Ribs posterior

Most comphcations, such as infection, fracture of ribs, posterior vertebral elements or pedicles, allergic reaction, as well as bleeding from the puncture site, have... 

UPPER EXHALATION/POSTERIOR RIB (POSTERIOR SECOND RIB ON RIGHT)—SEATED... 

FIG. 74-lA Upper exhalation/posterior Rib (posterior second rib on right), seated. 

POSTERIOR/EXHALATION RIB (POSTERIOR THIRD RIB ON THE RIGHT)-PATIENT SEATED... 

FIG. 74-4 Posterior/exhalation rib (posterior third rib on the right), patient seated (physician anterior to patient). 

The humerus is the long bone of the upper arm and at its proximal end is a neck with a smooth, round head that is covered with cartilage and forms one articulating surface of the true shoulder joint. The scapula is a flat, triangular bone overlying the ribs posteriorly. Easily palpable are its borders, spine posteriorly, coracoid process anteriorly, and the acromion process supero-laterally. 

FIGURE 12.2 Structure of Dinophysis cell, (a) Right side view aca, acp anterior and posterior cingular lists E depth of the epitheca H depth of the hypotheca L length Em central axis asd, asi right and left sulcal lists i i, i 2> 3 the three ribs (b) ventral view. Shaded area corresponds to sulcus, (c) apical view Ei-E epithecal plates A apical plates Zm megacytic zone. (Modified from Balech 2002 [64].)... 

Each subclavian vein is a continuation of the axillary vein and runs from the outer rim of the first rib to the medial rim of the anterior scalene muscle. Here the subclavian and internal jugular veins join inside the anterior edge of the superior thoracic opening and create right and left innominate veins behind the sternal manubrium. The vein usually has a pair of valves about 2 cm from its end. The heads of clavicles extend posteriorly into the superior thoracic opening, displacing the veins posteriorly from the sternum. Because of the anteroposterior slope of the superior aperture, the arteries are... 

For the posterior decompression and reduction procedure, the patient is positioned on blanket rolls, and not on a laminectomy frame. The patient is positioned comfortably and the lateral ribs are supported dorsally by... 

Fig. 6.3. Blown up chest radiograph and corresponding bone scan showing posterior left rib fractures. Their detection is improved by the use of the bone scan...

Rib fractures comprise 5%-27% (Akbarnia et al. 1974 Barrett and Kozlowski 1979 Herndon 1983) of all fractures in abused children and are probably even more common than published figures suggest because of the difficulty in demonstrating them radiologically in the acute situation prior to the appearance of callus. Any part of the rib may be affected, and fractures are frequently bilateral and multiple, although 20% of rib fractures are solitary (Carty and Pierce 2002) (Fig. 11.6). Rib fractures in infancy are unusual because normal ribs are so pliable. Considerable force is required to produce them and even in children who undergo cardiopulmonary resuscitation, 99.5% do not develop rib fractures (Feldman and Brewer 1984 John et al. 2005). Posterior rib fractures do not occur as a result of cardiopulmonary resuscitation. Thomas (1977), in a review of over 10,000 chest X-rays of infants... 

Fig. 11.6. Postmortem radiograph demonstrates multiple posterior rib (arrows) and costochondral fractures (arrowheads) of differing ages. Fractures of similar ages are aligned one with another...

Many posterior rib fractures only become visible with the appearance of callus. In a post-mortem and radiological study, Kleinman et al. (1988) failed to identify any acute posterior rib fractures and more than 50% of healing posterior rib fractures by conventional radiography. Evidence of healing, as manifested by callus formation, was essential for reliable diagnosis of fractures near the costo-vertebral articulations. Thus failure to observe the fracture at presentation and the appearance of callus after admission to hospital is not necessarily evidence of injury after admission (Fig. 11.7). 

The anatomical structure of the rib cage facilitates these changes in the dimensions of the thoracic cavity. Each rib constitutes a semicircle joining the spine with the sternum. However, the half circle is not on a single horizontal plane. Two major slopes can be distinguished (1) a posterior slope that brings the ribs downward and outward (2) an anterior slope also oriented downward and outward. Thus, by raising the ribs hori-... 

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