PMC6479153_01
A: A chest computed tomography (CT) scan showed a mild 4th rib fracture. B: A subsequent CT scan showed a significant dislocation of fractured ribs and hemopneumothorax. C: A 3D reconstruction of the bony thorax showed a rib fracture from the 3rd-7th ribs (4th rib was fractured at two locations).
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A computed tomography (CT) scan showed fractures in the 4th-6th ribs, but no intrathoracic complications, such as a hemopneumothorax and lung contusion (Fig. 1A). A subsequent CT scan showed that the ribs fractures progressed significantly, and the stump was in contact with the heart (Fig. 1B and C).
A: The rib stump of the dislocated 4th rib was exposed in the thoracic cavity and was in direct contact with the heart (red circle). B: There was a pericardial injury just below the broken rib stump (arrow heads). C: A chest radiograph showed that the 4th-7th ribs were fixed by titanium plates.
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Video-assisted thoracic surgery (VATS) showed that the 4th rib stump was exposed in the thoracic cavity and was in contact with the heart (Fig. 2A). When repairing the fractured rib, hemorrhage due to a pericardial laceration appeared below the stump (Fig. 2B). After hemostasis, it was confirmed that there was no pulmonary fistula, and the 4th-7th ribs were internally fixed using screwless titanium metal plates (KANI, USCI Japan, Tokyo) (Fig. 2C).