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Editor,—The article by Reid et al1 contains an interesting case report of aortic rupture resulting from low velocity crush injury, followed by a literature review of the possible mechanisms of aortic disruption. Unfortunately, however, their literature review is incomplete. It fails to mention the “osseous pinch” theory of traumatic aortic rupture.2, 3 The “osseous pinch” mechanism proposes that as a result of massive forces, the thoracic aorta ruptures as the first rib and clavicle “swing down” to “pinch” the aorta.2, 3 The theory neatly provides an explanation as to why thoracic aortic disruption nearly always occurs at the same point (the junction of the arch with the descending part) as this is the point that has been shown radiologically to feel the “pinch”. The “osseous pinch” provides an attractive explanation for the mechanism of aortic rupture in the case described by Reid et al1 as this explanation would account for the rupture in the absence of massive deceleration forces.1
Reid et al1 also suggest that their case report justifies low velocity crush injury causing aortic injury being added to the ATLS manual. However, the ATLS manual does not claim to be an exhaustive tome, but a practical guide to cover common situations.4 The fact that this isolated case was published as a report underlines that it is unusual; certainly, previously large studies demonstrate that thoracic aortic rupture most commonly follows high velocity impacts.5
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