Buckle Rib Fractures Are More Than a Pleural Surface Phenomenon A Case Report and Literature Review

Abstract

In 2004, Love and Symes introduced buckle rib fractures into the anthropological literature, defining them as “a fracture wherein the bone failed at the point of compressive stress before failure at the point of tensile stress.” In the 20+ years since this straightforward definition was introduced, several variations have been presented, including specifying that fractures only occur on the inner or pleural rib surface, leading to possible confusion about what constitutes a buckle rib fracture. We conducted a literature review to explore these differences. All peer-reviewed sources in English mentioning buckle rib fractures and/or citing Love and Symes’s article were investigated to determine whether they define buckle rib fractures and if they specify a loading mechanism and/or affected rib surface. In addition, a case study is presented that demonstrates multiple incomplete fractures on the right ribs, where the outer or cutaneous surface near the sternal end presented a sharp disruption in the normal alignment of the cortical bone surface, while the pleural surface remained intact. The totality of trauma present suggested that the cutaneous surface was in compression while the pleural surface was in tension. This case study thus demonstrates that buckle rib fractures are not only a pleural surface phenomenon. Therefore, practitioners should specify which anatomical surface is affected, notated as pleural or cutaneous buckle rib fracture, to more precisely describe fractures.