Ribs and Thorax Fractures

Published on 16/04/2015 by admin

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Last modified 16/04/2015

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6 Ribs and Thorax Fractures

Anatomy of the Ribs and Thorax

image

Thoracic Skeleton

Ribs

• Mature rib: largely cancellous bone, light, easily fractured
• Cortical bone can fracture into sharp spicules, damaging pleura, lungs, and neurovasculature.
• Parts and landmarks: head, neck, tubercle, angle, shaft/body, notch, costal cartilage
• Ribs are overlaid and protected superiorly by pectoral girdle bones and muscles: pectoralis major and minor, subclavius, serratus anterior, scapula, rhomboids, and trapezius.
• Intercostal muscles span the intervals between successive ribs, from T1-T12: external, internal, and innermost layers.
• Intercostal neurovascular bundles lie between internal and innermost intercostal muscles.

image Superior (large) lie along the lower borders of ribs, within costal notches.
image Inferior (small, variable) lie just above the lower rib of each intercostal space.

• Proximal articulations are synovial.

image Costovertebral joints: articular facets of heads of ribs with hemifacets on bodies of successive vertebrae
image Costotransverse joints: between articular tubercles of ribs and transverse processes of related vertebrae

• First sternocostal (distal rib) joint: fibrous
• Sternocostal joints T2-T7: synovial
• Costochondral joints: costal cartilages of T8-T10 (false ribs) attach to T7 cartilage
• T11 and T12 floating ribs with no distal joints
• Free movement of most rib joints needed for unrestricted ventilation in normal thorax

Sternum

• Formed from sternebrae (multiple ossification centers) during development: gaps can persist
• Manubrium: articulations with clavicles, jugular (suprasternal) notch
• Body: lateral articular recesses for synovial, sternocostal joints
• Xiphoid process: may be bifid, notched, perforated
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