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Hisamune R, Kobayashi M, Nakasato K, Yamazaki T, Ushio N, Mochizuki K, Takasu A, Yamakawa K. A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures. World J Emerg Surg 2024; 19:11. [PMID: 38504282 PMCID: PMC10949653 DOI: 10.1186/s13017-024-00540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Operative treatment of traumatic rib fractures for better outcomes remains under debate. Surgical stabilization of rib fractures has dramatically increased in the last decade. This study aimed to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) to assess the effectiveness and safety of operative treatment compared to conservative treatment in adult patients with traumatic multiple rib fractures. METHODS A systematic literature review was performed according to the preferred reporting items for systematic reviews and meta-analyses guidelines. We searched MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials and used the Cochrane Risk-of-Bias 2 tool to evaluate methodological quality. Relative risks with 95% confidence interval (CI) were calculated for outcomes: all-cause mortality, pneumonia incidence, and number of mechanical ventilation days. Overall certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, with trial sequential analysis performed to establish implications for further research. RESULTS From 719 records, we included nine RCTs, which recruited 862 patients. Patients were assigned to the operative group (received surgical stabilization of chest wall injury, n = 423) or control group (n = 439). All-cause mortality was not significantly different (RR = 0.53; 95% CI 0.21 to 1.38, P = 0.35, I2 = 11%) between the two groups. However, in the operative group, duration of mechanical ventilation (mean difference -4.62; 95% CI -7.64 to -1.60, P < 0.00001, I2 = 94%) and length of intensive care unit stay (mean difference -3.05; 95% CI -5.87 to -0.22; P < 0.00001, I2 = 96%) were significantly shorter, and pneumonia incidence (RR = 0.57; 95% CI 0.35 to 0.92; P = 0.02, I2 = 57%) was significantly lower. Trial sequential analysis for mortality indicated insufficient sample size for a definitive judgment. GRADE showed this meta-analysis to have very low to low confidence. CONCLUSION Meta-analysis of large-scale trials showed that surgical stabilization of multiple rib fractures shortened the duration of mechanical ventilation and reduced the incidence of pneumonia but lacked clear evidence for improvement of mortality compared to conservative treatment. Trial sequential analysis suggested the need for more cases, and GRADE highlighted low certainty, emphasizing the necessity for further targeted RCTs, especially in mechanically ventilated patients. SYSTEMATIC REVIEW REGISTRATION UMIN Clinical Trials Registry UMIN000049365.
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Affiliation(s)
- Ryo Hisamune
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Mako Kobayashi
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Karin Nakasato
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Taiga Yamazaki
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Noritaka Ushio
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Katsunori Mochizuki
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
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Mohseni S, Forssten MP, Mohammad Ismail A, Cao Y, Hildebrand F, Sarani B, Ribeiro MAF. Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures. Trauma Surg Acute Care Open 2024; 9:e001206. [PMID: 38347893 PMCID: PMC10860062 DOI: 10.1136/tsaco-2023-001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures. Methods All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding. Results A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001]. Conclusion There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.
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Affiliation(s)
- Shahin Mohseni
- Orebro universitet Fakulteten for medicin och halsa, Orebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Babak Sarani
- George Washington University, Washington, District of Columbia, USA
| | - Marcelo AF Ribeiro
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
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Capelastegui A, Oca R, Iglesias G, Larena JA. MRI in suspected chest wall fractures: diagnostic value in work-related chest blunt trauma. Skeletal Radiol 2024; 53:275-283. [PMID: 37417996 DOI: 10.1007/s00256-023-04399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To describe and analyze MRI findings in suspected early fractures of the chest (ribs and sternum) and assess if this technique can add value in occupational medicine. MATERIALS AND METHODS In this retrospective study, we reviewed 112 consecutive patients with work-related mild closed chest trauma who underwent early thoracic MRI, when there was not a clear fracture on radiograph or when the symptoms were intense and not explained by radiographic findings. MRI was evaluated by two experienced radiologists independently. The number and location of fractures and extraosseous findings were recorded. A multivariate analysis was performed to correlate the fracture characteristics and time to RTW (return-to-work). Interobserver agreement and image quality were assessed. RESULTS 100 patients (82 men, mean age 46 years, range 22-64 years) were included. MRI revealed thoracic wall injuries in 88%: rib and/or sternal fractures in 86% and muscle contusion in the remaining patients. Most patients had multiple ribs fractured, mostly at the chondrocostal junction (n=38). The interobserver agreement was excellent, with minor discrepancies in the total number of ribs fractured. The mean time to return-to-work was 41 days, with statistically significant correlation with the number of fractures. Time to return-to-work increased in displaced fractures, sternal fractures, extraosseous complications, and with age. CONCLUSION Early MRI after work-related chest trauma identifies the source of pain in most patients, mainly radiographically occult rib fractures. In some cases, MRI may also provide prognostic information about return-to-work.
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Affiliation(s)
- Ana Capelastegui
- Department of Radiology, Mutualia, Bilbao, Spain.
- Department of Radiology, Osatek Galdakao-Usansolo, Galdakao, Spain.
| | - Roque Oca
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Osatek Deusto, Bilbao, Spain
| | - Gotzon Iglesias
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Cruces Hospital, Barakaldo, Spain
| | - Jose Alejandro Larena
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Osatek Galdakao-Usansolo, Galdakao, Spain
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Rehme-Röhrl J, Sicklinger K, Brand A, Fürmetz J, Neuerburg C, Stuby F, von Rüden C. Early Internal Fixation of Concomitant Clavicle Fractures in Severe Thoracic Trauma Prevents Posttraumatic Pneumonia. J Clin Med 2023; 12:4878. [PMID: 37568281 PMCID: PMC10420208 DOI: 10.3390/jcm12154878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Severe thoracic trauma can lead to pulmonary restriction, loss of lung volume, and difficulty with ventilation. In recent years, there has been increasing evidence of better clinical outcomes following surgical stabilization of clavicle fractures in the setting of this combination of injuries. The aim of this study was to evaluate surgical versus non-surgical treatment of clavicle fractures in severe thoracic trauma in terms of clinical and radiological outcomes in order to make a generalized treatment recommendation based on the results of a large patient cohort. PATIENTS AND METHODS This retrospective study included 181 patients (42 women, 139 men) from a European level I trauma centre with a median of 49.3 years in between 2005 and 2021. In 116 cases, the clavicle fracture was stabilized with locking plate or hook plate fixation (group 1), and in 65 cases, it was treated non-surgically (group 2). Long-term functional outcomes at least one year postoperatively using the disabilities of the arm, shoulder and hand (DASH) questionnaire and the Nottingham Clavicle Score (NCS) as well as radiological outcomes were collected in addition to parameters such as hospital days, intensive care days, and complication rates. RESULTS The Injury Severity Score (ISS) was 17.8 ± 9.8 in group 1 and 19.9 ± 14.4 in group 2 (mean ± SEM; p = 0.93), the time in hospital was 21.5 ± 27.2 days in group 1 versus 16 ± 29.3 days in group 2 (p = 0.04). Forty-seven patients in group 1 and eleven patients in the group 2 were treated in the ICU. Regarding the duration of ventilation (group 1: 9.1 ± 8.9 days, group 2: 8.1 ± 7.7 days; p = 0.64), the functional outcome (DASH group 1: 11 ± 18 points, group 2: 13.7 ± 18. 4 points, p = 0.51; NCS group 1: 17.9 ± 8.1 points, group 2: 19.4 ± 10.3 points, p = 0.79) and the radiological results, no significant differences were found between the treatment groups. With an overall similar complication rate, pneumonia was found in 2% of patients in group 1 and in 14% of patients in group 2 (p = 0.001). DISCUSSION This study could demonstrate that surgical locking plate fixation of clavicle fractures in combination with CWI significantly reducing the development of posttraumatic pneumonia in a large patient collection and, therefore, can be recommended as standard therapeutic approach for severe thoracic trauma.
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Affiliation(s)
- Julia Rehme-Röhrl
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
| | - Korbinian Sicklinger
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, Ludwig-Maximilians University Munich, 81377 Munich, Germany
| | - Andreas Brand
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
| | - Julian Fürmetz
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, Ludwig-Maximilians University Munich, 81377 Munich, Germany
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, Ludwig-Maximilians University Munich, 81377 Munich, Germany
| | - Fabian Stuby
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
| | - Christian von Rüden
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Weiden Medical Center, 92637 Weiden, Germany
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Rogers FB, Larson NJ, Rhone A, Amaya D, Olson-Bullis BA, Blondeau BX. Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians. J Intensive Care Med 2023; 38:327-339. [PMID: 36600614 DOI: 10.1177/08850666221148644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Rib fractures are present in 15% of all traumas and 60% of patients with chest traumas. Rib fractures are not life-threatening in isolation, but they can be quite painful which leads to splinting and compromise of respiratory function. Splinting limits the ability of a patient to take a deep breath, which leads to atelectasis, atelectasis to poor secretion removal, and poor secretion removal leads to pneumonia. Pneumonia is the common pathway to respiratory failure in patients with rib fractures. It is noted that in the elderly, each rib fracture increases developing pneumonia by 27% and the risk of dying by 19%. From a public health perspective, rib fractures have long-term implications with only 59% of patients returning to work at 6 months. In this review we will examine the state of art as it currently exists with regard to the management of pain associated with rib fractures. Included in this overview will be a brief review of the anatomy of the thorax and some important physiologic concepts, the latest trends in pharmacologic and noninvasive means of managing rib pain, a special section on epidural anesthesia, some other alternative invasive methods of pain control, and a review of the recent literature on rib plating. Finally, a practical, easy to follow guideline, to manage the patient with pain from rib fractures will be presented.
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Oppizzi G, Xu D, Patel T, Diaz JJ, Zhang LQ. Open reduction internal fixation of rib fractures: a biomechanical comparison between the RibLoc U Plus ® system and anterior plate in rib implants. Eur J Trauma Emerg Surg 2023; 49:383-391. [PMID: 36018371 PMCID: PMC10148598 DOI: 10.1007/s00068-022-02075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In this study, we assessed the bending strength of two surgical repairs of rib fracture using RibLoc® U Plus system made by Acute Innovations and the anterior plate by Synthes. METHODS After a rib fracture was created in seven pairs of cadaveric rib specimens, one side was repaired with the anterior plate and the other side repaired with the RibLoc U Plus® plate. Each of the rib is loaded using a custom device over 360,000 bending cycles to simulate in vivo fatiguing related to respiration. Upon completion of the cyclic loading, the specimens were compressively loaded to failure and the failure bending moment was determined. RESULTS The ribs repaired with the RibLoc U Plus® system showed 79% higher failure bending moment than that of the anterior plate, with a p value of 0.033. The ribs repaired with RibLoc U Plus® showed a trend of less stiffness reduction over the 360,000 loading cycles. CONCLUSION The biomechanical study showed that the RibLoc U Plus® system is stronger in the bending moment loading of repaired ribs, possibly due to the U-shape structure supporting both the inner and outer cortices of a repaired rib.
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Affiliation(s)
- Giovanni Oppizzi
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD, 20742, USA.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Dali Xu
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Tirth Patel
- Chicago College of Osteopathic Medicine, Midwestern University, 555 31st Street, Downers Grove, IL, 60515, USA
| | - Jose J Diaz
- Department of Surgery, School of Medicine, University of Maryland, 22 S Greene Street, Baltimore, MD, 21201, USA.,Department of Orthopedics, School of Medicine, University of Maryland, 110 S. Paca Street, Baltimore, MD, 21201, USA
| | - Li-Qun Zhang
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD, 20742, USA. .,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA. .,Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 W. Redwood Street, Baltimore, MD, 21201, USA. .,Department of Orthopedics, School of Medicine, University of Maryland, 110 S. Paca Street, Baltimore, MD, 21201, USA.
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Kwater A, Sen S, de Haan J, Ge M, Kim A, Hernandez N. Ultrasound-guided percutaneous cryoneurolysis for management of acute sternal fracture pain. Trauma Case Rep 2023; 43:100751. [PMID: 36636466 PMCID: PMC9829744 DOI: 10.1016/j.tcr.2022.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
Background Establishing adequate analgesia for rib and sternal fractures remains a challenge due to the prolonged nature of the associated pain. Historically, cryoneurolysis has demonstrated beneficial in treating chronic pain, and the recent development of hand-held devices has allowed its functionality to expand into the management of acute pain. Case We present a polytrauma patient with sternal and multiple rib fractures that underwent ultrasound-guided intercostal cryoneurolysis at bedside, resulting in significant analgesia lasting several weeks and improving mobilization. This is the first report of the utilization of cryoneurolysis to treat acute sternal fracture pain. Conclusion The most common sternal fracture pattern is transverse which only requires treatment of four intercostal nerves, making cryoneurolysis feasible in trauma centers. This portable, minimally invasive, and low risk technique has the added benefits of reducing opioid requirements, decreasing length of hospital stay, and improving mobility in polytrauma patients.
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Affiliation(s)
- A.P. Kwater
- University of Texas MD Anderson Cancer Center, Department of Anesthesiology & Perioperative Medicine, 1400 Holcombe Blvd., Unit 409, Houston, TX 77030, United States of America
| | - S. Sen
- McGovern School of Medicine at UTHealth, Department of Anesthesiology & Perioperative Medicine, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
| | - J.B. de Haan
- McGovern School of Medicine at UTHealth, Department of Anesthesiology & Perioperative Medicine, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
| | - M.A. Ge
- McGovern School of Medicine at UTHealth, Department of Anesthesiology & Perioperative Medicine, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
| | - A.M. Kim
- McGovern School of Medicine at UTHealth, 6431 Fannin Street, Houston, TX 77030, United States of America,Corresponding author.
| | - N. Hernandez
- McGovern School of Medicine at UTHealth, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
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Muacevic A, Adler JR. A Novel Approach to Sternal Fracture Repair With the Implementation of a Compression/Distraction Device. Cureus 2023; 15:e33218. [PMID: 36733582 PMCID: PMC9888318 DOI: 10.7759/cureus.33218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/05/2023] Open
Abstract
Sternal fractures are common following blunt traumatic injury. Most sternal fractures can be managed successfully nonoperatively; however, surgical fixation should be considered in certain scenarios. Specifically, surgery may be indicated in cases of severe pain, respiratory failure or dependency on mechanical ventilation, cosmetic deformity, malunion, disunion, and compression of the heart. A variety of surgical approaches to sternal fracture fixation have been documented (steel wire, suture materials, a seven-hole aluminum plate, an eight-holed Sternolock X plate, sternum-osteosynthesis plate, t-shaped plate); however, few techniques have been discussed for the initial reduction of the sternal fracture prior to fixation. In this paper, we describe a novel surgical technique used to reduce sternal fractures and approximate the edges of the sternum using a compression/distraction device.
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Traboulsy SI, Bachir R, El Sayed M. Trauma center designation level and survival of patients with chest wall instability. Am J Emerg Med 2022; 62:1-8. [DOI: 10.1016/j.ajem.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022] Open
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Attia H, Ben Saad H, Masmoudi K, Bannour I, Ouaz M, Gardabbou K, Majdoub A. Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study. Expert Rev Respir Med 2022; 16:1085-1092. [PMID: 36196899 DOI: 10.1080/17476348.2022.2131543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the predictive factors of nebulized morphine (MOR) failure in patients with chest trauma. RESEARCH DESIGN AND METHODS This was an interventional clinical study. Patients admitted with isolated chest trauma with a pain visual analog score > 4 were included. Each patient received 10 mg nebulized MOR. If pain was still > 4 after 10 minutes of nebulization, the latter was repeated every 10 minutes until pain was relieved (i.e. ≤ 4). If pain was > 4 at 30 minutes, nebulized MOR was considered a failure. Patients were divided into two groups: MOR (+) and MOR (-) (good response to and nebulized MOR failure, respectively). RESULTS Seventy-five patients were included. Analysis of the risk factors revealed that road traffic accidents (relative risk (RR): 0.117 [0.031-0.443]; p=0.002), number of fractured ribs > 4 (RR: 0.317 [0.092-0.543]; p=0.006), bilateral injury (RR: 0.114 [0.037-0.349]; p<0.001), flail chest (RR: 0.120 [0.037-0.386]; p<0.001), hemothorax (RR: 0.203 [0.062-0.660]; p=0.008), pulmonary contusion (RR: 0.202 [0.069-0.589]; p=0.003), and pain at admission > 7 (RR: 0.363 [0.147-0.579]; p=0.004) were predictors of nebulized MOR failure. CONCLUSION Our results can help optimize the analgesic management of chest trauma patients by identifying the most eligible patients to benefit from nebulized MOR. CLINICAL TRIAL REGISTRATION : www.clinicaltrials.gov identifier is NCT03580187.
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Affiliation(s)
- Hela Attia
- University of Monastir, Faculty of Medicine of Monastir, Mahdia, Tunisia
| | - Helmi Ben Saad
- University of Sousse, Faculty of Medicine of Sousse, Research Laboratory "Heart Failure, Sousse, Tunisia
| | - Karim Masmoudi
- University of Monastir, Faculty of Medicine of Monastir, Mahdia, Tunisia
| | - Imen Bannour
- University of Monastir, Faculty of Medicine of Monastir, Mahdia, Tunisia
| | - Mouna Ouaz
- University of Monastir, Faculty of Medicine of Monastir, Mahdia, Tunisia
| | - Kais Gardabbou
- University of Monastir, Faculty of Medicine of Monastir, Mahdia, Tunisia
| | - Ali Majdoub
- University of Monastir, Faculty of Medicine of Monastir, Mahdia, Tunisia
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"Fighting the Minotaur" a Complex Blunt Chest Trauma Due to a Bull Attack: A Case Report. Rom J Anaesth Intensive Care 2022; 28:36-39. [PMID: 36846540 PMCID: PMC9949006 DOI: 10.2478/rjaic-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Bull-related injury continues to contribute to an unacceptable number of serious injuries and deaths, and bullfighting continues to be a popular, deeply traditional celebration of the culture of many Iberic-American countries. Most accidents due to bull attacks are horn-related penetrating traumas. Blunt chest trauma can cause a wide range of clinical presentations and injuries, making the diagnostics and therapies extremely challenging. Consequently, it is vital to quickly identify major life-threatening chest wall and intrathoracic injuries. In this case report, we aimed to describe the complexity of the management and the treatment of a blunt trauma patient hit by a bull.
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Bai B, Hao J, Hou M, Wang T, Wu X, Liu Y, Wang Y, Dai C, Hua Y, Ji G, Zhou G. Repair of Large-Scale Rib Defects Based on Steel-Reinforced Concrete-Designed Biomimetic 3D-Printed Scaffolds with Bone-Mineralized Microenvironments. ACS APPLIED MATERIALS & INTERFACES 2022; 14:42388-42401. [PMID: 36094886 DOI: 10.1021/acsami.2c08422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Tissue engineering technology provides a promising approach for large-scale bone reconstruction in cases of extensive chest wall defects. However, previous studies did not consider meticulous scaffold design specific to large-scale rib regeneration in terms of three-dimensional (3D) shape, proper porous structures, enough mechanical strength, and osteogenic microenvironments. Thus, there is an urgent need to develop an appropriate bone biomimetic scaffold (BBS) to address this problem. In this study, a BBS with controllable 3D morphology, appropriate mechanical properties, good biocompatibility and biodegradability, porous structure suitable for cell loading, and a biomimetic osteogenic inorganic salt (OIS) microenvironment was successfully prepared by integrating computer-aided design, 3D-printing, cast-molding, and freeze-drying technologies. The addition of the OIS in the scaffold substantially promoted ectopic bone regeneration in vivo, which might be attributed to the activation of osteogenic and angiogenic signaling pathways as well as upregulated expression of osteogenic genes. More importantly, dual long rib defects could be successfully repaired and medullary cavity recanalized by the rib-shaped mature cortical bone, which might be mediated by the activation of osteoclast signaling pathways. Thus, this paper presents a reliable BBS and proposes a new strategy for the repair of large-scale bone defects.
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Affiliation(s)
- Baoshuai Bai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Junxiang Hao
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Mengjie Hou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Tao Wang
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Xiaodi Wu
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Yanhan Liu
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
| | - Yiyang Wang
- National Tissue Engineering Center of China, Shanghai 200001, China
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Chengxiang Dai
- Cellular Biomedicine Group, Incorporated, No. 85 Faladi Road, Building 3, Pudong New Area, Shanghai 201210, China
| | - Yujie Hua
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
| | - Guangyu Ji
- National Tissue Engineering Center of China, Shanghai 200001, China
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
- Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
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13
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Williams BM, Mulima G, Charles A. Chest Trauma Management in Low- and Middle-Income Countries. Thorac Surg Clin 2022; 32:329-336. [PMID: 35961741 DOI: 10.1016/j.thorsurg.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Trauma is a leading cause of death and disability worldwide and disproportionately affects those in low- and middle-income countries (LMICs). Globally, two-thirds of injured patients sustain trauma to the thoracic cavity. Further research, capacity building, and increased awareness are needed to limit the high thoracic trauma-associated morbidity and mortality in LMICs.
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Affiliation(s)
| | | | - Anthony Charles
- Department of Surgery, University of North Carolina-Chapel Hill; Kamuzu Central Hospital, Lilongwe, Malawi.
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14
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Timm K, Walter N, Heinrich M, Knapp G, Thormann U, El Khassawna T, Alt V, Heiss C, Rupp M. Influence of Thoracic Trauma on Fracture Healing in Long Bones-A Retrospective Analysis. J Clin Med 2022; 11:jcm11030717. [PMID: 35160169 PMCID: PMC8837065 DOI: 10.3390/jcm11030717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: Pre-clinical studies indicate that concomitant thoracic trauma impairs fracture healing of long bones and reduces callus formation. The aim of this study was to investigate whether patients with accompanying chest trauma suffer from delayed fracture healing of long bones in comparison with patients with fractures of two long bones or isolated fractures. Patients and Methods: This is a clinical retrospective study from a level I trauma center. The patients were divided into three groups: (1) thoracic trauma and fracture of a long bone, (2) fractures of two long bones, (3) isolated fracture of a long bone. The fracture consolidation was defined using the radiographic union scale in tibial fractures (RUST). A RUST value of ≥10 six-to-eight months after definitive operative intervention represented complete fracture healing. Results: In the first group 19 (43.2%) fractures did not show full consolidation, in the second group 14 (45.2%) and 13 (41.9%) and in the third group 14 (36.8%). The analysis revealed no statistically significant differences between the groups regarding consolidation of the fractures six-to-eight months after definitive operative intervention (p = 0.84). Conclusions: Unlike previously reported pre-clinical data, this study did not demonstrate a negative effect on fracture consolidation in long bones when accompanied by thoracic trauma. Furthermore, the results demonstrated that concomitant fractures of two long bones does not have a negative effect on fracture consolidation.
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Affiliation(s)
- Karsten Timm
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Martin Heinrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Ulrich Thormann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Thaqif El Khassawna
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Volker Alt
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Markus Rupp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
- Correspondence:
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15
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Abstract
BACKGROUND To improve care for nonintubated blunt chest wall injury patients, our Level I trauma center developed a treatment protocol and a pulmonary evaluation tool named "PIC Protocol" and "PIC Score," emphasizing continual assessment of pain, incentive spirometry, and cough ability. OBJECTIVE The primary objective was to reduce unplanned intensive care unit admissions for blunt chest wall injury patients using the PIC Protocol and the PIC Score. Additional outcomes included intensive care unit length of stay, ventilator days, length of hospital stay, inhospital mortality, and discharge destination. METHODS This was a retrospective cohort study comparing outcomes of rib fracture patients treated at our facility 2 years prior to (control group) and 2 years following PIC Protocol use (PIC group). The protocol included admission screening, a power plan order set, the PIC Score patient assessment tool, in-room communication board, and patient education brochure. Outcomes were compared using independent-samples t tests for continuous variables and Pearson's χ2 for categorical variables with α set to p < .05. RESULTS There were 1,036 patients in the study (control = 501; PIC = 535). Demographics and injury severity were similar between groups. Unanticipated escalations of care for acute pulmonary distress were reduced from 3% (15/501) in the control group to 0.37% (2/535) in the PIC group and were predicted by a preceding fall in the PIC Score of 3 points over the previous 8-hr shift, marking pulmonary decline by an acutely falling PIC Score. CONCLUSIONS The PIC Protocol and the PIC Score are easy-to-use, cost-effective tools for guiding care of blunt chest wall injury patients.
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16
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Bakir MS, Langenbach A, Pinther M, Lefering R, Krinner S, Grosso M, Ekkernkamp A, Schulz-Drost S. The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2021; 48:3623-3634. [PMID: 34739544 PMCID: PMC9532310 DOI: 10.1007/s00068-021-01819-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
Purpose Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax. Methods A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF. Results 73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF. Conclusion Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.
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Affiliation(s)
- Mustafa Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. .,Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
| | - Andreas Langenbach
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Orthopaedics and Trauma Surgery, Klinikum Forchheim, Krankenhausstraße 10, 91301, Forchheim, Germany
| | - Melina Pinther
- Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany
| | - Rolf Lefering
- Department of Medicine, Institute for Research in Operative Medicine (IFOM), Faculty of Health, Universität Witten-Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Sebastian Krinner
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Marco Grosso
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.,Department for Trauma Surgery, Helios Hospital Schwerin, Wismarsche Strasse 393-397, 19049, Schwerin, Germany
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17
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Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model. Injury 2021; 52:1215-1220. [PMID: 33422290 DOI: 10.1016/j.injury.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.
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Billings JD, Khan AD, Clement LP, Douville AA, Brown EW, Schroeppel TJ. A clinical practice guideline using percentage of predicted forced vital capacity improves resource allocation for rib fracture patients. J Trauma Acute Care Surg 2021; 90:769-775. [PMID: 33891571 DOI: 10.1097/ta.0000000000003083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Predicting rib fracture patients that will require higher-level care is a challenge during patient triage. Percentage of predicted forced vital capacity (FVC%) incorporates patient-specific factors to customize the measurements to each patient. A single institution transitioned from a clinical practice guideline (CPG) using absolute forced vital capacity (FVC) to one using FVC% to improve triage of rib fracture patients. This study compares the outcomes of patients before and after the CPG change. METHODS A review of rib fracture patients was performed over a 3-year retrospective period (RETRO) and 1-year prospective period (PRO). RETRO patients were triaged by absolute FVC. Percentage of predicted FVC was used to triage PRO patients. Demographics, mechanism, Injury Severity Score, chest Abbreviated Injury Scale score, number of rib fractures, tube thoracostomy, intubation, admission to intensive care unit (ICU), transfer to ICU, hospital length of stay (LOS), ICU LOS, and mortality data were compared. A multivariable model was constructed to perform adjusted analysis for LOS. RESULTS There were 588 patients eligible for the study, with 269 RETRO and 319 PRO patients. No significant differences in age, gender, or injury details were identified. Fewer tube thoracostomy were performed in PRO patients. Rates of intubation, admission to ICU, and mortality were similar. The PRO cohort had fewer ICU transfers and shorter LOS and ICU LOS. Multivariable logistic regression identified a 78% reduction in odds of ICU transfer among PRO patients. Adjusted analysis with multiple linear regression showed LOS was decreased 1.28 days by being a PRO patient in the study (B = -1.44; p < 0.001) with R2 = 0.198. CONCLUSION Percentage of predicted FVC better stratified rib fracture patients leading to a decrease in transfers to the ICU, ICU LOS, and hospital LOS. By incorporating patient-specific factors into the triage decision, the new CPG optimized triage and decreased resource utilization over the study period. LEVEL OF EVIDENCE Therapeutic/Care Management. Trauma, Rib, Triage, level IV.
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Affiliation(s)
- Joshua D Billings
- From the Department of Trauma and Acute Care Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado Health Memorial Hospital, Colorado Springs; Department of Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado, Aurora; and Department of Pharmacy (L.P.C., A.A.D., E.W.B.), University of Colorado Health Memorial Hospital, Colorado Springs, Colorado
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19
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Yang TH, Ko HJ, Wang AD, Tseng WJ, Chia WT, Chen MK, Su YH. Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study. BMC Musculoskelet Disord 2021; 22:294. [PMID: 33743671 PMCID: PMC7981946 DOI: 10.1186/s12891-021-04148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI. Methods A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. A CWI and no-CWI group were distinguished, and the CWI group was subdivided into the minor-CWI (three or fewer rib fractures without flail chest) and complex-CWI (flail chest, four or more rib fractures) subgroup. Demographic data, classification of the clavicle fracture, number of rib fractures, and associated injuries were recorded. Overall complications included surgery-related complications and unplanned hospital readmissions. Univariate analysis and stepwise backward multivariate logistic regression were used to identify potential risk factors for complications. Results A total of 314 patients undergoing 316 clavicle fracture operations were studied; 28.7% of patients (90/314) occurred with associated CWI. Patients with associated CWI showed a significantly higher age, body mass index, and number of rib fractures. The overall and surgical-related complication rate were similar between groups. Unplanned 30-day hospital readmission rates were significantly higher in the complex-CWI group (p = 0.02). Complex CWI and number of rib fractures were both independent factor for 30-day unplanned hospital readmission (OR 1.59, 95% CI: 1.00–2.54 and OR 1.33, 95% CI: 1.06–1.68, respectively). Conclusion CWI did not affect surgery-related complications after clavicle fracture repair. However, complex-CWI may increase 30-day unplanned hospital readmission rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04148-1.
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Affiliation(s)
- Tsung-Han Yang
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan.,Department of Orthopedics, National Taiwan University Hospital, Taipei City, 10002, Taiwan
| | - Huan-Jang Ko
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, 30059, Taiwan
| | - Alban Don Wang
- Department of Emergency, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, 30059, Taiwan
| | - Wo-Jan Tseng
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wei-Tso Chia
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan
| | - Men-Kan Chen
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, 30059, Taiwan.
| | - Ying-Hao Su
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan. .,Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, County, 30261, Taiwan. .,Department of Orthopedics, National Taiwan University College of Medicine, Taipei City, 10002, Taiwan.
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20
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Abshagen KF, Stolberg-Stolberg J, Loyen JP, Riesenbeck O, Everding J, Freise H, Raschke MJ. [Improvement in breathing mechanics by plate osteosynthesis of the ribs after cardiac massage : Case report and review of the literature]. Unfallchirurg 2021; 124:774-778. [PMID: 33433646 PMCID: PMC8397626 DOI: 10.1007/s00113-020-00950-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
Es wird der Fall eines 69-jährigen Patienten vorgestellt, welcher nach wiederholter Herzdruckmassage (CPR) multiple Rippenfrakturen und eine Sternumfraktur mit inverser Atmung zeigte. Aufgrund der insuffizienten Atemmechanik wurde am 10. Tag nach Reanimation die Indikation zur Plattenosteosynthese der Rippen gestellt. Der Patient konnte am 4. postoperativen Tag extubiert werden. Die Literatur zeigt 5 weitere Fälle. Während es über die Verletzungsmuster nach CPR zahlreiche internationale Arbeiten gibt, ist zur Behandlung des instabilen Thorax nach CPR keine Evidenz gegeben. Jedoch konnte die Osteosynthese von Rippenfrakturen bei traumatischer Genese Vorteile wie verringerte Intensivbehandlungszeit, geringere beatmungsassoziierte Pneumonien, weniger atemabhängige Schmerzen und geringere Kosten für das Gesundheitssystem zeigen. Bei der Behandlung von reanimierten Patienten sollte im interdisziplinären Konsens auch die Osteosynthese von Rippenfrakturen berücksichtigt werden.
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Affiliation(s)
- Karl Friedrich Abshagen
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland.
| | - Josef Stolberg-Stolberg
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland
| | - Jan Philipp Loyen
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland
| | - Oliver Riesenbeck
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland
| | - Jens Everding
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland
| | - Hendrik Freise
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland
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21
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Weaver JL, Kaufman EJ, Young AJ, Keating JJ, Subramanian M, Cannon JW, Shiroff A, Seamon MJ. Outcomes in Delayed Drainage of Hemothorax. Am Surg 2020; 87:1140-1144. [PMID: 33342278 DOI: 10.1177/0003134820956343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prompt drainage of traumatic hemothorax is recommended to prevent empyema and trapped lung. Some patients do not present the day of their trauma, leading to their delayed treatment. Delayed drainage could be challenging as clotted blood may not evacuate through a standard chest tube. We hypothesized that such delays would increase the need for surgery or secondary interventions. METHODS Our trauma registry was reviewed for patients with a hemothorax admitted to our level 1 trauma center from 1/1/00 to 4/30/19. Patients were included in the delayed group if they received a drainage procedure >24 hours after injury. These patients were matched 1:1 by chest abbreviated injury score to patients who received drainage <24 hours from injury. RESULTS A total of 19 patients with 22 hemothoraces received delayed drainage. All but 3 patients had a chest tube placed as initial treatment. Four patients received surgery, including 3 who initially had chest tubes placed. Longer time to drainage increased the odds of requiring intrathoracic thrombolytics or surgery. In comparison, 2 patients who received prompt drainage received thrombolytics (P = .11) and none required surgery (P = .02). Patients needed surgery when initial drainage was on or after post-injury day 5, but pigtail catheter drainage was effective 26 days after injury. DISCUSSION Longer times from injury to intervention are associated with increased likelihood of needing surgery for hemothorax evacuation, but outcomes were not uniform. A larger, multicenter study will be necessary to provide better characterization of treatment outcomes for these patients.
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Affiliation(s)
- Jessica L Weaver
- University of California San Diego Division of Trauma, Surgical Critical Care, Burn, and Acute Care Surgery, San Diego, CA, USA
| | - Elinore J Kaufman
- University of Pennsylvania Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, PA, USA
| | - Andrew J Young
- University of Pennsylvania Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, PA, USA
| | - Jane J Keating
- University of Pennsylvania Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, PA, USA
| | - Madhu Subramanian
- University of Pennsylvania Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, PA, USA
| | - Jeremy W Cannon
- University of Pennsylvania Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, PA, USA
| | - Adam Shiroff
- University of Pennsylvania Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, PA, USA
| | - Mark J Seamon
- University of Pennsylvania Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, PA, USA
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22
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Age differences in blunt chest trauma: a cross-sectional study. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:123-126. [PMID: 33014086 PMCID: PMC7526491 DOI: 10.5114/kitp.2020.99074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/15/2020] [Indexed: 01/22/2023]
Abstract
Introduction Trauma is the most common cause of presentation to hospital emergency services. After extremity and cranial injuries, blunt thoracic trauma is the third most common injury. Aim In this study, we aimed to present and assess blunt chest trauma in adults aged below 65 and elderly (age ≥ 65). Material and methods In this study, 130 patients (86 young (age 18-64) and 44 elderly (age ≥ 65)) who applied to the emergency department with blunt thoracic trauma between October 2017 and October 2019 were evaluated retrospectively. Results Of the patients, 99 (76.1%) were male, and 31 (23.9%) were female. The mean age was 54.41 ±20.13 years, and the patients were between 18 and 95 years of age. The most common cause of blunt thoracic trauma in the elderly group was a fall (n = 27; 61.3%), while in-vehicle traffic accident was most common in the young group (n = 43; 50%). "Flail chest," which is observed as a complication after multiple rib fractures, was present in 1 patient in the young group and in 10 patients in the elderly group; the difference was statistically significant (p > 0.05). Seven (5.3%) patients died. The mean hospital stay was 5.1 (1-60) days, which was borderline-significantly higher in the elderly group (p = 0.056). Conclusions Due to its life-threatening properties, the detection of blunt thorax trauma is a priority among multiple-trauma patients. For this reason, an aggressive diagnosis and treatment approach is essential in the whole patient group, especially among the elderly.
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Butano V, Zebley JA, Sarani B. Current Status of Rib Plating: Hardware Failure When and How? CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol 2020; 23:125-138. [PMID: 32417043 PMCID: PMC7296362 DOI: 10.1016/j.cjtee.2020.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/15/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.
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Wu TH, Lin HL, Chou YP, Huang FD, Huang WY, Tarng YW. Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:49. [PMID: 32050985 PMCID: PMC7017455 DOI: 10.1186/s13054-020-2755-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/29/2020] [Indexed: 12/04/2022]
Abstract
Background Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence. Methods This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes. Results A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011). Conclusion Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.
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Affiliation(s)
- Tung-Ho Wu
- Department of Critical Care Medicine, Kaohsiung-Veterans General Hospital, Kaohsiung, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Kaohsiung-Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsing-Lin Lin
- Department of Critical Care Medicine, Kaohsiung-Veterans General Hospital, Kaohsiung, Taiwan
| | - Yi-Pin Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung-Veterans General Hospital, Kaohsiung, Taiwan.,Division of Trauma, Department of Emergency, Kaohsiung-Veterans General Hospital, Kaohsiung, Taiwan.,Department of Cosmetic Science, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Fong-Dee Huang
- Division of Trauma, Department of Emergency, Kaohsiung-Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Yen Huang
- School of Accounting and Finance, Beijing Institute of Technology, Zhuhai, China
| | - Yih-Wen Tarng
- Department of Orthopedics, Kaohsiung-Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan.
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Hsieh CH, Tsai PL, Huang CY, Chuang JF, Chou SE, Su WT, Hsu SY. Factors affecting mortality in trauma patients with more than three rib fractures. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Treatment for Anterior Flail Chest With a Vacuum Bell. Ann Thorac Surg 2019; 110:e55-e57. [PMID: 31862493 DOI: 10.1016/j.athoracsur.2019.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 11/22/2022]
Abstract
We describe a patient with polytrauma that included anterior chest flail caused by a fall while climbing. As the situation was similar to a pectus excavatum, we attempted to stabilize the depressed chest wall by using a vacuum bell. Deep breath, peak flow, and pectus index were increased when the patient used the vacuum bell. Conservative treatment with a vacuum bell during the day and continuous positive airway pressure during the night was undertaken for 6 weeks. This report documents stabilization of an anterior flail chest using a vacuum bell.
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Sternotomy for Hemorrhage Control in Trauma. J Surg Res 2019; 247:227-233. [PMID: 31759620 DOI: 10.1016/j.jss.2019.09.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/27/2019] [Accepted: 09/15/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about the injuries, mechanisms, and outcomes in trauma patients undergoing sternotomy for hemorrhage control (SHC). The purpose of this study was to identify predictors of mortality for SHC and provide a descriptive analysis of the use of SHC in trauma. We hypothesize blunt trauma is associated with higher mortality compared with penetrating trauma among trauma patients requiring SHC. METHODS The Trauma Quality Improvement Program (2013-2016) database was queried for adult patients undergoing SHC within 24 h of admission. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U-test. A multivariable logistic regression model was used to determine the risk of mortality. RESULTS Of 584 patients undergoing SHC, 322 (55.1%) were involved in penetrating trauma, and 69 (11.8%) were involved in blunt. The blunt trauma group had a higher median injury severity score (31.5 versus 25.0; P < 0.001) compared with the penetrating group. The median time to hemorrhage control was longer in those with blunt compared with penetrating trauma (84.6 versus 49.8 min; P < 0.001). The mortality rate was higher in patients with blunt compared with penetrating trauma (29.0% versus 12.7%; P < 0.001). However, after adjusting for covariates, there was no difference in risk of mortality between blunt and penetrating trauma (P = 0.06). CONCLUSIONS Trauma patients requiring SHC after blunt trauma had a higher mortality rate than those in penetrating trauma. After adjusting for predictors of mortality, there was no difference in risk of mortality despite nearly double the time to hemorrhage control in patients presenting after blunt trauma.
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[Injuries of the posterior and lateral chest wall-importance of an additional clavicular fracture]. Unfallchirurg 2019; 121:615-623. [PMID: 30043074 DOI: 10.1007/s00113-018-0528-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Flail chest wall injuries (FCI) are common in younger patients due to high-speed trauma and in older patients due to low-energy trauma or falls from a low height. They show a high incidence of concomitant injuries and are therefore associated with high morbidity and mortality. If there is also an ipsilateral clavicular fracture (CF), the outcome is significantly poorer. The skeleton of the shoulder and chest loses stability and can lead to a loss of function of the shoulder and a pronounced deformation of the chest wall. OBJECTIVE This article shows the origin and clinical importance of FCI. What importance does a concomitant ipsilateral CF have and how can these costoclavicular injuries (CCI) be managed conservatively and operatively? MATERIAL AND METHODS After primary emergency care of the patients with appropriate diagnostics, in the presence of CCI operative stabilization was carried out by means of locked plate osteosynthesis of the clavicle and the affected ribs via minimally invasive approaches with the patient under general anesthesia. Patients were followed up postoperatively. Various minimally invasive posterolateral approaches to the chest wall were previously performed in a corpse study and then put into practice. RESULTS AND CONCLUSION This study presents therapeutic options for the reconstruction of the chest wall based on the established literature and clinical examples. An ipsilateral CF combined with fractures of the 2nd-4th ribs can be treated through an innovative clavipectoral approach. For the other fractures, standard approaches to the anterolateral and posterolateral chest wall are performed, which are associated with a good outcome in clinical practice. An operative stabilization should be performed at the latest when FCI or CCI together with a dislocating fracture and a marked deformation of the thoracic wall are present. Remaining misalignments are associated with a simultaneous loss of function of the chest wall and shoulder.
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Marro A, Chan V, Haas B, Ditkofsky N. Blunt chest trauma: classification and management. Emerg Radiol 2019; 26:557-566. [DOI: 10.1007/s10140-019-01705-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
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Khosa AH, Durrani HD, Wajid W, Khan M, Hussain MI, Haider I, Gulnaz M, Butool S. Choice of Analgesia in Patients with Critical Skeletal Trauma. Cureus 2019; 11:e4694. [PMID: 31338269 PMCID: PMC6639069 DOI: 10.7759/cureus.4694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The adequate management of thoracic trauma requires a systematic approach including pain control, respiratory therapy, and mobility achieved by surgical fixation. Failure to achieve pain control prolongs hospital stay. There are several options for achieving analgesia including epidural catheters, intravenous narcotics, intercostal, paravertebral or interpleural blocks, oral opioids, or simply a combination of the aforementioned interventions. In this study, we aim to compare the efficacy of thoracic epidural analgesia with systemic analgesia in patients with polytrauma. Methods This prospective study was conducted in the intensive care unit (ICU) of District Headquarters Hospital in Dera Ghazi Khan, Pakistan. Patients of age ≥18 years with skeletal trauma - rib fractures, limb fractures, and pelvic fractures - were included in the study. Group A patients were given epidural - bupivacaine and tramadol. Group B patients were given systemic analgesia with intravenous opioids. The severity of pain was assessed on the visual analogue scale (VAS) at time 0, 24 hours, and 48 hours. Data was entered and analysis was performed using Statistical Package for Social Sciences version 22.0. Results At 24 hours and 48 hours interval, group A showed a lower mean VAS score than group B (p = 0.74; p = 0.03). Group A required lesser mean doses of additional short-acting analgesics than group B (4.87 ± 1.06 vs. 6.77 ± 1.44; p < 0.0001). In Group A, 94% were discharged and the mortality rate was 6%; in group B, 86% were discharged and the mortality rate was 14% (p = 0.21). Conclusion Epidural analgesia provides better pain relief and requires fewer short-acting supplementing analgesics as compared to systemic analgesia in patients with multi-trauma.
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Affiliation(s)
- Abrar H Khosa
- Critical Care, District Headquarter Teaching Hospital, Dera Ghazi Khan, PAK
| | - Haq Dad Durrani
- Anesthesiology, D.G Khan Medical College, Dera Ghazi Khan, PAK
| | - Wafa Wajid
- Internal Medicine - Critical Care, District Headquarter Hospital, Dera Ghazi Khan, PAK
| | - Maria Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Imran Haider
- Orthopedic Surgery, District Headquarter Hospital, Dera Ghazi Khan, PAK
| | - Mahrukh Gulnaz
- Critical Care, District Headquarter Hospital, Dera Ghazi Khan, PAK
| | - Shahla Butool
- Internal Medicine, District Headquarter Hospital, Dera Ghazi Khan, PAK
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Zanette GZ, Waltrick RS, Monte MB. Epidemiological profile of thoracic trauma in a reference hospital of Foz do Rio Itajai. ACTA ACUST UNITED AC 2019; 46:e2121. [PMID: 31017180 DOI: 10.1590/0100-6991e-20192121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/05/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to describe the epidemiological profile of thoracic trauma in the region of Foz do Rio Itajai, in the state of Santa Catarina, Brazil. METHODS observational, descriptive and prospective study performed through the collection of data starting with a form elaborated by researchers and filled in by the team in charge of a reference hospital between June 2017 and May 2018. RESULTS one hundred and nineteen forms from victims of thoracic trauma were analyzed, constituted of 70.5% male patients and 29.4% female patients, with an average of 39.8 years of age. Medical care happened mainly in daytime (67.9%), 30.2% of patients arriving by their own means, and 52.9% of patients one hour after suffering trauma. As to admission exams, most victims only went through chest X-ray (67.2%). There was a prevalence of closed thoracic trauma (89%), whose main cause was motorcycle accidents (35.2%) and the predominant lesion was rib fracture (42%). Most patients (53.8%) went through a conservative treatment. The average admission time was 2.6 days and the death rate was 5%. CONCLUSION the profile of patients with thoracic trauma in Itajai comprises young men, admitted during the day, most of them presenting rib fracture, with closed thoracic trauma due to a road traffic accident involving a motorcycle. Chest X-ray were used to confirm most of the diagnoses, and there was a prevalence for conservative treatment. The admission time and the death rate were smaller than those cited in medical literature, which can be explained by the high index of exclusive muscular lesions.
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Pereira LDDS, Bassi E, Tomazini BM, Jesus VLM, Tierno PFGMM, Novo FDCF, Malbouisson LM, Utiyama EM. Sternal fractures in a level III trauma intensive care unit. ACTA ACUST UNITED AC 2019; 46:e2059. [PMID: 30916208 DOI: 10.1590/0100-6991e-20192059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to evaluate epidemiology, anatomical characteristics, management, and prognosis of critical patients with sternum fractures. METHODS retrospective analysis of patients admitted to intensive care unit (ICU) of a Level III trauma center in Sao Paulo, Brazil. RESULTS 1552 trauma patients were admitted from January 2012 to April 2016. A total of 439 patients had thoracic trauma and among these, 13 patients had sternum fracture, making up 0.9% of all trauma admissions and 3% of all thoracic trauma cases. Three of these 13 patients had unstable chest, two underwent surgical management for fracture fixation, and three died (mortality was of 29%). In one of the deaths, sternum fracture was assessed as the main contributor to the outcome. CONCLUSION sternum fracture was diagnosed in 0.9% of critical trauma patients in a specialized ICU. Only 15% of patients required specific surgical management in the acute phase. In most cases, mortality was due to other injuries.
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Affiliation(s)
- Leonardo Dantas da Silva Pereira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Estevão Bassi
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Bruno Martins Tomazini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Vinicius Luiz Menezes Jesus
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | | | - Fernando Da Costa Ferreira Novo
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Luiz Marcelo Malbouisson
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Anestesiologia, São Paulo, SP, Brasil
| | - Edivaldo Massazo Utiyama
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
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Kani KK, Mulcahy H, Porrino JA, Chew FS. Thoracic cage injuries. Eur J Radiol 2019; 110:225-232. [DOI: 10.1016/j.ejrad.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023]
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Liu Y, Xu S, Yu Q, Tao Y, Peng L, Qi S, Han H, Chen M. Surgical versus conservative therapy for multiple rib fractures: a retrospective analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:439. [PMID: 30596069 DOI: 10.21037/atm.2018.10.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background In this study, we aimed to evaluate the clinical effects of multiple rib fracture treatments using a rib plate fixator. Methods From June 2014 to December 2016, 110 cases of patients with multiple rib fractures were collected for our study from the 105th Hospital of PLA; 59 patients were treated by surgery, and 51 patients received conservative treatment. We compared surgical rib plate fixation with conservative treatment for patients with multiple rib fractures. Results The hospital stay for the surgical group was 13.12±4.21 days, whereas for the conservative group, it was 18.57±5.39 days (P<0.001). The duration of the thoracic intensive care unit (ICU) stay was 4.02±1.41 days in the surgical group and 5.06±1.80 days in the conservative group (P=0.001). The indwelling thoracic drainage tube time was 5.85±1.52 days in the surgical group and 8.26±1.96 days in the conservative group (P<0.001). The index of partial pressure of arterial oxygen (PaO2) was 91.05±10.88 mmHg 24 h after surgery whereas 86.49±11.69 mmHg 24 h after conservative treatment (P=0.036). The index of partial pressure of carbon dioxide (PaCO2) was 37.80±2.86 mmHg 24 h after surgery and it was 39.08±2.46 mmHg 24 h after conservative treatment. The hospitalization cost was 6,206.44±371.42 USD for the surgical group and 4,544.61±524.79 USD for the conservative group (P<0.001). The number of rib displacement cases after treatment was 1 case in the surgical group and 2 cases in the conservative group (P=0.475). Atelectasis occurred in 10 cases in the surgical group and in 17 cases in the conservative group (P=0.046). Delayed hemopneumothorax occurred in 7 cases in the surgical group and in 16 cases in the conservative group (P=0.012). Conclusions Surgical treatment is a safe and effective therapy for multiple rib fractures. Our data suggested that surgical treatment can significantly shorten the patients' pain-endurance time, hospitalization time, and can reduce complication incidence. Severe rib fracture patients might benefit from surgical fixation.
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Affiliation(s)
- Yongjing Liu
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Shun Xu
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Qi Yu
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Yu Tao
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Leilei Peng
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Shengbo Qi
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Hao Han
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Mengran Chen
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
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Sangal RB, Holena DN. Man in Motor Vehicle Collision. J Emerg Med 2018; 54:544-546. [PMID: 29310961 DOI: 10.1016/j.jemermed.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/10/2017] [Accepted: 12/01/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Rohit B Sangal
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Reduced invasive and muscle-sparing operative approaches to the posterolateral chest wall provide an excellent accessibility for the operative stabilization! Eur J Trauma Emerg Surg 2017; 44:471-481. [DOI: 10.1007/s00068-017-0877-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
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