American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which rib fractures are typically associated with a risk of aortic transection?

1. 1st or 2nd rib fractures

2. 5th or 6th rib fractures

3. 3rd or 4th rib fractures

4. 7th or 8th rib fractures

The correct answer is: 1st or 2nd rib fractures

The first and second rib fractures are associated with a higher risk of aortic transection due to their anatomical location and proximity to major vascular structures. The aorta runs along the posterior thorax, and fractures of the upper ribs can indicate significant blunt force trauma, which can result in injury to the aorta or other vital structures in the thoracic cavity. Upper rib fractures occur in severe trauma scenarios, such as high-energy impacts or falls from heights, and the mechanisms that cause these fractures can also damage the aorta, particularly at the aortic isthmus, where the vessel is more vulnerable. The concern with these fractures is increased due to the stiff nature of the rib cage, which, when fractured, may transmit forces that can lead to serious vascular injuries. In contrast, fractures of the lower ribs are less commonly associated with these critical vascular injuries, as they are located further from the aorta and often indicate trauma of a less severe nature.