The Canadian Rib Fracture Nonunion Society
Matthew 5:5 Blessed are the meek: for they shall inherit the earth.


WHO International Classifications of Diseases ICD-10 Version:2010
ICD code M99 Biomechanical lesions, not elsewhere classified, subcategory 8 Rib cage.


Journal of Trauma-Injury Infection & Critical Care. 37(6):975-979, December 1994.
Ziegler, Daniel W. MD; Agarwal, Nikhileshwer N. MD
The incidence of rib fractures secondary to trauma has not been clearly reported. Of the 7147 patients seen by our trauma service from January 1987 to June 1992, 711 (10%) had rib fractures. Among the patients with rib fractures, 84 (12%) died, 670 (94%) had associated injuries, 274 (32%) had a hemothorax or pneumothorax, and 187 (26%) had a lung contusion. Fifty-five percent of the patients required an immediate operation or admission to the intensive care unit. Thirty-five percent of the patients required discharge to an extended care facility and 35% developed a pulmonary complication. We conclude that rib fractures are a marker of severe injury in which (1) 12% will die because of their injuries, (2) more than 90% will have associated injuries, (3) one half will require operative and ICU care, (4) one third will develop pulmonary complications, and (5) one third will require discharge to an extended care facility.

R2 Rib Fractures in the Elderly.
Annual Meeting Articles
Journal of Trauma-Injury Infection & Critical Care. 48(6):1040-1047, June 2000.
Bulger, Eileen M. MD; Arneson, Matthew A. MD; Mock, Charles N. MD, PhD; Jurkovich, Gregory J. MD
Background: We sought to ascertain the extent to which advanced age influences the morbidity and mortality after rib fractures (fxs), to define the relationship between number of rib fractures and morbidity and mortality, and to evaluate the influence of analgesic technique on outcome.
Methods: A retrospective cohort study involving all 277 patients >= 65 years old with rib fxs admitted to a Level I trauma center over 10 years was undertaken. The control group consisted of 187 randomly selected patients, 18 to 64 years old, with rib fxs admitted over the same time period. Outcomes included pulmonary complications, number of ventilator days, length of intensive care unit and hospital stay (LOS), disposition, and mortality. The specific analgesic technique used was also examined.
Results: The two groups had similar mean number of rib fxs (3.6 elderly vs. 4.0 young), mean chest Abbreviated Injury Scores (3.0 vs. 3.0), and mean Injury Severity Score (20.7 vs. 21.4). However, mean number of ventilator days (4.3 vs. 3.1), intensive care unit days (6.1 vs. 4.0), and LOS (15.4 vs. 10.7 days) were longer for the elderly patients. Pneumonia occurred in 31% of elderly versus 17% of young (p < 0.01) and mortality was 22% for the elderly versus 10% for the young (p < 0.01). Mortality and pneumonia rates increased as the number of rib fxs increased with and odds ratio for death of 1.19 and for pneumonia of 1.16 per each additional rib fracture (p < 0.001). The use of epidural analgesia in the elderly (LOS >2 days) was associated with a 10% mortality versus 16% without the use of an epidural (p = 0.28). In the younger group (LOS >2 days), mortality with and without the use of an epidural was 0% and 5%, respectively.
Conclusion: Elderly patients who sustain blunt chest trauma with rib fxs have twice the mortality and thoracic morbidity of younger patients with similar injuries. For each additional rib fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27%. As the number of rib fractures increases, there is a significant increase in morbidity and mortality in both groups, but with different patterns for each group. Further prospective study is needed to determine the utility of epidural analgesia in this population.

R3 Rib Fracture Pain and Disability: Can We Do Better?
Journal of Trauma-Injury Infection & Critical Care. 54(6):1058-1064, June 2003.
Kerr-Valentic, Mahlon A. BS; Arthur, Melanie PhD; Mullins, Richard J. MD; Pearson, Tuesday E.; Mayberry, John C. MD
Objective : The purpose of this study was to determine the magnitude and duration of pain and disability in patients with rib fractures treated using current standard therapy. This was a prospective case series.
Methods : Injured patients with a chest radiographic diagnosis of one or more rib fractures between June 1, 2001, and October 31, 2001, were asked to participate. Pain levels were assessed at days 1, 5, 30, and 120 after injury using a visual pain scale (0-10). Disability at 30 days was assessed using the SF-36 Health Status Survey, and the total number of days lost from work/usual activity was recorded at day 120. The setting was a university-based Level I trauma center.
Results : Forty patients with a mean of 2.7 +/- 1.6 rib fractures were enrolled. Twenty-three patients had isolated rib fractures and 17 patients had associated extrathoracic injuries. Mean rib fracture pain was 3.5 +/- 2.1 at 30 days and 1.0 +/- 1.4 at 120 days. For patients with associated extrathoracic injuries, rib pain was equivalent to pain in the rest of the body at all intervals. When compared with the chronically ill reference population of the RAND Medical Outcomes Study, our patients as a group were more disabled at 30 days (p < 0.001) in all categories except emotional stability, where they showed equivalent disability, and in their perception of general health, where they were significantly less disabled (p < 0.001). The total mean days lost from work/usual activity was 70 +/- 41. Patients with isolated rib fractures went back to work/usual activity at a mean of 51 +/- 39 days compared with 91 +/- 33 days in patients with associated extrathoracic injuries (p < 0.01).
Conclusion : Rib fractures are a significant cause of pain and disability in patients with isolated thoracic injury and in patients with associated extrathoracic injuries. Developing new therapies to accelerate pain relief and healing would substantially improve the outcome of patients with rib fractures. 
   Eurythmics - I've Got A Life - deleted
    MRI Evaluation of Costal Cartilage Injuries - obsolete
   Emergency bedside ultrasound for the diagnosis of rib fractures. - obsolete
   Costal Cartilage Fractures as Revealed on CT and Sonography - obsolete

The Canadian Rib Fracture Nonunion Society
Articles of Incorporation
Letters Patent
The society is concerned equally with veterinary medicine as with human medicine and accepts the use of animal models in place of human experimentation.
The society is committed to the highest level of medical ethics either in animal research or human research.
Rib fracture nonunion has been known since antiquity. Rib fracture is serious because of the risk of rib fracture nonunion and of other related kinds of tissue damage to the thorax wall or to internal  organs. Rib fracture or rib fracture nonunion increases the risk of morbibity and of mortality {R1, R2, R3}. 
Rib fracture or rib fracture nonunion increases the risk of pain, disability, other ailments and death.
Members of the society are students, volunteers, activists and employees of the society who are committed to advancing the aims of the society

The purpose of the society is to reduce, minimize and reverse the aggregate morbidity and mortality in animals and humans due to rib fractures.


The objective of the Society will be to advanced by
1) Health care advocacy.

2) Education of public, physicians, surgeons, medical students and veterinarians. Education and advocacy is to be achieved through a website www.CRFNS.org and other means of Internet communications and publishing.

3) A research program in new methods of medical imaging involving 1. 3D image analyses of CT scan data (computerized axial x-ray tomography) of the thorax. 2. MRI (magnetic resonance imaging) of the thorax and 3. 3D image analyses of MRI scan data of the thorax. These medical imaging advancements will be offered to serve as guidance for surgeons in adoption and development of new surgical methods.


Copyright 2011, 2012 The Canadian Rib Fracture Nonunion Society
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Canadian Rib Fracture Nonunion Society
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