OBJECTIVES: The artificial intelligence-aided diagnosis model of rib fractures based on YOLOv3 algorithm was established and applied to practical case to explore the application advantages in rib fracture cases in forensic medicine. METHODS: DICOM format CT images of 884 cases with rib fractures caused by thoracic trauma were collected, and 801 of them were used as training and validation sets. A rib fracture diagnosis model based on YOLOv3 algorithm and Darknet53 as the backbone network was built. After the model was established, 83 cases were taken as the test set, and the precision rate, recall rate, F1-score and radiology interpretation time were calculated. The model was used to diagnose a practical case and compared with manual diagnosis. RESULTS: The established model was used to test 83 cases, the fracture precision rate of this model was 90.5%, the recall rate was 75.4%, F1-score was 0.82, the radiology interpretation time was 4.4 images per second and the identification time of each patient's data was 21 s, much faster than manual diagnosis. The recognition results of the model was consistent with that of the manual diagnosis. CONCLUSIONS The rib fracture diagnosis model in practical case based on YOLOv3 algorithm can quickly and accurately identify fractures, and the model is easy to operate. It can be used as an auxiliary diagnostic technique in forensic clinical identification.
Humans ; Rib Fractures/diagnostic imaging* ; Artificial Intelligence ; Thoracic Injuries ; Algorithms ; Radiography ; Retrospective Studies

OBJECTIVE: To explore the applications of imaging examination on rib fracture sites in forensic identification. METHODS: Features including the sites, numbers of the processed imaging examination and the first radiological technology at diagnosis in 56 cases of rib fractures from 163 injuries were retrospectively analyzed. RESULTS: The detection rate of the rib fractures within 14 days was 65.6%. The initial detection rate of anterior rib fracture proceeded by X-ray was 76.2%, then 90.5% detected at a second time X-ray, while the detection rate of CT was 66.7% and 80.0%, respectively. The initial detec- tion rate of rib fracture in axillary section proceeded by X-ray was 27.6%, then 58.6% detected at a second time X-ray, while the detection rate of CT was 54.3% and 80.4%, respectively. The initial detection rate of posterior rib fracture proceeded by X-ray was 63.6%, then 81.8% detected at a second time X-ray, while the detection rate of CT was 50.0% and 70.0%, respectively. CONCLUSION It is important to pay attention to the use of combined imaging examinations and the follow-up results. In the cases of suspicious for rib fracture in axillary section, CT examination is suggested in such false X-ray negative cases.
Aged ; Diagnostic Imaging ; Forensic Medicine ; Fractures, Bone/diagnostic imaging* ; Humans ; Image Processing, Computer-Assisted/methods* ; Retrospective Studies ; Rib Fractures/diagnostic imaging* ; Time Factors ; Tomography, X-Ray Computed

Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.
Accidental Falls ; Female ; Hemothorax/*complications/surgery ; Humans ; Rib Fractures/complications/*diagnosis ; Thoracic Arteries/diagnostic imaging ; Time Factors ; Young Adult

PURPOSE: Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma. METHODS: This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient. RESULTS: Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures. CONCLUSION There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.
Abdominal Injuries/diagnostic imaging* ; Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rib Fractures/epidemiology* ; Thoracic Injuries/epidemiology* ; Wounds, Nonpenetrating/diagnostic imaging*

OBJECTIVE: To assess the value of dual-energy subtraction radiography (DESR) in the detection of rib bone lesions. METHODS: The images of DESR and digital radiography (DR) in 66 patients with 118 rib bone lesions were reviewed. The detectability of DESR and DR in the rib bone lesions was analyzed by receiver operating characteristic (ROC) method, and their detection rates were compared in different thoracic regions such as those overlaid with the diaphragm and the mediastinum, located in the region of midaxillary line,and the rest. RESULTS: In the detection of rib bone lesions, the area under ROC curve in the DESR group (Az=0.946) was significantly larger than that in the DR group (Az=0.755). In different regions of the rib lesions, the detection rates of DESR were significantly larger than those of DR (P<0.05). CONCLUSION DESR can improve the detection of rib bone lesions, and is a useful supplement to DR.
Adolescent ; Adult ; Aged ; Bone Neoplasms ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Radiography, Dual-Energy Scanned Projection ; methods ; Retrospective Studies ; Rib Fractures ; diagnostic imaging ; Ribs ; diagnostic imaging ; Young Adult

OBJECTIVE: To explore an approach of CT rendering and mechanical analysis for rib fracture that was inextricable on X-ray film in legal medical practice. METHODS: 17 cases with rib fracture undetermined on X-ray chest film in legal medical practice underwent CT scans. The thin slices (0.75 mm or lmm) of images were reconstructed with smooth and sharp kernel. The multiplanar reformatted images along rib and surface shaded display were obtained to investigate rib fracture. RESULTS: All rib fractures were accurately displayed by CT scan and MPR images along rib. The torque that caused rib fracture was divided presumably into vertical and rotary types. The two kinds of rib fracture, composed of vertical and rotary type, were proposed. CONCLUSION CT scan with thin slice and MPR images can definitely reveal the rib fracture unresolved on X-ray film in legal medical practice. The proposition of two kinds of torque will be help avoid misunderstanding acute rotary type of rib fracture as old healed one.
Adult ; Aged ; Biomechanical Phenomena ; Bony Callus/diagnostic imaging* ; Diagnosis, Differential ; Female ; Humans ; Image Processing, Computer-Assisted/methods* ; Male ; Middle Aged ; Rib Fractures/diagnostic imaging* ; Ribs/diagnostic imaging* ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods* ; X-Ray Film

OBJECTIVE: To assess the clinical application of spiral CT 3D reconstruction in forensic diagnosis of rib fracture. METHODS: Thirty-five cases of rib fractures were collectively studied by X-ray, regular CT scan, and adoptive 3D reconstruction with spiral CT. RESULTS: Clear and stereoscopic images of rib fractures without interference of the surrounding soft tissue were obtained in all of 35 cases examined. CONCLUSION Spiral CT 3D reconstruction could be a valuable means in forensic diagnosis of rib fracture.
Adolescent ; Adult ; Aged ; Female ; Forensic Pathology/methods* ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Rib Fractures/diagnostic imaging* ; Ribs/pathology* ; Thoracic Injuries/diagnostic imaging* ; Tomography, Spiral Computed/methods* ; Young Adult

OBJECTIVE: To investigate forensic diagnosis application of three-dimentional reconstruction with spiral computed tomography in fracture of anatomical complicated bones. METHODS: Selected eleven patients of bone fracture who were examined with SCT 3D and conventional X-ray examination. The location, number and characteristics were observed and analyzed. RESULTS: In all of eleven patients with bone fractures, X-ray examination could detect thirty-four rib fracture, one scapula fracture, two nasal fracture, one metacarpal bone incomplete fracture and one left tibia-fibula fracture, one pubis fracture. While there were forty-seven rib fracture, one scapula smash fracture, one nasal fracture with obvious displacement and eliminate one misplace, one left tibia-fibula obsolete fracture and one sacroiliac joint dislocation, one No 5 lumbar vertebrae pedicle of vertebrae arch fracture. Combining 3D reconstruction images, coronary and sagittal reconstruction images could show clearly the fracture line, location of fracture, number of fracture, displacement and recovery. CONCLUSION 3D reconstruction technique of SCT is a very useful examination method in the objective forensic diagnosis of anatomical complicated bones fracture, it excels the routine X-ray examination.
Adult ; Aged ; Female ; Forensic Medicine ; Fractures, Bone/pathology* ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Nasal Bone/injuries* ; Rib Fractures/diagnostic imaging* ; Scapula/injuries* ; Tomography, Spiral Computed/methods* ; Young Adult

OBJECTIVETo compare screw's inserting angle through the 11th and 12th rib in treating L1 burst fracture, explore effects on inserting screw and postoperative angle.

METHODSFrom October 2007 to October 2010, 108 patients with L1 brust fracture treated through anterior approach were analyzed,including 68 males and 40 females, aged from 21 to 64 years (mean 38.22 years). All patients were divided into the 11th (A, 51 cases) and 12th (B, 57 cases) approach. The data of operation time,blood loss, duration of incision pain, JOA score, Oswestry score, VAS score, quality of life (SF-36), recovery of nervous function, coronal Cobb angle, included angle between screw and plate were observed.

RESULTSAll patients were followed up for 9 to 37 months, mean 23 months. The operation time, blood loss, duration of incision pain, in group A were lower than group B (P<0.05), JOA score, Oswestry score, VAS score, SF-36, recovery of nervous function had no significant differences (P>0.05). There were no differences in Cobb angle before operation, but had significance after operation (P=0.000). There were statistically significance between two group in angle between screw and plate (P=0.000, P=0.003).

CONCLUSIONThe 11th rib approach for the treatment of L1 burst fracture has less effects on screw, less trauma and less angle between screw and plate.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Recovery of Function ; Rib Fractures ; diagnostic imaging ; physiopathology ; surgery ; Ribs ; surgery ; Spinal Cord ; physiopathology ; Tomography, X-Ray Computed ; Young Adult