{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T18:54:53Z","timestamp":1776365693545,"version":"3.51.2"},"reference-count":24,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Two major classification systems exist for rib fracture (RFX) displacement. One system uses a 50% displacement threshold: Grade I (&lt;50%), Grade II (\u226550% to &lt;100%), and Grade III (completely dislocated). Another proposes a 10% threshold: Undisplaced (&lt;10%), Offset (\u226510% to &lt;100%), and Displaced (completely dislocated). We analyzed risk factors for adverse outcomes for pulmonary complications and mortality according to both classification criteria. Materials and Methods: We retrospectively reviewed trauma registry and medical records from January 2019 to December 2023. All radiographic parameters were recorded based on initial computed tomography. Primary outcomes were pneumonia and other pulmonary complications requiring surgery. Least absolute shrinkage and selection operator (LASSO) regression was conducted to select risk factors and minimize overfitting. Multivariable logistic regression (MLR) was performed after LASSO. Results: Among the 621 patients, 61 (9.8%) had one or more adverse outcomes. In MLR, regardless of both classifications, the age (p &lt; 0.001), ISS (p &lt; 0.001), and number of completely displaced RFX (p = 0.001) were statistically significant. After excluding 280 patients with completely displaced RFX, we conducted a subgroup analysis with the remaining 341 patients. In this analysis, 22 (6.5%) patients experienced one or more adverse outcomes. Regardless of both classifications, the AIS head (p = 0.006), AIS extremities (p = 0.012), and number of segmental RFX (p &lt; 0.001) were statistically significant in MLR. The area under the receiver operating curve for both MLR models was 0.757 in the total patient group and 0.823 in the subgroup that excluded patients with completely displaced RFX. Conclusions: Completely displaced RFX is the most crucial factor, regardless of the classification criteria. Unless ribs are completely displaced, the degree of displacement may not be crucial, and the number of segmental RFX was a significant risk factor.<\/jats:p>","DOI":"10.3390\/medicina61010081","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T10:40:52Z","timestamp":1736160052000},"page":"81","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Non-Completely Displaced Traumatic Rib Fractures: Potentially Less Crucial for Pulmonary Adverse Outcomes, Regardless of Classification"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3149-5344","authenticated-orcid":false,"given":"Hongrye","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su Young","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7370-4197","authenticated-orcid":false,"given":"Jonghee","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9010-6495","authenticated-orcid":false,"given":"Junepill","family":"Seok","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"},{"name":"Department of Thoracic and Cardiovascular Surgery, Chungbuk National University, College of Medicine, Cheongju 28644, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0136-4458","authenticated-orcid":false,"given":"Wu Seong","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju 63127, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1148\/rg.286085510","article-title":"Multidetector CT of Blunt Thoracic Trauma","volume":"28","author":"Kaewlai","year":"2008","journal-title":"Radiographics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.20408\/jti.2023.0065","article-title":"Chest Wall Injury Fracture Patterns Are Associated with Different Mechanisms of Injury: A Retrospective Review Study in the United States","volume":"37","author":"Brewer","year":"2024","journal-title":"J. Trauma. Inj."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/s1010-7940(02)00813-8","article-title":"Chest Injury Due to Blunt Trauma","volume":"23","author":"Liman","year":"2003","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13049-017-0368-y","article-title":"The Number of Displaced Rib Fractures Is More Predictive for Complications in Chest Trauma Patients","volume":"25","author":"Chien","year":"2017","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Seok, J., Yoon, S.Y., Lee, J.Y., Kim, S., Cho, H., and Kang, W.S. (2023). Novel Nomogram for Predicting Pulmonary Complications in Patients with Blunt Chest Trauma with Rib Fractures: A Retrospective Cohort Study. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-36679-z"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/ageing\/afz157","article-title":"New Horizons in Rib Fracture Management in the Older Adult","volume":"49","author":"Coary","year":"2020","journal-title":"Age Ageing"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1007\/s00068-019-01183-5","article-title":"Predictors of Mortality in Patients with Rib Fractures","volume":"47","author":"Marini","year":"2021","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1097\/00005373-200006000-00007","article-title":"Rib Fractures in the Elderly","volume":"48","author":"Bulger","year":"2000","journal-title":"J. Trauma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.surg.2005.07.022","article-title":"Half-a-Dozen Ribs: The Breakpoint for Mortality","volume":"138","author":"Flagel","year":"2005","journal-title":"Surgery"},{"key":"ref_10","first-page":"1543","article-title":"Blunt Pulmonary Contusion: Admission Computed Tomography Scan Predicts Mechanical Ventilation","volume":"71","author":"Manolakaki","year":"2011","journal-title":"J. Trauma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jss.2019.06.009","article-title":"Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture","volume":"244","author":"Seok","year":"2019","journal-title":"J. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Seok, J., Jeong, S.T., Yoon, S.Y., Lee, J.Y., Kim, S., Cho, H., and Kang, W.S. (2023). Novel Nomogram for Predicting Paradoxical Chest Wall Movement in Patients with Flail Segment of Traumatic Rib Fracture: A Retrospective Cohort Study. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-47700-w"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1097\/TA.0000000000002282","article-title":"Taxonomy of Multiple Rib Fractures: Results of the Chest Wall Injury Society International Consensus Survey","volume":"88","author":"Edwards","year":"2020","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The Injury Severity Score: A Method for Describing Patients with Multiple Injuries and Evaluating Emergency Care","volume":"14","author":"Baker","year":"1974","journal-title":"J. Trauma"},{"key":"ref_15","unstructured":"Gennarelli, T.A., and Wodzin, E. (2008). Abbreviated Injury Scale 2005: Update 2008, Association for the Advancement of Automotive Medicine."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1097\/00005373-199905000-00011","article-title":"Pulmonary Contusions: Quantifying the Lesions on Chest X-Ray Films and the Factors Affecting Prognosis","volume":"46","author":"Tyburski","year":"1999","journal-title":"J. Trauma"},{"key":"ref_17","unstructured":"R Core Team (2022, October 01). R: A Language and Environment for Statistical Computing, Available online: https:\/\/www.R-project.org\/."},{"key":"ref_18","unstructured":"Gareth, J., Daniela, W., Trevor, H., and Robert, T. (2013). An Introduction to Statistical Learning: With Applications in R, Spinger."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/cjs.11313","article-title":"Post-Selection Inference for-Penalized Likelihood Models","volume":"46","author":"Taylor","year":"2018","journal-title":"Can. J. Stat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1097\/00005373-200009000-00018","article-title":"Appraisal of Early Evaluation of Blunt Chest Trauma: Development of a Standardized Scoring System for Initial Clinical Decision Making","volume":"49","author":"Pape","year":"2000","journal-title":"J. Trauma"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.surg.2014.06.045","article-title":"A Chest Trauma Scoring System to Predict Outcomes","volume":"156","author":"Chen","year":"2014","journal-title":"Surgery"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/TA.0000000000000867","article-title":"RibScore: A Novel Radiographic Score Based on Fracture Pattern That Predicts Pneumonia, Respiratory Failure, and Tracheostomy","volume":"80","author":"Chapman","year":"2016","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.forsciint.2016.04.035","article-title":"The Impact Velocity and Bone Fracture Pattern: Forensic Perspective","volume":"266","author":"Cohen","year":"2016","journal-title":"Forensic Sci. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1097\/TA.0000000000003384","article-title":"Are Rib Fractures Stable? An Analysis of Progressive Rib Fracture Offset in the Acute Trauma Setting","volume":"91","author":"Head","year":"2021","journal-title":"J. Trauma Acute Care Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/81\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:23:42Z","timestamp":1759919022000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/81"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["medicina61010081"],"URL":"https:\/\/doi.org\/10.3390\/medicina61010081","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]}}}