Evidence map›Paper›PMID 41561394›Full record

ArticleTrauma surgery & acute care open2026

Lost fractures: prevalence and risk factors for missed costosternal and costal cartilage fractures among patients with radiologic chest wall injury.

Joseph D Forrester, Mohamad Abou Chaar, Andrew T Barnes, Zachary M Bauman, Samy Bendjemil, Nizama N Betts, Benjamin Christie, Raaga Dasari, Devoe Wb, Michelle J Earley and 11 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Trauma surgery & acute care open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Joseph D ForresterStanford, Stanford, California, USA.ORCID https://orcid.org/0000-0002-8558-6180
Mohamad Abou ChaarDivision of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota, USA.ORCID https://orcid.org/0000-0002-9584-2184
Andrew T BarnesAtrium Health Navicent, Macon, Georgia, USA.
Zachary M BaumanAcute Care Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Samy BendjemilStanford, Stanford, California, USA.
Nizama N BettsLandstuhl Regional Medical Center, Landstuhl, Germany.
Benjamin ChristieMercer University School of Medicine, Macon, Georgia, USA.
Raaga DasariUniversity of Nebraska Medical Center, Omaha, Nebraska, USA.
Devoe WbRiverside Methodist Hospital, Columbus, Ohio, USA.
Michelle J EarleyDivision of General Surgery, Stanford University, Stanford, California, USA.
Bradley FaliksHonorHealth Scottsdale Osborn Medical Center, Scottsdale, Arizona, USA.
Tracy J JohnsAtrium Health Navicent, Macon, Georgia, USA.
Connie JohnsonLandstuhl Regional Medical Center, Landstuhl, Germany.
Michelle S JunkerMayo Clinic, Rochester, Minnesota, USA.
Brian D KimMayo Clinic, Rochester, Minnesota, USA.
Jonathan M KingStanford, Stanford, California, USA.ORCID https://orcid.org/0009-0006-7144-3214
Ariel Whitney KnightDepartment of Surgery, Stanford University, Stanford, California, USA.ORCID https://orcid.org/0000-0001-8046-9324
Alexis A SchweibinzRiverside Methodist Hospital, Columbus, Ohio, USA.
Daniel StephensMayo Clinic, Rochester, Minnesota, USA.
Mary StueverLandstuhl Regional Medical Center, Landstuhl, Germany.
Simeng WangDepartment of Surgery, Stanford University, Stanford, California, USA.ORCID https://orcid.org/0000-0002-2897-7652

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Costosternal cartilages and the costal margin, collectively termed costal cartilage, are hyaline cartilage connecting ribs to the sternum and to adjacent ribs, respectively. Presence of intact costal cartilage is essential for elasticity of the chest wall. Anecdotally, costal cartilage injuries are underdiagnosed on trauma CT scan in patients with rib fractures. Our aim was to determine a baseline frequency of acute costal cartilage injury among patients presenting with rib fractures. Methods: We performed a retrospective cohort study of injured adult patients admitted to Level I/II trauma centers with rib fractures from January 2020 to July 2024. CT images obtained at admission were manually reviewed by chest wall surgeons for presence of costal cartilage injury. Concordance with the original radiology report was obtained. Multivariable regression was used to analyze factors associated with costal cartilage injury and missed cartilage fractures. Results: 1441 patients were identified; 197 (14%) had a costal cartilage fracture. A plurality of injuries included falls (n=667, 46%). Median ISS (Injury Severity Score) was 13 (IQR: 9 to 21), median Abbreviated Injury Scale thorax score was 3 (IQR: 3 to 3), and median number of fractured ribs was 3 (IQR: 3 to 7). 294 (21%) patients had radiographic flail segments, and 136 (9%) had sternal fractures. 172 (87%) patients had a costal cartilage fracture missed on initial trauma chest CT. On multivariable analysis, ISS (adjusted OR (aOR) 1.02 (95% CI 1.01 to 1.04), radiographic flail segment (aOR 1.6 (95% CI 1.10 to 2.31)) and presence of sternal fracture (aOR 1.85 (95% CI 1.19 to 2.89)) were associated with costal cartilage fractures. Only the total number of rib fractures was associated with a missed costal cartilage fracture on univariate analysis (OR 1.17 (95% CI 1.01 to 1.36)). Conclusions: Costal cartilage injuries are common and frequently are not identified during interpretation of the initial trauma CT. A higher index of suspicion is warranted for costal cartilage fractures among patients with greater injury burden, radiographic flail segment, and sternal fractures. Level of evidence: Level III.

Indexed as

injuryribSternum

Identifiers

PMID41561394
PMCPMC12815250

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.