Injuries  resulting from trauma remains a major global public health concern.[1,2] According to the World Health Organization, physical trauma is the leading cause of death among individuals under 45 years of age and contributes to nearly 10% of global mortality.[3] Musculoskeletal injuries constitute a substantial proportion of trauma-related morbidity and are frequently associated with long-term adverse effects on daily functioning, return to work, and health-related quality of life, thereby contributing significantly to the global burden of non-fatal injuries.[4,5]

 

Thoracic injuries account for approximately 10–15% of all trauma-related hospital admissions and represent the third most common category of injuries  among trauma patients.[6,7] The spectrum of thoracic trauma includes chest wall fractures, pulmonary injuries, and cardiovascular involvement. Thoracic injuries are broadly classified as blunt or penetrating injuries based on the mechanism of injury. Blunt chest trauma constitutes nearly 90% of thoracic injuries, most commonly resulting from motor vehicle collisions, whereas penetrating injuries account for the remaining 10%.[7] Rib fractures are the most frequent injuries  following blunt chest trauma and are identified in nearly 10% of polytrauma patients.[6,8-10] These fractures range from isolated, minimally displaced injuries to severe forms such as flail chest, which occurs when three or more consecutive ribs are fractured at two or more sites, resulting in paradoxical chest wall movement during respiration.[8]

 

Rib fractures are clinically significant due to their association with substantial pulmonary morbidity and mortality.[11,12] Even isolated rib fractures can lead to dyspnoea, persistent pain, and long-term functional impairment.[13,-15] Pain-related splinting of the chest wall compromises effective ventilation and coughing, predisposing patients to complications such as pneumothorax, pulmonary contusion, atelectasis, pneumonia, and respiratory failure requiring mechanical ventilation.[16,17] Physical examination and radiography remain the primary diagnostic tools for rib fractures; however, up to 51% of fractures may be missed using these methods alone, particularly those involving costal cartilage fractures.

               

 

AIMS AND OBJECTIVES

The aim of this study is to compare the diagnostic sensitivity of ultrasonography and radiography in the detection of rib fractures following blunt chest trauma. Specifically, the study seeks to evaluate the limitations of chest radiography, particularly in identifying fractures involving the costal cartilage, and to assess the effectiveness of ultrasonography in detecting rib fractures that may be overlooked on conventional chest X-ray in cases of minor blunt trauma. The study also aims to define the overall role of ultrasonography as a diagnostic tool in the evaluation of rib fractures.

Study Design This study was designed as a prospective observational study conducted over a period of two years, from June 2020 to June 2022. The research was carried out at a tertiary care centre, Meenakshi Medical College and Research Institute, Kanchipuram. The study population comprised of 50 patients presenting with a history of chest trauma who were evaluated for suspected rib fractures during the study period. Inclusion and Exclusion Criteria Patients with a history of blunt chest trauma presenting with aggravated chest pain on change in position, coughing, or deep inspiration, along with focal tenderness over the ribs, were included in the study. Patients were excluded if they had penetrating chest trauma, were haemodynamically unstable, were pregnant, or did not provide informed consent to participate in the study. Data Collection Procedure Patients with acute blunt chest trauma and clinically suspected rib fractures were included based on localized rib tenderness and chest pain aggravated by coughing or deep inspiration. Demographic details, clinical features, and injury-related information were collected using a structured questionnaire. All patients underwent ultrasonography using a 7.5 MHz linear transducer, performed by an emergency medicine resident, with the probe aligned along the long axis of the most painful rib; fractures were identified by cortical disruption, acoustic shadowing, or an associated hematoma. Subsequently, posteroanterior chest radiographs with oblique rib views were obtained and interpreted by a blinded senior resident. The duration of both imaging procedures was recorded. In the absence of a definitive gold standard, rib fractures detected by either modality were considered confirmatory evidence. Variables analyzed included age, gender, BMI, clinical presentation, mechanism of injury, complications, and the number of patients and ribs diagnosed as fractured by ultrasonography and radiography. Statistical Analysis The collected data were entered into Microsoft Excel and analyzed using SPSS version 22. Descriptive statistics were expressed as proportions or as means with standard deviation. Sensitivity analysis was performed using appropriate diagnostic test formulas. The paired t-test was applied to compare the time taken for ultrasonography and radiographic investigations. A p-value of less than 0.05 was considered statistically significant.