Pediatric emergency medicine trisk 3717 3717

The elasticity and flexibility of a child’s thoracic cage make chest wall injuries
less common than internal thoracic injuries such as a pulmonary contusion. When
chest wall injuries do occur, the patient is at increased risk for intrathoracic
injuries. Included in chest wall injuries are rib, sternal, and scapular fractures, as
well as flail chest. Goals of treatment should include appropriate evaluation of the
extent of injury and presence of underlying intrathoracic injury. Interventions for
chest wall injuries are mostly supportive, consisting of pain control to prevent
splinting and encouragement of ambulation to prevent hypoventilation.
CLINICAL PEARLS AND PITFALLS
Chest wall injuries are less common in children than adults due to
increased elasticity and compliance of the chest wall, and therefore
their presence often indicates coincident intrathoracic injury.
Most isolated chest wall injuries can be managed as an outpatient with
adequate analgesia to prevent splinting and hypoventilation.
Posterior rib fractures, rib fractures in infants and toddlers, fractures of
different ages, and the absence of a clear mechanism of injury are all
highly concerning for child abuse and should prompt further evaluation.

FIGURE 115.9 Algorithm for the evaluation and diagnosis of traumatic rupture of the thoracic
aorta.