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We commend the authors for their multi-institutional review evaluating missed costosternal and costal cartilage fractures in blunt thoracic trauma. This retrospective cohort study of patients admitted to level I and II trauma centers with rib fractures highlights important associations between increased Injury Severity Score, flail segments, sternal fractures, and costal cartilage fractures.1 While these findings are not unexpected, it is striking that costal cartilage fractures were overlooked on initial imaging in 87% of cases.1 The critical question remains: does timely diagnosis of these injuries alter clinical management or outcomes?