BACKGROUND: The accurate diagnosis of rib fractures is clinically important because these injuries are associated with complications. Despite its advantages, computed tomography is not infallible, and rib fractures may remain undetected on initial examinations. OBJECTIVE: This study aims to perform a CT-based comparative analysis of occult and overt rib fractures. METHODS: This longitudinal observational study included hospitalized patients presenting with blunt chest trauma. The patients were classified as having either overt rib fractures or occult rib fractures. Demographic and clinical data, including age, sex, and trauma severity, were retrospectively extracted from medical records. All CT examinations were performed using a standardized protocol and independently reviewed by two experienced radiologists. RESULTS: A total of 313 patients with a median age of 34.00 years, comprising of 62.3% males were included. Overall injury severity was high, with 82.7% of patients presenting with moderate to severe thoracic injury. Occult fractures were more frequently located in the posterior rib arc and demonstrated higher CT attenuation values. The prevalence of pleural thickening and pulmonary contusion was similar between groups, whereas associated thoracic skeletal injuries were more common in the overt group. Cortical irregularity (87.8%) and non-sharp angulation (70.5%) were frequent in occult fractures. CONCLUSION: Occult rib fractures may be missed on initial CT imaging despite trauma severity comparable to that of patients with overt rib fractures. Thus, the absence of a visible fracture line on initial CT should not be interpreted as evidence of minor injury, particularly in patients with moderate to severe thoracic trauma.
Maymand et al. (Mon,) studied this question.