Posterior rib fractures as a cause of delayed aortic injury: A case series and literature review

SummaryMultiple rib fractures are common in blunt thoracic trauma, and while indicative of the severity of injury, are rarely implicated as the solitary cause of death. Significant chest wall injury and the presence of flail chest is associated with substantial dysfunction and morbidity, including the need for respiratory support, pneumonia or septicemia, and prolonged hospitalization and pain medication requirements [12]. Posterior rib fractures are commonly associated with flail segments, but are often minimally displaced due to surrounding soft tissue attachments and support. However, if associated with intrathoracic displacement, the risks of significant morbidity and even mortality increase exponentially, and surgical intervention is indicated to minimize this risk.Review of the literature produced one case report describing a posterior rib fracture causing aortic injury and subsequent mortality [13]. However, we were able to find an additional ten patients who had successful treatment of this injury pattern [1–3,5–10,14].The purpose of this report is to describe the circumstances of this unique case and review the existing literature on this topic. This will highlight the importance of attention to the posterior chest wall, as negligence of this injury pattern can prove to be fatal