| Abstrakt: |
During the past decade, there has been increasing recognition of the association between fracture of the first rib due to blunt trauma and the injury of the closely related vascular structures. As percutaneous arteriography became routine, it was recommended that all patients with fracture of the first rib undergo arteriography. Twenty-six consecutive patients with 31 first rib fractures had aortic arch arteriography for the indication of first rib fracture at the Harbor/UCLA Medical Center from January, 1977 through December, 1980. Their records and arteriograms were reviewed to evaluate this policy. Twenty-five were injured in motor vehicle accidents and one in a fall. Twenty had associated injuries. Review of chest roentgenograms revealed seven fractures to be anterior, 14 lateral, nine posterior, and one segmental. Apical extrapleural density was noted in 23 of 31 fractures and a hemothorax in five. Two patients had brachial plexus palsies, and one of these is the only patient in the series to have a distal pulse deficit. Only the patient with a pulse deficit and nerve injury showed positive findings on arteriography, complete transection of the left subclavian artery in association with a lateral fracture of the first rib. This experience indicates that the subclavian artery is infrequently injured in association with first rib fracture and that arteriography should be performed selectively rather than routinely. This policy is supported by a review of the literature. Arteriography is indicated for stable patients with evidence of {1) distal vascular insufficiency, (2) hemorrhage, particularly large extrapleural hematoma or hemothorax, (3) concomitant brachial plexus injury, (4) significantly displaced fragments, and (5) multiple thoracic-injuries. Immediate exploration may be necessary, and patients must be followed for possible late complications. |
