Skip to main content
SpringerLink
Log in

MRI in suspected chest wall fractures: diagnostic value in work-related chest blunt trauma

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To describe and analyze MRI findings in suspected early fractures of the chest (ribs and sternum) and assess if this technique can add value in occupational medicine.

Materials and methods

In this retrospective study, we reviewed 112 consecutive patients with work-related mild closed chest trauma who underwent early thoracic MRI, when there was not a clear fracture on radiograph or when the symptoms were intense and not explained by radiographic findings. MRI was evaluated by two experienced radiologists independently. The number and location of fractures and extraosseous findings were recorded. A multivariate analysis was performed to correlate the fracture characteristics and time to RTW (return-to-work). Interobserver agreement and image quality were assessed.

Results

100 patients (82 men, mean age 46 years, range 22–64 years) were included. MRI revealed thoracic wall injuries in 88%: rib and/or sternal fractures in 86% and muscle contusion in the remaining patients. Most patients had multiple ribs fractured, mostly at the chondrocostal junction (n=38). The interobserver agreement was excellent, with minor discrepancies in the total number of ribs fractured. The mean time to return-to-work was 41 days, with statistically significant correlation with the number of fractures. Time to return-to-work increased in displaced fractures, sternal fractures, extraosseous complications, and with age.

Conclusion

Early MRI after work-related chest trauma identifies the source of pain in most patients, mainly radiographically occult rib fractures. In some cases, MRI may also provide prognostic information about return-to-work.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Anantharaman V, Zuhary TM, Ying H, Krishnamurthy N. Characteristics of injuries resulting from falls from height in the construction industry. Singapore Med J. 2023;64:237–43.

    Article  PubMed  Google Scholar 

  2. Atanasijevic TC, Popovic VM, Nikolic SD. Characteristics of chest injury in falls from heights. Leg Med (Tokyo). 2009;11(Suppl 1):315–7.

    Article  Google Scholar 

  3. Talbot BS, Gange CP Jr, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment. Radiographics. 2017;37:628–51.

    Article  PubMed  Google Scholar 

  4. Majercik S, Pieracci FM. Chest wall trauma. Thorac Surg Clin. 2017;27:113–21.

    Article  PubMed  Google Scholar 

  5. Expert panel on thoracic imaging: Henry TS, Donnelly EF, Boiselle PM, Crabtree TD, Iannettoni MD, Johnson GB, et al. ACR Appropriateness Criteria® Rib Fractures. J Am Coll Radiol 2019; 16:S227-S234.

  6. Tomas X, Facenda C, Vaz N, Castañeda EA, Del Amo M, Garcia-Diez AI, et al. Thoracic wall trauma-misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging. Quant Imaging Med Surg. 2017;7:384–97.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Subhas N, Kline MJ, Moskal MJ, White LM, Recht MP. MRI evaluation of costal cartilage injuries. AJR. 2008;191:129–32.

    Article  PubMed  Google Scholar 

  8. Zhang T, Wu J, Chen YC, Wu X, Lu L, Mao C. Magnetic resonance imaging has better accuracy in detecting new-onset rib fractures as compared to computed tomography. Med Sci Monit. 2021;11(27):e928463.

    Google Scholar 

  9. American College of Surgeons. ATLS: advanced trauma life support, ACS 10th Edition. J Trauma Acute Care Surg. 2018;84:1–55.

    Google Scholar 

  10. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  PubMed  Google Scholar 

  11. Ghiasi MS, Chen J, Vaziri A, Rodriguez EK, Nazarian A. Bone fracture healing in mechanobiological modeling: a review of principles and methods. Bone Rep. 2017;16:87–100.

    Article  Google Scholar 

  12. Jarraya M, Hayashi D, Roemer FW, Crema MD, Diaz L, Conlin J, et al. Radiographically occult and subtle fractures: a pictorial review. Radiol Res Pract. 2013;2013:370169.

    PubMed  PubMed Central  Google Scholar 

  13. Wilson MP, Nobbee D, Murad M, Dhillon S, Mcinnes MDF, Katlariwala P, Low G. diagnostic accuracy of limited MRI protocols for detecting radiographically occult hip fractures: a systematic review and meta-analysis. AJR. 2020;215:559–67.

    Article  PubMed  Google Scholar 

  14. Haj-Mirzaian A, Eng J, Khorasani R, Raja AS, Levin AS, Smith SE, et al. Use of advanced imaging for radiographically occult hip fracture in elderly patients: a systematic review and meta-analysis. Radiology. 2020;296:521–31.

    Article  PubMed  Google Scholar 

  15. Nachtrab O, Cassar-Pullicino VN, Lalam R, Tins B, Tyrrell PN, Singh J. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures. Eur J Radiol. 2012;81:3813–23.

    Article  CAS  PubMed  Google Scholar 

  16. Clementson M, Björkman A, Thomsen NOB. Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT Open Rev. 2020;5:96–103.

    Article  PubMed  PubMed Central  Google Scholar 

  17. De Zwart AD, Beeres FJ, Ring D, Kingma LM, Coerkamp EG, Meylaerts SA, Rhemrev SJ. MRI as a reference standard for suspected scaphoid fractures. Br J Radiol. 2012;85:1098–101.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gäbler C, Kukla C, Breitenseher M, et al. Diagnosis of occult scaphoid fractures and other wrist injuries. Langenbeck’s Arch Surg. 2001;386:150–4.

    Article  Google Scholar 

  19. Zhang L, McMahon CJ, Shah S, Wu JS, Eisenberg RL, Kung JW. Clinical and radiologic predictive factors of rib fractures in outpatients with chest pain. Curr Probl Diagn Radiol. 2018;47:94–7.

    Article  CAS  PubMed  Google Scholar 

  20. Livingston DH, Shogan B, John P, Lavery RF. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64:905–11.

    PubMed  Google Scholar 

  21. Schowalter S, Le B, Creps J, McInnis KC. Rib fractures in professional baseball pitchers: mechanics, epidemiology, and management. Open Access J Sports Med. 2022;13:89–105.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Harris R, Trease L, Wilkie K, et al. Rib stress injuries in the 2012–2016 (Rio) Olympiad: a cohort study of 151 Australian Rowing Team athletes for 88.773 athlete days. British Journal of Sports Medicine. 2020;54:991–6.

    Article  PubMed  Google Scholar 

  23. Awh MH. Costal cartilage injuries. MRI web clinic February 2017. https://radsource.us/costal-cartilage-injuries/.

  24. Nummela MT, Bensch FV, Pyhältö TT, Koskinen SK. Incidence and imaging findings of costal cartilage fractures in patients with blunt chest trauma: a retrospective review of 1461 consecutive whole-body CT examinations for trauma. Radiology. 2018;286:696–704.

    Article  PubMed  Google Scholar 

  25. Malghem J, Vande Berg B, Lecouvet F, Maldague B. Costal cartilage fractures as revealed on CT and sonography. AJR. 2001;176:429–32.

    Article  CAS  PubMed  Google Scholar 

  26. Baker E, Xyrichis A, Norton C, Hopkins P, Lee G. The long-term outcomes and health-related quality of life of patients following blunt thoracic injury: a narrative literature review. J Trauma Resusc Emerg Med. 2018;26:67–83.

    Article  Google Scholar 

  27. Kerr-Valentic MA, Arthur M, Mullins RJ, Pearson TE, Mayberry JC. Rib fracture pain and disability: can we do better? J Trauma. 2003;54:1058–63.

    Article  PubMed  Google Scholar 

  28. Prins JTH, Wijffels MME, Wooldrik SM, Panneman MJM, Verhofstad MHJ, Van Lieshout EMM. Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands. Eur J Trauma Emerg Surg. 2022;48:3601–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mutualia, Bilbao, Spain

    Ana Capelastegui, Roque Oca, Gotzon Iglesias & Jose Alejandro Larena

  2. Department of Radiology, Osatek Galdakao-Usansolo, Galdakao, Spain

    Ana Capelastegui & Jose Alejandro Larena

  3. Department of Radiology, Osatek Deusto, Bilbao, Spain

    Roque Oca

  4. Department of Radiology, Cruces Hospital, Barakaldo, Spain

    Gotzon Iglesias

Authors
  1. Ana Capelastegui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roque Oca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gotzon Iglesias
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jose Alejandro Larena
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ana Capelastegui.

Ethics declarations

Disclosures

The authors declare that there are no disclosures relevant to the subject matter of this article.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Capelastegui, A., Oca, R., Iglesias, G. et al. MRI in suspected chest wall fractures: diagnostic value in work-related chest blunt trauma. Skeletal Radiol 53, 275–283 (2024). https://doi.org/10.1007/s00256-023-04399-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-023-04399-0

Keywords

Search

Navigation