ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center
Mehmet Oğuzhan Özyurtkan1, Zeliha Arslan Ulukan2, Uğur Temel3
1Department of Thoracic Surgery, Biruni University Medical Faculty, Istanbul, Türkiye
2Department of Pulmonology, Biruni University Medical Faculty, Istanbul, Türkiye
3Department of Thoracic Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2024.25655
Background: This study aims to evaluate clinical and radiological characteristics of the patients with cough-induced rib fractures.

Methods: Between January 2008 and December 2022, a total of 90 patients (35 males, 55 females; mean age: 58±20 years; range, 20 to 92 years) who had cough-induced rib fractures were retrospectively analyzed. Patients' characteristics, findings of physical and radiological examination, and patients" outcomes were recorded.

Results: Of the patients, 64% were postmenopausal, 37% had metabolic disease of the bone, and 21% had chronic cough. Cough etiology was acute upper respiratory tract infection (32%), followed by chronic obstructive pulmonary disease. Thoracic computed tomography documented 154 fractures. Cough-induced rib fractures were mostly on the right side (58%). Multiple fractures were more commonly seen in older patients (p=0.007), in the presence of novel coronavirus disease-2019 (COVID-19) pneumonia (p=0.03), and metabolic disease of the bone (p=0.01). Mostly the sixth rib was affected (23%). Most fractures (81.3%) affected the fourth to ninth ribs. Most fractures developed on the anterolateral aspect of the rib (51%). The mean duration of hospital stay was 5.0±1.6 days. Morbidity developed in one patient (1.1%) (hemothorax). Mortality occurred in two patients (2.2%) due to COVID-19 pneumonia and acute myocardial infarction.

Conclusion: Localized pain after cough should be investigated in terms of cough-induced rib fractures. Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. Postmenopausal women are more risky to develop cough-induced rib fractures. Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia.

Keywords : Chest pain, cough, outcomes, rib fracture
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