Diagnosis: Upper rib fractures Fractures of the upper ribs have previously been thought to be an indication for aortography to rule out aortic dissection. However, the current thinking it that upper rib fracture is not neccesarily an indicator of aortic dissection. Other findings such as mediastinal widening and obliteration of the normal aortic contour are considered to be more sensitive indicators of aortic transection or dissection on chest Xray. In prior years before the use of shoulder harnesses, upper rib fractures in MVAs were due to striking the steering column. Now, many upper rib fractures are due to striking the shoulder harness instead. Perhaps this less forceful mechanism is responsible for the lower incidence of aortic rupture seen today in association with upper rib fracture.
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