{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T08:04:41Z","timestamp":1770278681952,"version":"3.49.0"},"reference-count":6,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T00:00:00Z","timestamp":1662940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Blunt high-energy chest trauma is often associated with thoracic and abdominal organ injuries. Literature for a hyperextension-distraction mechanism resulting in a costal arch fracture combined with a thoracic spine fracture is sparse. A 65-year-old male suffered a fall from a height of six meters. Initial X-ray of the chest shows left-sided high-riding diaphragm and CT scan proves anterior cartilage fracture, posterolateral serial rib fractures, traumatic intercostal pulmonary hernia, avulsion of the diaphragm, and 7th thoracic vertebral fracture. An exploratory thoracotomy was performed and the rupture of the diaphragm, creating a two-cavity injury, had been re-fixed, the pulmonary hernia was closed, and locking plate osteosyntheses of the fractured ribs including the costal arch were performed. We generally recommend surgical therapy of the thorax to restore stability in this severe injury entity. The spine was fixed dorsally using a screw-rod system. In conclusion, this thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Since two-cavity traumata and particularly diaphragmatic injuries are often diagnosed delayed, injuries to the costal arch can act as an indicator of severe trauma. They should be detected through clinical examination and assessment of the trauma CT in the soft tissue window.<\/jats:p>","DOI":"10.3390\/diagnostics12092206","type":"journal-article","created":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T20:52:25Z","timestamp":1663015945000},"page":"2206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined Disruption of the Thoracic Spine and Costal Arch Fracture: An Indicator of a Severe Chest Trauma"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0945-8523","authenticated-orcid":false,"given":"Stefan","family":"Schulz-Drost","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049 Schwerin, Germany"},{"name":"Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany"},{"name":"Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Stra\u00dfe 7, 12683 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Kloesel","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049 Schwerin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Carsten","family":"K\u00fchling","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049 Schwerin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Ekkernkamp","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Stra\u00dfe 7, 12683 Berlin, Germany"},{"name":"Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Stra\u00dfe, 17471 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2448-2150","authenticated-orcid":false,"given":"Mustafa Sinan","family":"Bakir","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Stra\u00dfe 7, 12683 Berlin, Germany"},{"name":"Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Stra\u00dfe, 17471 Greifswald, Germany"},{"name":"Department of Paediatric Surgery, Medical University Greifswald, Ferdinand-Sauerbruch-Stra\u00dfe, 17471 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1749-7922-7-14","article-title":"Thoracic hyperextension injury with complete \u201cbony disruption\u201d of the thoracic cage: Case report of a potentially life-threatening injury","volume":"7","author":"Bailey","year":"2012","journal-title":"World J. Emerg. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1302\/0301-620X.39B3.487","article-title":"Flexion-compression injury of the sternum","volume":"39-B","author":"Fowler","year":"1957","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/00000658-190502000-00007","article-title":"VII. Contrecoup Fracture of the Sternum","volume":"41","year":"1905","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1177\/0003134820945273","article-title":"Transdiaphragmatic Intercostal Hernia After Trauma: A Case Report, Literature Review, and Discussion of a Challenging Clinical Scenario","volume":"88","author":"Sapp","year":"2020","journal-title":"Am. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1093\/ejcts\/ezz020","article-title":"Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries","volume":"56","author":"Gooseman","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1097\/00005373-199810000-00039","article-title":"Transdiaphragmatic intercostal hernia resulting from blunt trauma: Case report","volume":"45","author":"Hruska","year":"1998","journal-title":"J. Trauma."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/9\/2206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:29:49Z","timestamp":1760142589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/9\/2206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,12]]},"references-count":6,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["diagnostics12092206"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12092206","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,12]]}}}