Obscure fracture at right 11th rib with displacement and rotation

Case contributed by Muhammad Shoyab

Presentation

History of fall 7 days prior. Patient consults orthopedics due to persistent pain.

Patient Data

Age: 60 years
Gender: Male

Lucent defect across posterior shaft of right 11th rib near lateral angle, accompanied by mild lateral displacement and outward rotation.

No reduction of bony opacity in any of imaged bones.

Lung fields streaky, likely representing senile changes.

Zoomed and annotated

Annotated image

The fractured fragment is displaced several mm laterally (green arrowheads), so that its tip projects beyond the lateral margin of the bony thorax (pink line). There is also outward rotation of the fragment, so that its tip is directed inferolaterally (yellow arrow), whereas the rest of the ribs' tips are directed inferomedially (white arrows).

Case Discussion

Rib fractures are a common association of traumatic incidents, but may often be missed on plain x-ray. Meticulous search in this case was prompted by the history of persistent pain, which made the patient consult orthopedics.

The fracture in this case may be difficult to notice at first sight, owing to camouflage by the hepatic shadow, and also perhaps due to poor inspiration.

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