cartilage Due to their low incidence they may also be easily overlooked on additional imaging • CT: CT is a reliable method of identifying costal cartilage fractures They tend to be mid-substance (i.e in the centre of the costal cartilage) and CT offers the advantage of demonstrating other injuries, such as rib fractures and involvement of lung parenchyma • Ultrasound: Ultrasound can be used reliably to diagnose costal cartilage fractures and can increase the sensitivity of their detection when used together with CT scanning Unlike CT it does not involve radiation and is therefore preferable in a paediatric population and for follow-up examinations Furthermore, it may be helpful to perform an ultrasound examination when there is a high clinical suspicion, with or without a mass, and other modalities have not demonstrated an injury • Signs of a cartilage fracture include a fracture line, disruption of the anterior echogenic margin, a step-off deformity or gas located at the costochondral junction • MRI: MRI can demonstrate costal cartilage fractures as well and, like ultrasound, doesn't result in radiation exposure • Treatment and prognosis: It is unclear if costal cartilage fractures actually completely heal, but reported cases state a return to normal and sports activities when the pain goes away ... or stepping 43-year-old man with trauma 10 days previously and confirmed traumatic rib fracture Radiograph shows cortical disruption with soft-tissue swelling (arrows) 43-year-old man with trauma... pathologic fracture GẢY XƯƠNG SƯỜN • High-resolution sonography was performed with a 5-1 2– MHz linear array sonography unit • The high-resolution sonography of the ribs and costal cartilage in the most... due to blunt trauma sustained in high-energy trauma or a fall While the more immobile first and second ribs seem to be more prone to costochondral separation, the lower ribs can suffer costal cartilage