Ultrasonography in the diagnosis of rib and sternal fracture

Purpose: Lesions of the thoracic skeleton can sometimes be a problem in radiological diagnosis. Aim of the study was to investigate the value of ultrasound in the diagnosis of thoracic trauma in clinical practice. Method: Patients with thoracic trauma and suspected rib or sternal fracture were entered in the study. The results of the thoracic x-ray including a special target film and thoracic sonography were compared. Results: 103 patients took part in the study (32 women, 71 men, average age 54.3 years). In x-ray the diagnosis of rib fracture was certain in 27 patients (30%), in US 56 patients (58%) had definitive signs of rib fracture. Because of multiple fractures in the same patients the total number of radiologically found rib fractures was 49, whereas 101 fractures could be detected by sonography. Also minimal pleural effusions could be found in 31 patients (32%) sonographically, only 18 of them were seen in x-ray. Larger effusions in six patients (6%) with serial rib fractures and haematothorax could all be diagnosed in x-ray and also US. The seven patients with suspected sternum fracture showed clear fracture signs in x-ray as well as US. Conclusions: Rib fractures could be found about twice as often US than x-ray. There was no difference in the diagnosis of sternal fracture. Detection of fluids (local haematoma and pleural effusion) is better via US than by x-ray. Therapeutical consequences may follow a quick bed-side diagnosis by US in a patient who needs intensive care. Other aspects after detection of a rib fracture US apart from thoracic contusion are psychological effects for the patients (usually they can cope better with their pain), the importance in the interpretation of the duration of incapacity to work and the additional information provided by expert opinions.