1
|
Hylands M, Gomez D, Tillmann B, Haas B, Nathens A. Surgical stabilization of rib fractures for flail chest: Analysis of center-based variability in practice and outcomes. J Trauma Acute Care Surg 2024; 96:882-892. [PMID: 38196120 DOI: 10.1097/ta.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Given the lack of high-quality data on patient selection for surgical stabilization of rib fractures (SSRF), significant variability in practice likely exists across trauma centers. We aimed to determine whether centers with a more liberal approach to SSRF had improved outcomes. METHODS We performed a retrospective cohort study of adult patients with flail chest admitted to Level I or II trauma centers participating in the American College of Surgeons' Trauma Quality Improvement Program. The primary outcome was hospital mortality; secondary outcomes included discharge status, tracheostomy, duration of mechanical ventilation, and hospital length of stay. Logistic regression was performed to calculate center-level observed/expected rates of SSRF and centers were grouped into quintiles from "most liberal" to "most restrictive." Multivariable regression was used to determine the association between these quintiles and outcomes. We also used an instrumental variable analysis to evaluate the association between SSRF and mortality at the patient level. RESULTS Among 23,619 patients with flail chest across 354 centers, 22% underwent SSRF. Center rates of fixation ranged from 0% to 88%. Higher rates of SSRF were not associated with lower mortality overall (highest vs. lowest quintile: odds ratio, 0.86; 95% confidence interval, 0.63-1.17). However, centers with a more liberal approach to SSRF had lower rates of independent status at discharge, higher tracheostomy rates, longer duration of mechanical ventilation, and longer hospital and ICU length of stay. The patient level analysis demonstrated that SSRF as was associated with a 25% lower risk of death. CONCLUSION Overall, centers with a liberal approach to SSRF do not show improved outcomes among patients with a flail chest, but have higher resource utilization. Results at the patient level suggest that there is a population likely to benefit but these patients remain to be identified through further research. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
Collapse
Affiliation(s)
- Mathieu Hylands
- From the Division of General Surgery Department of Surgery, (M.H.), Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Department of Surgery, St. Michael's Hospital-Unity Health and the Temerty Faculty of Medicine (D.G.), Tory Trauma Program, Sunnybrook Health Sciences Center and the Temerty Faculty of Medicine (B.T., B.H., A.N.), University of Toronto; Division of Respirology and Critical Care Medicine, Department of Medicine, University Health Network (B.T.), Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
2
|
Przeslawski C, Knaggs M, Habib PM, Ghamraoui A, Wahl C, Gerken J. A Penetrating Neck Injury Resulting in the Complete Transection of the Ipsilateral Common Carotid Artery, Delayed Contralateral Pneumothorax, and Occult Esophageal Injury: A Case Report With a Multidisciplinary Approach to Management. Cureus 2024; 16:e56988. [PMID: 38665745 PMCID: PMC11045256 DOI: 10.7759/cureus.56988] [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] [Received: 02/03/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
A 29-year-old male presented with a zone one penetrating neck injury resulting in complete transection of the left carotid sheath and its contents. The proximal common carotid artery and internal jugular vein injuries were successfully managed with vessel ligation without adverse neurological sequelae. The patient also developed a contralateral pneumothorax, which was due to an occult through-and-through esophageal injury at the junction of the cervical and thoracic esophagus. The esophageal injury was successfully managed with surgical repair and wide drainage of the neck and right chest.
Collapse
Affiliation(s)
| | - Michaela Knaggs
- General Surgery, Beaumont Hospital - Farmington Hills Campus, Farmington Hills, USA
| | - Peter M Habib
- Osteopathic Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, USA
- General Surgery, Beaumont Hospital - Farmington Hills Campus, Farmington Hills, USA
| | - Ahmed Ghamraoui
- Vascular Surgery, Beaumont Hospital - Farmington Hills Campus, Farmington Hills, USA
| | - Caitlin Wahl
- Thoracic Surgery, Beaumont Hospital - Farmington Hills Campus, Farmington Hills, USA
| | - Jeffrey Gerken
- General Surgery, Beaumont Hospital - Farmington Hills Campus, Farmington Hills, USA
| |
Collapse
|
3
|
Lopez-Melia M, Magnin V, Marchand-Maillet S, Grabherr S. Deep learning for acute rib fracture detection in CT data: a systematic review and meta-analysis. Br J Radiol 2024; 97:535-543. [PMID: 38323515 PMCID: PMC11027249 DOI: 10.1093/bjr/tqae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES To review studies on deep learning (DL) models for classification, detection, and segmentation of rib fractures in CT data, to determine their risk of bias (ROB), and to analyse the performance of acute rib fracture detection models. METHODS Research articles written in English were retrieved from PubMed, Embase, and Web of Science in April 2023. A study was only included if a DL model was used to classify, detect, or segment rib fractures, and only if the model was trained with CT data from humans. For the ROB assessment, the Quality Assessment of Diagnostic Accuracy Studies tool was used. The performance of acute rib fracture detection models was meta-analysed with forest plots. RESULTS A total of 27 studies were selected. About 75% of the studies have ROB by not reporting the patient selection criteria, including control patients or using 5-mm slice thickness CT scans. The sensitivity, precision, and F1-score of the subgroup of low ROB studies were 89.60% (95%CI, 86.31%-92.90%), 84.89% (95%CI, 81.59%-88.18%), and 86.66% (95%CI, 84.62%-88.71%), respectively. The ROB subgroup differences test for the F1-score led to a p-value below 0.1. CONCLUSION ROB in studies mostly stems from an inappropriate patient and data selection. The studies with low ROB have better F1-score in acute rib fracture detection using DL models. ADVANCES IN KNOWLEDGE This systematic review will be a reference to the taxonomy of the current status of rib fracture detection with DL models, and upcoming studies will benefit from our data extraction, our ROB assessment, and our meta-analysis.
Collapse
Affiliation(s)
- Manel Lopez-Melia
- University Centre of Legal Medicine Lausanne-Geneva, Geneva 1206, Switzerland
- University Hospital and University of Geneva, Geneva 1205, Switzerland
| | - Virginie Magnin
- University Centre of Legal Medicine Lausanne-Geneva, Geneva 1206, Switzerland
- University Hospital and University of Geneva, Geneva 1205, Switzerland
- University Hospital and University of Lausanne, Lausanne 1005, Switzerland
| | | | - Silke Grabherr
- University Centre of Legal Medicine Lausanne-Geneva, Geneva 1206, Switzerland
- University Hospital and University of Geneva, Geneva 1205, Switzerland
- University Hospital and University of Lausanne, Lausanne 1005, Switzerland
| |
Collapse
|
4
|
Balakrishnan S. CT angiography of non-aortic thoracic arterial trauma. Emerg Radiol 2023; 30:667-681. [PMID: 37704920 DOI: 10.1007/s10140-023-02170-5] [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: 05/19/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
While aortic injury is the most commonly cited thoracic arterial injury, non-aortic arterial injuries represent an uncommon but significant source of morbidity and mortality in blunt and penetrating thoracic trauma patients. Knowledge of the spectrum of vascular injury and anatomic considerations that dictate patterns of associated thoracic hemorrhage will assist the radiologist in the accurate and efficient diagnosis of these injuries. This article provides a review of anatomy, pertinent clinical exam and CT angiography findings, as well as therapeutic options for non-aortic thoracic arterial trauma.
Collapse
Affiliation(s)
- Sudheer Balakrishnan
- Department of Radiology, Division of Emergency and Trauma Imaging, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
5
|
Shandilya S, Roy S, Rai A, Kumar S, Kumar S, Tiwari S, Sonkar AA. A Prospective Observational Study on the Outcome Assessment of Conservative Management Versus Intercostal Drainage (ICD) in Blunt Chest Injury Patients With ≤3 Rib Fractures in a North Indian Tertiary Care Center. Cureus 2023; 15:e42167. [PMID: 37602137 PMCID: PMC10439305 DOI: 10.7759/cureus.42167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Trauma 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. Seventy percent of thoracic traumas are due to blunt injury. This indicates the importance of chest trauma among all traumas. Quick and precise assessment bears paramount importance in deciding life-saving and definitive management. Often, the initial management in blunt injury patients is based on subjective assessment by the attending clinician. A scoring system that provides early identification of the patients at the greatest risk for respiratory failure and more likely to require mechanical ventilation and require prolonged care, as well as those with a higher mortality risk, may allow the early institution of intervention to improve outcomes. Thoracic Trauma Severity Score (TTSS) poses to be a precise tool in directing the management modality to be employed. Methodology This was an observational study including 112 patients of age >12 years, with blunt chest injury, sustaining ≤3 rib fractures, and with a stable chest wall. The patients with penetrating injury, those with blunt chest injury having flail segment, patients in the pediatric age group (<12 years), or polytrauma patients were excluded from our study. Of the 112 patients, 56 had been managed by intercostal drainage (ICD), and the rest (56) had been managed conservatively. Result Road traffic accidents (RTA) were the most common mode of injury in both groups. The percentage of the patients with one, two, and three rib fractures was 57.14%, 32.14%, and 10.71%, respectively, in the ICD group and 85.71%, 7.14%, and 7.14%, respectively, in the conservative management group (p = 0.124). The mean TTSS score was significantly more in the ICD group as compared to the conservative management group in the single rib fracture patients (p = 0.001*), as well as all patients of any number of rib fractures (p < 0.01*) (significance was defined as a value of p less than 0.05 {indicated by an asterisk}). The mean hospital stay was significantly lower in the conservative group as compared to the ICD group (p < 0.01*). The mean SF-36 (outcome) was significantly more in the conservative management group as compared to the ICD group (p = 0.020*). The mean cost of treatment was significantly more in the ICD group as compared to the conservative management group (p < 0.001*). Conclusion In our study, a TTSS (as measured by the primary care surgeon) of >7, across any number of rib fractures, was preferably predictive of management by ICD, while a <7 value was favorable for conservative management. TTSS can be used as an important tool to predict the management modality in blunt chest injury patients with ≤3 rib fractures.
Collapse
Affiliation(s)
| | - Shubhajeet Roy
- Medical Sciences, King George's Medical University, Lucknow, IND
| | - Anurag Rai
- Thoracic Surgery, King George's Medical University, Lucknow, IND
| | - Suresh Kumar
- General Surgery, King George's Medical University, Lucknow, IND
| | - Shailendra Kumar
- Thoracic Surgery, King George's Medical University, Lucknow, IND
- General Surgery, King George's Medical University, Lucknow, IND
| | - Sandeep Tiwari
- Trauma Surgery, King George's Medical University, Lucknow, IND
| | | |
Collapse
|
6
|
Hamamoto N, Kikuta S, Takahashi R, Ishihara S. Delayed Tension Hemothorax With Nondisplaced Rib Fractures After Blunt Thoracic Trauma. Cureus 2023; 15:e38835. [PMID: 37303319 PMCID: PMC10254092 DOI: 10.7759/cureus.38835] [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: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Blunt thoracic trauma often causes rib fractures, hemothorax, and pneumothorax. Although there is no established definition regarding the duration and management of delayed hemothorax, it commonly occurs in a few days and exhibits at least one displaced rib fracture. Moreover, delayed hemothorax rarely develops tension hemothorax. A 58-year-old male who had a motorcycle accident received conservative treatment from his orthopedic doctor. He felt a sudden severe chest pain 19 days after the accident. Contrast-enhanced computed tomography (CT) of the chest revealed multiple left-sided rib fractures without displacement, left pleural effusion, and extravasation near the intercostal space of the seventh rib fracture. After transfer to our hospital and a plain CT scan, which showed a more mediastinal shift toward the right, his condition deteriorated with cardiorespiratory embarrassment, such as restlessness, hypotension, and neck vein distention. We diagnosed him with obstructive shock due to tension hemothorax. Immediate chest drainage ameliorated restlessness and elevated blood pressure. Here, we report an extremely rare and atypical case of delayed tension hemothorax after blunt thoracic trauma without displaced rib fractures.
Collapse
Affiliation(s)
- Nana Hamamoto
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
| | - Shota Kikuta
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
| | - Ryo Takahashi
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
| | - Satoshi Ishihara
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
| |
Collapse
|
7
|
Fukushima K, Kambe M, Aramaki Y, Ichikawa Y, Isshiki Y, Nakajima J, Sawada Y, Oshima K. Evaluation of injury threshold from the number of rib fracture for predicting pulmonary injuries in blunt chest trauma. Heliyon 2023; 9:e15278. [PMID: 37095910 PMCID: PMC10121455 DOI: 10.1016/j.heliyon.2023.e15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
Background Blunt chest trauma is a common presentation in emergency departments. The relationship between bone fractures and organ injuries has not been studied in detail. The purpose of this study was to examine the degree of external force represented by the number of rib fractures that causes lung injury in blunt chest trauma. Patients and methods This study was performed retrospectively using trauma patients who received medical examinations in a single university hospital emergency center between April 2015 and March 2020. We examined the association between the number of rib fractures and pulmonary damage using multivariable regression analysis and considered the relationship between rib fracture location and each type of lung injury. Results A total of 317 patients were included. The mean age was 63.1 years, 65.0% were male, and traffic accidents were the most common mechanism of injury (55.8%). The number of mean rib fractures was 4.0, and the mean Injury Severity Score was 11.3. The number of rib fractures was associated with an increased risk of pulmonary injuries: pulmonary contusion (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14-1.48, p < 0.05); hemothorax (OR 1.22, 95% CI 1.08-1.38, p < 0.05); pneumothorax (OR 1.15, 95% CI 1.02-1.30, p < 0.05); and hemopneumothorax (OR 1.14, 95% CI 1.01-1.28, p < 0.05). In addition, bilateral rib fractures were associated with fractures of the superior ribs more often and more severely, but were not associated with the occurrence of each type of lung injury. Conclusion The number of rib fractures was associated with an increased risk of pulmonary injuries. In addition, the type of pulmonary injury could be predicted from the number of rib fractures in blunt chest trauma.
Collapse
Affiliation(s)
- Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Kambe
- ER General Medical Center, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| |
Collapse
|
8
|
Thomas CN, Lindquist TJ, Schroder LK, Cole PA. Rib Fracture Map in High-Energy Injuries. J Orthop Trauma 2023; 37:e165-e169. [PMID: 36730005 DOI: 10.1097/bot.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To use a novel rib unfurling technology to investigate the locations of multiple rib fractures occurring from high-energy trauma to discern if there are reproducible rib fracture patterns. METHODS Patients between the ages of 18 and 48 years presenting to a Level 1 academic trauma center with ≥2 rib fractures after a high-energy mechanism of injury between 2017 and 2019 were identified. Curved planar reformatting of CT scans was used to create two-dimensional unfurled rib images by flattening out the view of the ribs from a CT scan. Rib fractures were placed on a template map using a standardized measurement method, and subsequent frequency and heat maps were created. RESULTS Among 100 consecutive patients, 534 fractures on 454 ribs were identified. The most common high-energy mechanism of injury was motor vehicle accidents (41%). Flail chest occurred in 8% of patients. The mean number of ribs fractured per patient was 4.54 ± 3.14 and included a mean of 5.34 ± 4.38 total fractures. Among all fractures, 50.9% were located on ribs 4 through 7. The most common fracture location was located in the lateral or anterolateral zone of the rib cage. CONCLUSIONS Patients with multiple rib fractures from high-energy trauma have rib fractures with locations of common occurrence. An understanding of location and frequency of rib fractures can help inform surgical approaches, prognosis, indications, classifications, and implant design in the management of a complex population of patients with chest wall injury after trauma. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Claire N Thomas
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
| | | | - Lisa K Schroder
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- HealthPartners Orthopaedics & Sports Medicine, Bloomington, MN
| |
Collapse
|
9
|
Okoye OG, Olaomi OO, Adamu YB, Anumenechi N. Thoracic trauma in national hospital Abuja, Nigeria: The epidemiology, injury severity and initial management options. Afr J Emerg Med 2023; 13:15-19. [PMID: 36700166 PMCID: PMC9852269 DOI: 10.1016/j.afjem.2022.12.002] [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: 08/17/2022] [Revised: 11/16/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
Background Trauma is the leading cause of death in individuals between the ages of 1 and 44 years and it is the third commonest cause of death regardless of age. Thoracic trauma is a relatively common cause of preventable death among trauma patients. The spectrum of injuries after blunt chest trauma presents a challenging problem to the emergency physician. This study is intended to discuss the epidemiology, severity and initial management strategies in chest trauma patients, in a low income country. Methods A cross sectional retrospective study among chest trauma patients seen in the emergency room of National Hospital Trauma Centre, Abuja, Nigeria, from January 2015 to December 2017. Relevant patients' information was retrieved from the trauma registry kept in the trauma centre. Data processing and analysis was done using statistical package for social sciences (SPSS) version 24. Test of significance was done where applicable using chi square and student t test, using p value less than 0.05 as significant. Results are presented in tables and figures. Results A total of 637 patients, male to female ratio of 3.6 and mean age of 34.18 ± 11.34 were enrolled into the study. The most common mechanisms of injury were MVC (54.6%) and assault (23.5%). Blunt injuries were 3.5 times more frequent than the penetrating injuries. The RTS of 12 (76.3%) and the ISS of 1-15 category (52.3%) were the most common scores. Up to 98% of patients were managed non-operatively. Recovery rate was high (89%) with relatively low mortality rate of 4.2%. Conclusion Majority of thoracic trauma can be managed effectively by employing simple, non-operative procedures such as needle decompression and chest tube insertion. Efforts should be made to include these procedures in the skill set of every medical officer working in the emergency room, particularly in low and middle income countries where there is paucity of emergency physicians.
Collapse
Affiliation(s)
- Onyedika Godfrey Okoye
- Trauma Centre, Department of Surgery, National Hospital Abuja, Central Business District, Garki, Abuja, Nigeria
- Corresponding author.
| | - Oluwole Olayemi Olaomi
- Trauma Centre, Department of Surgery, National Hospital Abuja, Central Business District, Garki, Abuja, Nigeria
| | - Yahaya Baba Adamu
- Cardiothoracic Division, Department of Surgery, National Hospital Abuja, Nigeria
| | - Ndubisi Anumenechi
- Cardiothoracic Division, Department of Surgery, National Hospital Abuja, Nigeria
| |
Collapse
|
10
|
Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis. J Surg Res 2023; 281:22-32. [PMID: 36108535 DOI: 10.1016/j.jss.2022.07.047] [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: 03/13/2022] [Revised: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Blunt thoracic injury (BTI) is one of the most common causes of trauma admission in the United States and is uncommonly associated with cardiac injuries. Blunt cardiac injury (BCI) after blunt thoracic trauma is infrequent but carries a substantial risk of morbidity and sudden mortality. Our study aims to identify predictors of concomitant cardiac contusion among BTI patients and the predictors of mortality among patients presenting with BCI on a national level. MATERIALS AND METHODS We performed a 1-y (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adults (aged ≥ 18 y) with the diagnosis of BTI. We excluded patients who were transferred, had a penetrating mechanism of injury, and who were dead on arrival. Our primary outcomes were the independent predictors of concomitant cardiac contusions among BTI patients and the predictors of mortality among BCI patients. Our secondary outcome measures were in-hospital complications, differences in injury patterns, and injury severity between the survivors and nonsurvivors of BCI. RESULTS A total of 125,696 patients with BTI were identified, of which 2368 patients had BCI. Mean age was 52 ± 20 y, 67% were male, and median injury severity score was 14 [9-21]. The most common type of cardiac injury was cardiac contusion (43%). Age ≥ 65 y, higher 4-h packed red blood cell requirements, motor vehicle collision mechanism of injury, and concomitant thoracic injuries (hemothorax, flail chest, lung contusion, sternal fracture, diaphragmatic injury, and thoracic aortic injuries) were independently associated with concomitant cardiac contusion among BTI patients (P value < 0.05). Age ≥ 65 y, thoracic aortic injury, diaphragmatic injury, hemothorax, and a history of congestive heart failure were independently associated with mortality in BCI patients (P value < 0.05). CONCLUSIONS Predictors of concomitant cardiac contusion among BTI patients and mortality among BCI patients were identified. Guidelines on the management of BCI should incorporate these predictors for timely identification of high-risk patients.
Collapse
|
11
|
No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial. Eur J Trauma Emerg Surg 2022; 49:1113-1120. [PMID: 36370185 DOI: 10.1007/s00068-022-02163-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/04/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC). METHODS Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups. RESULTS Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m CONCLUSION: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established. TRIAL REGISTRY DETAILS Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).
Collapse
|
12
|
Tokuda R, Okada Y, Nagashima F, Kobayashi M, Ishii W, Iizuka R. Open pneumothorax with extensive thoracic defects sustained in a fall: a case report. Surg Case Rep 2022; 8:204. [PMID: 36303013 PMCID: PMC9613823 DOI: 10.1186/s40792-022-01555-x] [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: 06/14/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background Open pneumothorax with chest wall deficit is a rare chest trauma that is serious and can lead to severe respiratory failure; however, it is a potentially lifesaving injury if utilized appropriately. Case presentation Herein, we report a case of an open pneumothorax with extensive chest wall deficit due to falling from a height and highlight the importance of appropriate evaluation and intervention. The patient was a Japanese man in his 50 s who fell from the 6th floor to the 3rd floor while working at a height. The left chest wall was punctured due to injury, the thoracic cavity was open as if a left anterolateral thoracotomy had been performed, and the left lung had prolapsed from the thoracic cavity to the outside. In our emergency department, tracheal intubation with a double lumen tube for differential positive pressure ventilation and a right thoracic drain were inserted, and an emergency operation was started immediately. A pulmonary suture for lung injury and closure of the left thorax were performed during the surgery. The defect was closed with the remaining tissue, but the anterior thoracic skin with poor blood flow was necrotic, so debridement was undertaken. After his general condition was improved, pedicled latissimus dorsi myocutaneous flap was implanted. He was discharged home on the 63rd hospital day. Conclusions Although open pneumothorax is rare and sometimes presents lurid findings, we highlighted that it is important to quickly assess the life-threatening organ injury, perform positive pressure ventilation by tracheal intubation, thoracic drainage, and wound closure simultaneously respond calmly as a team. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-022-01555-x.
Collapse
Affiliation(s)
- Rina Tokuda
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo 668-8501 Japan ,grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| | - Yohei Okada
- grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan ,grid.258799.80000 0004 0372 2033Department of Preventive Services, School of Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-ku, Kyoto, 606-8501 Japan ,grid.258799.80000 0004 0372 2033Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Yoshidahon-machi, Sakyo-ku, Kyoto City, Kyoto 606-8501 Japan
| | - Futoshi Nagashima
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Wataru Ishii
- grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| | - Ryoji Iizuka
- grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| |
Collapse
|
13
|
Abstract
INTRODUCTION Rib fractures are common injuries in trauma patients that often heal without intervention. Infrequently, symptomatic rib fracture nonunions are a complication after rib fractures. There is a paucity of literature on the surgical treatment of rib fracture nonunion. The purpose of this study was to describe the efficacy of rib fracture nonunion operative fixation with particular focus on surgical technique, healing rates, and complications. MATERIALS AND METHODS Patients aged ≥ 18 years with symptomatic rib fracture nonunions treated with open reduction and internal fixation (ORIF) with locking plates at a single urban level 1 trauma center were retrospectively reviewed. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed. RESULTS A total of 18 patients met inclusion criteria. The mean time from injury to undergoing ORIF for rib fracture nonunion was just under a year and the number of ribs plated was 2.95 ± 1.16 (1-5 ribs) with bone grafting used in six cases. All patients (100%) showed evidence of healing at an average of 2.65 ± 1.50 months (2-8 months). All patients reported a decrease in pain. No narcotic pain medication was used at an average of 3.88 ± 3.76 weeks (0-10 weeks) post-operatively. Intraoperative and postoperative complications were found in 4 (22.2%) patients. CONCLUSION This study concluded that operative fixation of symptomatic rib fracture nonunion demonstrated favorable outcomes with reduction in preoperative pain levels, decreased use of narcotic pain medication, minimal complications, and a high rate of fracture union. This described method provides symptomatic relief, reduction in pain, and promotes bony healing of the fracture nonunion without development of major complications. We suggest that operative fixation should be considered as the primary method of treatment of symptomatic rib nonunions.
Collapse
|
14
|
Ragipoglu D, Bülow J, Hauff K, Voss M, Haffner-Luntzer M, Dudeck A, Ignatius A, Fischer V. Mast Cells Drive Systemic Inflammation and Compromised Bone Repair After Trauma. Front Immunol 2022; 13:883707. [PMID: 35558068 PMCID: PMC9086903 DOI: 10.3389/fimmu.2022.883707] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
There is evidence that mast cells contribute to inflammation induced by hemorrhagic shock, severe tissue injury or sepsis. Mast cells are highly responsive to alarm signals generated after trauma, and release many inflammatory mediators including interleukin-6, a key mediator of posttraumatic inflammation. An overwhelming posttraumatic inflammation causes compromised bone healing; however, the underlying cellular and molecular mechanisms are poorly understood. Recently, we found that mast cells trigger local and systemic inflammation after isolated fracture leading to uneventful bone repair. Here, we investigated whether mast cells critically contribute to trauma-induced compromised bone healing. Male Mcpt5-Cre+ R-DTA mice, which lack connective tissue type mast cells, and their mast cell-competent Cre- littermates underwent a femur fracture with/without thoracic trauma. Posttraumatic systemic and local inflammation and bone repair were assessed 3 h and 21 d post injury. Both, the systemic and pulmonary inflammation was significantly increased in mast cell-competent mice upon combined trauma compared to isolated fracture. In mast cell-deficient mice, the increase of inflammatory mediators in the circulation induced by the severe trauma was abolished. In the bronchoalveolar lavage fluid, the trauma-induced increase of inflammatory cytokines was not reduced, but the neutrophil invasion into the lungs was significantly diminished in the absence of mast cells. Locally in the fracture hematoma, mast cell-competent mice displayed reduced inflammatory mediator concentrations after combined trauma compared to isolated fracture, which was abolished in mast cell-deficient mice. Notably, while combined trauma resulted in compromised bone repair in mast cell-competent mice, indicated by significantly reduced bone and increased cartilage fracture callus contents, this was abolished in Mcpt5-Cre+ R-DTA mice. Therefore, mast cells contribute to trauma-induced compromised bone repair and could be a potential target for new treatment options to improve fracture healing in multiply injured patients.
Collapse
Affiliation(s)
- Deniz Ragipoglu
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Jasmin Bülow
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Kristin Hauff
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Martin Voss
- Medical Faculty, Institute for Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Melanie Haffner-Luntzer
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Anne Dudeck
- Medical Faculty, Institute for Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Verena Fischer
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| |
Collapse
|
15
|
Florescu AM, Lange AB, Brandt EGS, Krusenstjerna-Hafstrøm AV, Vad H, Hallas P. Delayed dorsal scapular artery hematoma following blunt thoracic trauma: a case report and review of the literature. J Med Case Rep 2022; 16:179. [PMID: 35505373 PMCID: PMC9066913 DOI: 10.1186/s13256-022-03400-z] [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: 03/18/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background The present case contributes to the limited literature on delayed chest wall hematomas following blunt trauma. The literature review provides a summary of similar previously reported cases. Case presentation We report the case of a 59-year-old Caucasian male who presented to the emergency department with a rapidly expanding chest wall hematoma. Six weeks earlier, he had sustained multiple rib fractures and a pneumothorax after falling 4 m from a ladder. Computed tomography angiography was used to identify two sources of active bleeding on the left dorsal scapular artery. The patient underwent surgery with evacuation of the hematoma and ligation of the artery. The patient was hospitalized for 3 days and recovered with no sequelae. Conclusions A literature review revealed eight previously reported cases of chest wall hematomas exterior to the endothoracic fascia following blunt trauma. Most cases were initially diagnosed by computed tomography of the chest and finally by angiogram. Management options range from surgical drainage to angiographic embolization. This case is unusual regarding the delay in the development of the hematoma and illustrates the importance of considering this diagnosis even weeks after relevant trauma.
Collapse
Affiliation(s)
- Anna Maria Florescu
- Department of Neurology, Rigshospitalet Glostrup, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark.
| | - Ane Brøndum Lange
- Department of Internal Medicine, Sygehus Sønderjylland, Sønderborg, Denmark
| | | | | | - Henrik Vad
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Hallas
- Department of Emergency Medicine, Holbæk Hospital, Holbæk, Denmark
| |
Collapse
|
16
|
Blevins AJ, Repas SJ, Alexander BM, Siebenburgen C. Blunt traumatic coronary artery dissection: A case study. Trauma Case Rep 2022; 37:100594. [PMID: 35028357 PMCID: PMC8739455 DOI: 10.1016/j.tcr.2021.100594] [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: 12/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Coronary artery dissection is an extremely rare but lethal complication of blunt chest trauma. Dissection may cause thrombus formation or vasospasm, leading to the clinical presentation of acute myocardial infarction. Diagnosis can be difficult as traumatic chest pain has several etiologies; therefore, an electrocardiogram (ECG) is necessary in all cases of thoracic trauma [1-3]. Case report Thirty-eight-year old female, with no significant past medical history, presented to a freestanding emergency department with complaints of severe chest pain and right shoulder pain after a blunt trauma water sport accident. Upon selective angiography of left and right coronary artery and left heart catheterization, the patient was found to have an occluded distal left anterior descending artery (LAD). The patient underwent aspiration thrombectomy of the proximal LAD artery and percutaneous transluminal coronary angioplasty (PTCA) of distal LAD artery, which decreased the stenosis from 100% to less than 10%. The patient was discharged home on hospital day three with follow up in one month.Coronary artery dissection should be considered in blunt thoracic trauma particularly in cases of unexplained chest pain, regardless of the mechanism of injury, age of patient or comorbidities. Patients should be evaluated with an ECG, troponin, and possibly an echocardiogram to rule out this type of injury.
Collapse
Affiliation(s)
- Aaron J Blevins
- Wright State University Boonshoft School of Medicine, 3640 Colonel Glenn Hwy, Fairborn, OH 45324, USA
| | - Steven J Repas
- Wright State University Boonshoft School of Medicine, 3640 Colonel Glenn Hwy, Fairborn, OH 45324, USA
| | - Brittney M Alexander
- Acute Care, Trauma, and General Surgery, Kettering Medical Center, 3535 Southern Blvd, Dayton, OH 45429, USA
| | - Christa Siebenburgen
- Acute Care, Trauma, and General Surgery, Kettering Medical Center, 3535 Southern Blvd, Dayton, OH 45429, USA
| |
Collapse
|
17
|
Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study. Anesth Analg 2021; 133:1296-1302. [PMID: 34473654 DOI: 10.1213/ane.0000000000005730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The erector spinae block is an efficacious analgesic option for the management of rib fracture--related pain. Despite there being minimal published data specifically addressing the safety profile of this block, many societies have made statements regarding its safety and its use as an alternative to traditional regional anesthesia techniques in patients at risk of complications. The primary aim of this study was to characterize the safety profile of erector spinae plane block catheters by determining the incidence of early complications. The secondary aim of this study was to characterize the incidence of late adverse events, as well as the erector spinae plane block catheter failure rate. METHODS We analyzed electronic medical record data of patients who had an erector spinae plane block catheter inserted for the management of rib fractures between November 2017 and September 2020. To assess early adverse events, data collection included hypotension, hypoxemia, local anesthetic systemic toxicity, and pneumothorax thought to be associated with erector spinae plane block catheter insertion. Late complications included catheter site infection and catheter site hematoma. RESULTS A total of 224 patients received 244 continuous erector spinae catheters during the study period. After insertion of the erector spinae, there were no immediate complications such as hypotension, hypoxia, local anesthetic toxicity, or pneumothorax. Of all blocks inserted, 7.7% were removed due to catheter failure (8.4 per 100 catheters; 95% confidence interval [CI], 5.1-13.9 per 100 catheters). This resulted in a failure rate of 1.9 per 1000 catheter days (95% CI, 1.1-6.7 catheter days). Late complications included 2 erythematous catheter sites and 2 small hematomas not requiring intervention. The incidence of a minor late complication was 16.7 per 1000 catheters (95% CI, 6.1-45.5 per 1000 catheters). CONCLUSIONS This study supports the statements made by regional anesthesia societies regarding the safety of the erector spinae plane block. Based on the results presented in this population of trauma patients, the erector spinae plane block catheter is a low-risk analgesic technique that may be performed in the presence of abnormal coagulation status or systemic infection.
Collapse
|
18
|
Becker A, Dola T, Berlin Y, Hershko D. CT as a first-line modality in elderly patients with stable blunt chest trauma. Chin J Traumatol 2021; 24:255-260. [PMID: 34127345 PMCID: PMC8563857 DOI: 10.1016/j.cjtee.2021.03.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/28/2021] [Accepted: 03/25/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Blunt thoracic injuries are common among elderly patients and may be a common cause of morbidity and death from blunt trauma injuries. We aimed to examine the impact of chest CT on the diagnosis and change of management plan in elderly patients with stable blunt chest trauma. We hypothesized that chest CT may play an important role in providing optimal management to this subgroup of trauma patients. METHODS A retrospective analysis was performed on all the admitted adult blunt trauma patients between January 2014 and December 2018. Stable blunt chest trauma patients with abbreviated injury severity (AIS) < 3 for extra-thoracic injuries confirmed with chest X-ray (CXR) and chest CT on admission or during hospitalization were included in the study. The AIS is an international scale for grading the severity of anatomic injury following blunt trauma. Primary outcome variables were occult injuries, change in management, need for surgical procedures, missed injuries, readmission rate, intensive care unit (ICU) and length of hospital stay. RESULTS There are 473 patients with blunt chest trauma included in the study. The study patients were divided into two groups according to the age range: group 1: 289 patients were included and aged 18-64 years; group 2: 184 patients were included and aged 65-99 years . Elderly patients in group 2 more often required ICU admission (11.4% vs. 5.2%), had a longer length of ICU stay (days) (median 11 vs. 6, p = 0.01), and the length of hospital stay (days) (median 14 vs. 6, p = 0.04). Injuries identified on chest CT has led to a change of management in 4.4% of young patients in group 1 and in 10.9% of elderly patients in group 2 with initially normal CXR. Chest CT resulted in a change of management in 12.8% of young patients in group 1 and in 25.7% of elderly patients in group 2 with initially abnormal CXR. CONCLUSION Chest CT led to a change of management in a substantial proportion of elderly patients. Therefore, we recommend chest CT as a first-line imaging modality in patients aged over 65 years with isolated blunt chest trauma.
Collapse
Affiliation(s)
- Alexander Becker
- Department of Surgery A, Emek Medical Center, Afula, 18101, Israel,Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, 31096, Israel,Corresponding author. Department of Surgery A, Emek Medical Center, Afula, 18101, Israel
| | - Tamar Dola
- Department of Surgery A, Emek Medical Center, Afula, 18101, Israel
| | - Yuri Berlin
- Department of Surgery A, Emek Medical Center, Afula, 18101, Israel,Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, 31096, Israel
| | - Dan Hershko
- Department of Surgery A, Emek Medical Center, Afula, 18101, Israel,Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, 31096, Israel
| |
Collapse
|
19
|
[Interventional management of secondary retentions after thoracic and abdominal trauma]. Unfallchirurg 2021; 124:610-620. [PMID: 34338838 DOI: 10.1007/s00113-021-01050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Percutaneous treatment of secondary thoracic and abdominal retention formations after blunt or penetrating trauma now represents a standard interventional radiological procedure. Various supportive imaging procedures are available, whereby computed tomography is mostly the treatment of choice due to the high diagnostic sensitivity. OBJECTIVE Based on clinical examples this review article gives an overview of the state of the art minimally invasive interventional treatment of secondary posttraumatic retention formations of the thorax and abdomen. The indications and contraindications are illustrated and typical techniques and access routes are described. MATERIAL AND METHODS Besides the general introduction and technical part, the article is divided into the anatomical compartments thorax and abdomen and frequently asked questions are dealt with. CONCLUSION After the study of this article you should have got to know and understand the indications for a minimally invasive approach, the possible techniques and necessary materials as well as the indications and contraindications.
Collapse
|
20
|
Shoar S, Hosseini FS, Naderan M, Khavandi S, Tabibzadeh E, Khavandi S, Shoar N. Cardiac injury following blunt chest trauma: diagnosis, management, and uncertainty. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2021; 11:80-89. [PMID: 34094699 PMCID: PMC8166660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
Due to the evolving nature of injuries caused by high-speed motor vehicle accidents, the incidence rate of blunt chest trauma is continuously increasing. Blunt cardiac injury (BCI) is a potentially lethal entity as a result of trauma to the chest. Due to its indistinct clinical presentation and heterogeneous definition, BCI might be missed during the initial survey of trauma patients in the acute care setting. Additionally, unnecessary operation in hemodynamically stable patients in whom the extent of cardiac injury has not been thoroughly evaluated might result in adverse clinical outcome. Due to ongoing advances in the diagnostic modalities and minimally invasive procedures in the acute care and trauma setting, patients with blunt trauma to the chest, who are also suspected of having a BCI, can be monitored with more confidence and managed accordingly as the clinical scenario evolves. While low-yield diagnostics such as chest X ray, electrocardiogram, and a bedside ultrasonography are still routinely performed in patients with suspected BCI, high-yield modalities such as computed tomography, highly sensitive cardiac biomarkers, and transesophageal echocardiography are all a next step in the management approach. In either case, the clinical judgment of the medical team plays a pivotal role in transition to the next step with adequate resuscitation remaining an inevitable part.
Collapse
Affiliation(s)
- Saeed Shoar
- Department of Clinical Research, ScientificWriting CorpHouston, TX, USA
| | | | - Mohammad Naderan
- Faculty of Medicine, Tehran University of Medical SciencesTehran, Iran
| | - Siamak Khavandi
- Department of Ophthalmology, Tabriz University of Medical SciencesTabriz, Iran
| | - Elsa Tabibzadeh
- Department of Anaesthesiology and Critical Care, Tabriz University of Medical SciencesTabriz, Iran
| | - Soheila Khavandi
- Department of Cardiology, Tabriz University of Medical SciencesTabriz, Iran
| | - Nasrin Shoar
- Faculty of Medicine, Kashan University of Medical SciencesKashan, Iran
| |
Collapse
|
21
|
Yoga-An Alternative Form of Therapy in Patients with Blunt Chest Trauma: A Randomized Controlled Trial. World J Surg 2021; 45:2015-2026. [PMID: 33738521 PMCID: PMC7972014 DOI: 10.1007/s00268-021-06057-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Yoga as alternative form of therapy has shown positive impact on pulmonary functions, exercise capacity, behavioral changes, and inflammation in non-trauma patients. However, the efficacy of Yoga has not been studied in chest trauma patients. METHODS This randomized controlled trial was conducted at level-1 Trauma Centre. Isolated chest injury patients were randomized into either standard physiotherapy or Yogatherapy groups. Patients in physiotherapy group received conventional chest physiotherapy and Yogatherapy group received a set of Yogic exercises in addition to conventional chest physiotherapy. Primary outcome measure was changes in pulmonary function tests (PFT) at 4 weeks of discharge. Secondary outcomes were changes in quality of life (QoL), respiratory muscle strength and endurance, chest wall mobility, and levels of cytokines at 4 weeks. Data were analyzed using STATA v14.0. RESULTS A total of 89 eligible patients were randomized to physiotherapy (n = 46) and Yoga therapy (n = 43) groups. Demographic characteristics were comparable in both the groups. There were statistically significant improvements in PFT in the Yogatherapy group compared with physiotherapy with an increase in Forced vital capacity (p = 0.02) and Forced expiratory volume (p = 0.01) at 4 weeks. In addition, there were significant improvement in physical component of QoL, respiratory muscle endurance (p = 0.003) and axillary cirtometry (p = 0.009) in the Yogatherapy group. However, no statistically significant difference in the trends of cytokine markers seen between the groups. CONCLUSION Yoga was found to be effective in improving pulmonary functions and QoL in patients with chest trauma. (Trial registered at ctri.nic.in/clinicaltrials/login.php, numberREF/2016/05/011,287).
Collapse
|
22
|
Hachemi Y, Rapp AE, Lee S, Dorn AK, Krüger BT, Kaiser K, Ignatius A, Tuckermann J. Intact Glucocorticoid Receptor Dimerization Is Deleterious in Trauma-Induced Impaired Fracture Healing. Front Immunol 2021; 11:628287. [PMID: 33679723 PMCID: PMC7927427 DOI: 10.3389/fimmu.2020.628287] [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: 11/11/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Following severe trauma, fracture healing is impaired because of overwhelming systemic and local inflammation. Glucocorticoids (GCs), acting via the glucocorticoid receptor (GR), influence fracture healing by modulating the trauma-induced immune response. GR dimerization-dependent gene regulation is essential for the anti-inflammatory effects of GCs. Therefore, we investigated in a murine trauma model of combined femur fracture and thoracic trauma, whether effective GR dimerization influences the pathomechanisms of trauma-induced compromised fracture healing. To this end, we used mice with decreased GR dimerization ability (GRdim). The healing process was analyzed by cytokine/chemokine multiplex analysis, flow cytometry, gene-expression analysis, histomorphometry, micro-computed tomography, and biomechanical testing. GRdim mice did not display a systemic or local hyper-inflammation upon combined fracture and thorax trauma. Strikingly, we discovered that GRdim mice were protected from fracture healing impairment induced by the additional thorax trauma. Collectively and in contrast to previous studies describing the beneficial effects of intact GR dimerization in inflammatory models, we report here an adverse role of intact GR dimerization in trauma-induced compromised fracture healing.
Collapse
Affiliation(s)
- Yasmine Hachemi
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Anna E Rapp
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Sooyeon Lee
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Ann-Kristin Dorn
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Benjamin T Krüger
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Kathrin Kaiser
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Jan Tuckermann
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| |
Collapse
|
23
|
Khodadadi-Hassankiadeh N, Rad E, Woldemichae A, Monsef-Kasamei V. Time of return to work and associated factors in rib fracture victims. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
24
|
Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg 2020; 89:679-685. [PMID: 32649619 DOI: 10.1097/ta.0000000000002881] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH. METHODS We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX. RESULTS A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up. CONCLUSION Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
Collapse
|
25
|
Stop flailing: The impact of bicortically displaced rib fractures on pulmonary outcomes in patients with chest trauma - an American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2020; 89:658-664. [PMID: 32773671 DOI: 10.1097/ta.0000000000002848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current evaluation of rib fractures focuses almost exclusively on flail chest with little attention on bicortically displaced fractures. Chest trauma that is severe enough to cause fractures leads to worse outcomes. An association between bicortically displaced rib fractures and pulmonary outcomes would potentially change patient care in the setting of trauma. We tested the hypothesis that bicortically displaced fractures were an important clinical marker for pulmonary outcomes in patients with nonflail rib fractures. METHODS This nine-center American Association for the Surgery of Trauma multi-institutional study analyzed adults with two or more rib fractures. Admission computerized tomography scans were independently reviewed. The location, degree of rib fractures, and pulmonary contusions were categorized. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of pneumonia, acute respiratory distress syndrome (ARDS), and tracheostomy. Analyses were performed in nonflail patients and also while controlling for flail chest to determine if bicortically displaced fractures were independently associated with outcomes. RESULTS Of the 1,110 patients, 103 (9.3%) developed pneumonia, 78 (7.0%) required tracheostomy, and 30 (2.7%) developed ARDS. Bicortically displaced fractures were present in 277 (25%) of patients and in 206 (20.3%) of patients without flail chest. After adjusting for patient demographics, injury, and admission physiology, negative pulmonary outcomes occurred over twice as frequently in those with bicortically displaced fractures without flail chest (n = 206) when compared with those without bicortically displaced fractures-pneumonia (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.6), ARDS (OR, 2.6; 95% CI, 1.0-6.8), and tracheostomy (OR, 2.7; 95% CI, 1.4-5.2). When adjusting for the presence of flail chest, bicortically displaced fractures remained an independent predictor of pneumonia, tracheostomy, and ARDS. CONCLUSION Patients with bicortically displaced rib fractures are more likely to develop pneumonia, ARDS, and need for tracheostomy even when controlling for flail chest. Future studies should investigate the utility of flail chest management algorithms in patients with bicortically displaced fractures. LEVEL OF EVIDENCE Prognostic and epidemiological study, level III.
Collapse
|
26
|
ÇAKMAK V, TÜRKOĞLU S, ÖZEN M, ÇAKMAK P. Künt göğüs travmasında sternoklaviküler eklem mesafelerinin genişlemesi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.779481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
27
|
Naar L, El Hechi MW, van Erp IA, Mashbari HNA, Fawley J, Parks JJ, Fagenholz PJ, King DR, Mendoza AE, Velmahos GC, Kaafarani HMA, Saillant NN. Isolated rib cage fractures in the elderly: Do all patients belong to the intensive care unit? A retrospective nationwide analysis. J Trauma Acute Care Surg 2020; 89:1039-1045. [PMID: 32697447 DOI: 10.1097/ta.0000000000002891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Western Trauma Association guidelines recommend admitting patients 65 years or older with two or more rib fractures diagnosed by chest radiograph to the intensive care unit (ICU). Increased use of computed tomography has led to identification of less severe, "occult" rib fractures. We aimed to evaluate current national trends in disposition of older patients with isolated rib cage fractures and to identify characteristics of patients initially admitted to the ward who failed ward management. METHODS A retrospective cohort study of patients 65 years or older with isolated two or more blunt rib cage fractures using the 2010 to 2016 American College of Surgeons Trauma Quality Improvement Program database was performed. Ward failure was defined as patients initially admitted to the ward with subsequent need for unplanned ICU admission or intubation. Multivariable analyses were derived to study the independent predictors of failure of ward management. Propensity score matching sub-analysis was used to assess outcomes in patients admitted to the ward versus ICU. RESULTS There were 5,021 patients included in the analysis. Of these patients, 1,406 (28.0%) were admitted to the ICU. On multivariable analysis, age was an independent predictor of ICU admission. Of the 3,577 patients admitted directly to the ward, 38 (1.1%) patients required unplanned intubation or ICU admission. Independent predictors of failure of ward management included chronic renal failure (odds ratio [OR], 7.20; p ≤ 0.001; 95% confidence interval [CI], 2.50-20.76), traumatic pneumothorax (OR, 8.70; p = 0.008; 95% CI, 1.76-42.93), concurrent sternal fracture (OR, 6.52; p ≤ 0.001; 95% CI, 2.53-16.80), drug use disorder (OR, 6.58; p = 0.032; 95% CI, 1.17-36.96), and emergency department oxygen requirement or oxygen saturation less than 95% (OR, 2.38; p = 0.018; 95% CI, 1.16-4.86). Mortality was higher in patients with delayed ICU care versus patients with successful ward disposition (21.1% vs. 0.8%; p < 0.001). CONCLUSION Our results suggest that the majority of isolated rib cage fractures in older patients are safely managed on the ward with exceedingly low ward failure rates (1.1%). Patients with failure of ward management have significantly higher mortality, and we have identified predictors of failing the ward. LEVEL OF EVIDENCE Therapeutic/Care Management, level IV; Prognostic III.
Collapse
Affiliation(s)
- Leon Naar
- From the Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Affiliation(s)
- J. J. De Waele
- Department of Thoracic and Vascular Surgery, University Hospital Ghent, Gent, Belgium
| | - F. E. G. Vermassen
- Department of Thoracic and Vascular Surgery, University Hospital Ghent, Gent, Belgium
| | - J. De Roose
- Department of Thoracic and Vascular Surgery, University Hospital Ghent, Gent, Belgium
| |
Collapse
|
29
|
Affiliation(s)
- P. Segers
- Departments of Thoracic and Vascular Surgery and of Intensive Care, University Hospital of Antwerp, Edegem, Belgium
| | - P. Van Schil
- Departments of Thoracic and Vascular Surgery and of Intensive Care, University Hospital of Antwerp, Edegem, Belgium
| | - Ph. Jorens
- Departments of Thoracic and Vascular Surgery and of Intensive Care, University Hospital of Antwerp, Edegem, Belgium
| | - F. Van Den Brande
- Departments of Thoracic and Vascular Surgery and of Intensive Care, University Hospital of Antwerp, Edegem, Belgium
| |
Collapse
|
30
|
Muronoi T, Kidani A, Oka K, Konishi M, Kuramoto S, Shimojo Y, Hira E, Watanabe H. Delayed massive hemothorax due to diaphragm injury with rib fracture: A case report. Int J Surg Case Rep 2020; 77:133-137. [PMID: 33160173 PMCID: PMC7649592 DOI: 10.1016/j.ijscr.2020.10.125] [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] [Received: 09/18/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
Diaphragmatic injury can cause delayed hemothorax. A thoracotomy should be considered in patients with delayed hemothorax and shock. Delayed hemothorax required surgery to control bleeding from diaphragmatic injury.
Introduction Delayed massive hemothorax after blunt trauma is rare, although associated with significant morbidity and mortality. In most cases, the intercostal artery is the main bleeding source. We report a rare case of delayed massive hemothorax due to a diaphragm injury with a lower rib fractures. Presentation of case A 58-year-old man, transported to our hospital four hours after a 2-meter fall from a ladder, had left-sided fractures to ribs 11 and 12, thoracic and lumbar vertebral fractures, and traumatic subarachnoid hemorrhage. On admission, no left hemothorax was documented; however, 17 h post-injury he developed hypovolemic shock. Plain chest radiographs showed a massive left hemothorax with a mediastinal shift. Chest contrast-enhanced computed tomography revealed extravasation of the contrast agent in the chest cavity. No intercostal arterial bleeding was evident on emergency angiography. A left anterolateral thoracotomy through the 6th intercostal space revealed rib fractures and active bleeding from the dorsal side of the left hemidiaphragm. Suture hemostasis was performed for the diaphragm injury and the disrupted ribs were repaired. Discussion Embolization of diaphragm-feeding arteries is not a simple or fast procedure. Clinically, predicting delayed hemothorax is challenging, and careful observation of trauma patients with lower rib fractures is needed. Thoracotomy should be considered for immediate hemostasis in patients with sudden shock, with complete hematoma drainage and repair of the disrupted rib. Conclusion Diaphragmatic injury with lower rib fractures can result in delayed hemothorax, requiring thoracotomy.
Collapse
Affiliation(s)
- Tomohiro Muronoi
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan.
| | - Akihiko Kidani
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kazuyuki Oka
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Madoka Konishi
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Shunsuke Kuramoto
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Yoshihide Shimojo
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Eiji Hira
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Hiroaki Watanabe
- Department of Acute Care Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| |
Collapse
|
31
|
Traumatic right atrial rupture bridge to definitive repair with extra-corporeal life support. Trauma Case Rep 2020; 30:100373. [PMID: 33299923 PMCID: PMC7701842 DOI: 10.1016/j.tcr.2020.100373] [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: 11/01/2020] [Indexed: 11/25/2022] Open
Abstract
Cardiac injury secondary to non-penetrating trauma is more common than thought, albeit, the injury is usually minor and goes undiagnosed without significant sequelae in most cases. Blunt cardiac rupture is much rarer accounting for <0.05% of all trauma cases but lethal in most circumstances. We present a case report of a young trauma victim who presented with both right atrial rupture and traumatic atrial septal disruption (ASD) requiring extra-corporeal life support (ECLS) and surgical repair. Blunt cardiac trauma with chamber rupture and septal disruption is a devastating injury. Stopping the hemorrhage and using ECLS gave our patient time to stabilize before definitive management of her traumatic ASD.
Collapse
|
32
|
Mori S, Ai T, Morishita K, Otomo Y. A Case of Fatal Stanford Type A Aortic Dissection Caused by a Traffic Accident with Low Energy Impact. Open Access Emerg Med 2020; 12:287-291. [PMID: 33116964 PMCID: PMC7569054 DOI: 10.2147/oaem.s265409] [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] [Received: 06/05/2020] [Accepted: 09/18/2020] [Indexed: 12/30/2022] Open
Abstract
A seemingly healthy 84-year-old female pedestrian was mildly bumped by a car, and she hit her left shoulder, flank, and lower legs when she fell down on a street. She was conscious and stable when transferred to an emergency room. She had no sign of any major injuries except minor lacerations on her legs. Repeated evaluations including chest X-ray, ECG, and focused assessment with sonography for trauma did not reveal any abnormal findings. While waiting for discharge, she started having mild chest discomfort. Unexpectedly, the third echocardiogram showed mild pericardial effusion, and a CT with contrast showed aortic dissection in the ascending aorta and infra-left subclavian aortic dissection. She was immediately transferred by a helicopter to a tertiary trauma center for emergent repair surgery. Considering the site of dissections, progression of existing intrinsic intimal tear triggered by energy impact was suspected. However, traumatic causes could not be excluded. Extra caution and diligence should be exercised when examining elderly patients in blunt trauma.
Collapse
Affiliation(s)
- Shusuke Mori
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiko Ai
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan.,Emergency Department, JA Toride Medical Center, Ibaraki, Japan.,Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan.,Emergency Department, JA Toride Medical Center, Ibaraki, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
33
|
Aysan E. To be a surgeon may be life saving. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620933202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the first 24 h after multiple rib fractures, a life-threatening massive hemothorax is very rare but can cause death at home in cases who have been discharged. A 50-year-old male general surgeon, was admitted to the emergency unit after a motorcycle accident. Multiple rib fractures were diagnosed but no hemopneumothorax or hemodynamic instability were observed. After 24 h of observation, he was discharged. On the fifth day at home he was woken by symptoms of acute massive hemothorax. With the assistance of his wife he commenced intravenous fluid resuscitation to treat his own hemodynamic instability and transferred himself to his own hospital via ambulance where he subsequently underwent thoracotomy for arrest of haemorrhage. Late development of a massive hemopneumothorax after multiple rib fractures is rare, but may be a life-threatening risk. Such patients should be more closely followed up and informed about symptoms and treatment.
Collapse
Affiliation(s)
- Erhan Aysan
- Department of General Surgery, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| |
Collapse
|
34
|
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.
Collapse
|
35
|
Boyadzhieva G, Stickel M, Christ M, Minervini F. A Rare Case of Pyopericardium After Blunt Thoracic Trauma. Ann Thorac Surg 2020; 111:e259-e261. [PMID: 32882194 DOI: 10.1016/j.athoracsur.2020.06.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
The bacterial purulent pericarditis is rapidly progressive and represents a highly fatal infection, with mortality rates reaching up to 100% if untreated. Approximately 40% to 50% of all cases are caused by Gram-positive bacteria, especially Streptococcus pneumoniae. We describe an extremely rare case of S. pneumoniae purulent pericarditis as a delayed complication of a blunt thoracic trauma. The patient was successfully treated with urgent pericardiocentesis, thoracoscopic pericardial fenestration, and broad-spectrum antibiotics. Owing to the high mortality rate of a purulent pericarditis, a high index of suspicion is needed in order to instaurate an appropriate therapy with drainage and antibiotics.
Collapse
Affiliation(s)
| | - Michael Stickel
- Emergency Department, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Michael Christ
- Emergency Department, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| |
Collapse
|
36
|
Gemal H, Lu TC, Peeceeyen S. Delayed massive haemopneumothorax with shock after 'Zumba'. ANZ J Surg 2020; 91:E212-E213. [PMID: 32845555 DOI: 10.1111/ans.16283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/26/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hugo Gemal
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, New South Wales, Australia.,Emergency Department, St George Hospital, Sydney, New South Wales, Australia
| | - Thomas Chengxuan Lu
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, New South Wales, Australia.,Emergency Department, St George Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sheen Peeceeyen
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
37
|
Beshay M, Mertzlufft F, Kottkamp HW, Reymond M, Schmid RA, Branscheid D, Vordemvenne T. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg 2020; 15:45. [PMID: 32736642 PMCID: PMC7393329 DOI: 10.1186/s13017-020-00324-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/24/2020] [Indexed: 12/04/2022] Open
Abstract
Abstract Objectives Thoracic trauma (TT) is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. Its management is still a very challenging task. The purpose of this study was to analyse the risk factors affecting the outcome in a high-volume trauma centre and the efficacy of a specialised trauma team in level 1 trauma centres. Patients and methods Between January 2003 and December 2012, data of all patients admitted to the accident and emergency (A&E) department were prospectively collected at the German Trauma Registry (GTR) and thereafter retrospectively analysed. Patients with chest trauma, an Injury Severity Score (ISS) ≥ 18 and an Abbreviated Injury Scale (AIS) > 2 in more than one body region were included. Patients were divided into two groups: group I included patients presenting with thoracic trauma between January 2003 and December 2007. The results of this group were compared with the results of another group (group II) in a later 5-year period (Jan. 2008–Dec. 2012). Univariate and multivariate analyses were performed, and differences with p < 0.05 were considered statistically significant. Results There were 630 patients (56%) with thoracic trauma. A total of 540 patients (48%) had associated extrathoracic injuries. Group I consisted of 285 patients (197 male, mean age 46 years). Group II consisted of 345 patients (251 male, mean age 49 years). Overall 90-day mortality was 17% (n = 48) in group I vs. 9% (n = 31) in group II (p = 0.024). Complication rates were higher in group I (p = 0.019). Higher Injury Severity Scores (ISSs) and higher Abbreviated Injury Acale (AIS) scores in the thoracic region yielded a higher rate of mortality (p < 0.0001). Young patients (< 40 years) were frequently exposed to severe thoracic injury but showed lower mortality rates (p = 0.014). Patients with severe lung contusions (n = 94) (15%) had higher morbidity and mortality (p < 0.001). Twenty-three (8%) patients underwent emergency thoracotomy in group I vs. 14 patients (4%) in group II (p = 0.041). Organ replacement procedures were needed in 18% of patients in group I vs. 31% of patients in group II (p = 0.038). Conclusions The presence of severe lung contusion, a higher ISS and AISthoracic score and advanced age are independent risk factors that are directly related to a higher mortality rate. Management of blunt chest trauma with corrective chest tube insertion, optimal pain control and chest physiotherapy results in good outcomes in the majority of patients. Optimal management with better survival rates is achievable in specialised centres with multidisciplinary teamwork and the presence of thoracic surgical experience.
Collapse
Affiliation(s)
- Morris Beshay
- Department of General Thoracic Surgery, Protestant Hospital of Bethel Foundation, Burgsteig, 13, Bielefeld, Germany.
| | - Fritz Mertzlufft
- Department of Anesthesia and Intensive Care, Protestant Hospital of Bethel Foundation, Bielefeld, Germany
| | - Hans Werner Kottkamp
- Division of Accident & Emergency, Protestant Hospital of Bethel Foundation, Burgsteig, 13, Bielefeld, Germany
| | - Marc Reymond
- Department of General Thoracic Surgery, Protestant Hospital of Bethel Foundation, Burgsteig, 13, Bielefeld, Germany
| | | | - Detlev Branscheid
- Department of General Thoracic Surgery, Protestant Hospital of Bethel Foundation, Burgsteig, 13, Bielefeld, Germany
| | - Thomas Vordemvenne
- Division of Accident & Emergency, Protestant Hospital of Bethel Foundation, Burgsteig, 13, Bielefeld, Germany
| |
Collapse
|
38
|
Krestan C, Greitbauer M. Trauma an Brustwirbelsäule und knöchernem Thorax. Radiologe 2020; 60:610-623. [DOI: 10.1007/s00117-020-00712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Oyetunji TA, Jackson HT, Obirieze AC, Moore D, Branche MJ, Greene WR, Cornwell EE, Siram SM. Associated Injuries in Traumatic Sternal Fractures: A Review of the National Trauma Data Bank. Am Surg 2020. [DOI: 10.1177/000313481307900714] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.
Collapse
Affiliation(s)
| | - Hope T. Jackson
- Department of Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC
| | | | - Danier Moore
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Marc J. Branche
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Wendy R. Greene
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Edward E. Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | | |
Collapse
|
40
|
Baru A, Weldegiorgis E, Zewdu T, Hussien H. Characteristics and outcome of traumatic chest injury patients visited a specialized hospital in Addis Ababa, Ethiopia: A one-year retrospective study. Chin J Traumatol 2020; 23:139-144. [PMID: 32111481 PMCID: PMC7296352 DOI: 10.1016/j.cjtee.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Injury continues to be an important cause of morbidity and mortality in both developed and developing countries. Globally, it is responsible for approximately 5.8 million deaths per year and 91% of these deaths occur in developing countries. Road traffic collision, suicides and homicides are the leading cause of traumatic deaths. Despite the fact that traumatic chest injury is being responsible for 10% of all trauma-related hospital admissions and 25% of trauma-related deaths across the world including in Ethiopia, only few published studies showed the burden of traumatic chest injury in Ethiopia. So, this study aims at assessing the characteristics and outcome of traumatic chest injury patients visited Tikur Anbesa Specialized Hospital (TASH) over one year period. METHODS A single center based retrospective study was done. We collected data from patients' records to assess characteristics and outcome of traumatic chest injury at TASH over one year period. All patients diagnosed with traumatic chest injury and received treatment at the hospital from January 1 to December 31, 2016 regardless of its types and severity levels were included in the study. Patients with incomplete medical records for at least 20% of the study variables and without detailed medical history, or patients died before receiving any health care were excluded from the study. The collected data were cleaned and entered into Epidata version 3.1 and exported to SPSS Version 21.0 for analysis. Bivariate and multivariate logistic regression models were used to examine factors associated with outcome of traumatic chest injury patients. RESULTS A total of 192 chest injury patients were included in the study and about one-fourth of chest injury victims were died during treatment period in TASH. Road traffic collision (RTC) was the leading cause of morbidity and mortality among traumatic chest injury victims. Age of the victims (adjusted odds ratio (AOR) 8.9, 95% confidence interval (CI) 1.51-53.24), time elapsed between the occurrence of traumatic chest injury and admission to health care facilities (AOR 4.6, 95% CI 1.19-18.00), length of stay in hospital (AOR 0.12, 95% CI 0.02-0.58), presence of multiple extra-thoracic injury (AOR 25, 95% CI 4.18-150.02) and development of complications (AOR 23, 95% CI 10-550) were factors associated with death among traumatic chest injury patients in this study. CONCLUSION RTC contributed for a considerable number of traumatic chest injuries in this study. Old age, delay in delivering the victim to health care facilities, length of stay in hospital, and development of atelectasis and pneumonia were associated with death among traumatic chest injury patients. Road safety interventions, establishment of organized pre-hospital services, and early recognition and prompt management of traumatic chest injury related complications are urgently needed to overcome the underlying problems in the study setting.
Collapse
Affiliation(s)
- Ararso Baru
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia.
| | | | - Tigist Zewdu
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heyria Hussien
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
41
|
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.
Collapse
|
42
|
A Legal and Forensic Medicine Approach to Police Physical Intervention Techniques in High-Risk Situations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082809. [PMID: 32325816 PMCID: PMC7215352 DOI: 10.3390/ijerph17082809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/01/2022]
Abstract
Background: The physical intervention techniques (PITs) typically used by the police in troublesome situations are examined in terms of injuring potential depending on whether they target a body zone of high, medium or low vulnerability. Based on legal and forensic considerations, and principles of congruence, opportunity and proportionality, a need exists to favor opponent locking and arrest techniques targeting non-vulnerable zones to minimize the risk of severe damage. Methods: A search of the training manuals for the different kind of law of enforcement officers was carried out. Revision of injuries was available from electronic databases of academic o medical journals. Results: Three different locking and arrest PITs based on operational tactical procedures (OTP) that avoid zones of high or medium vulnerability are proposed. The new techniques use blocking, diverting and grabbing of the upper and lower limbs, followed by dislocation and locking of the same targets. Conclusions: The damaging potential of such PITs was assessed in terms of anatomical region and most were found to have a high risk of severe damage. The alternative PITs proposed here, which rely on OTP, improve in legal and forensic medical terms on existing choices and dramatically reduce the risk of injuring arrestees.
Collapse
|
43
|
Zahran MR, Elwahab AAEMA, El Nasr MMA, El Heniedy MA. Evaluation of the predictive value of thorax trauma severity score (TTSS) in thoracic-traumatized patients. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-0015-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Background
Thorax trauma severity score (TTSS) combines patient-related parameters with the anatomical and physiological parameters, and it can be easily calculated in the emergency room. The validity of this score in the Egyptian population has not been tested; therefore, the objective of this study was to evaluate the prognostic role of TTSS to predict the outcome of thoracic trauma in the Egyptian patients in two centers.
Results
The study included 284 male patients (94.7%) with a mean age of 41 years. Fifty-six patients (18.7%) had conservative management, 216 had morbidity (72%), and 28 patients died (9.3%). One hundred forty-eight patients (49.3%) had a thoracostomy tube, and thoracotomy was required in 4 patients (1.3%). Respiratory rate above 20 cycles/min at admission was associated with mortality (n = 28 (9.3%); p < 0.001). One hundred thirty-six patients had TTSS between 0 and 5 points; 56 of them were discharged and 80 of them were admitted to the inpatient ward with a good prognosis. Twenty-four patients had TTSS between 21 and 25 points; all the 24 patients had a fatal prognosis. A cut-off value of 7 points or more of TTSS was 100% sensitive and 97.73% specific to poor and fatal prognosis, and it was significantly associated with acute respiratory distress syndrome and the need for mechanical ventilation (n = 64; p < 0.001; AUC = 0.998).
Conclusion
The outcome of thoracic trauma patients could be predicted based on the thorax trauma severity score. A score of 7 points or above was associated with increased morbidity, and a score of 20 points or above predicted a fatal prognosis and prolonged mechanical ventilation.
Collapse
|
44
|
Abstract
Hemothorax is a collection of blood in the pleural cavity usually from traumatic injury. Chest X-ray has historically been the imaging modality of choice upon arrival to the hospital. The sensitivity and specificity of point-of-care ultrasound, specifically through the Extended Focal Assessment with Sonography in Trauma (eFAST) protocol has been significant enough to warrant inclusion in most Level 1 trauma centers as an adjunct to radiographs.1,2 If the size or severity of a hemothorax warrants intervention, tube thoracostomy has been and still remains the treatment of choice. Most cases of hemothorax will resolve with tube thoracostomy. If residual blood remains within the pleural cavity after tube thoracostomy, it is then considered to be a retained hemothorax, with significant risks for developing late complications such as empyema and fibrothorax. Once late complications occur, morbidity and mortality increase dramatically and the only definitive treatment is surgery. In order to avoid surgery, research has been focused on removing a retained hemothorax before it progresses pathologically. The most promising therapy consists of fibrinolytics which are infused into the pleural space, disrupting the hemothorax, allowing for further drainage. While significant progress has been made, additional trials are needed to further define the dosing and pharmacokinetics of fibrinolytics in this setting. If medical therapy and early procedures fail to resolve the retained hemothorax, surgery is usually indicated. Surgery historically consisted solely of thoracotomy, but has been largely replaced in non-emergent situations by video-assisted thoracoscopy (VATS), a minimally invasive technique that shows considerable improvement in the patients' recovery and pain post-operatively. Should all prior attempts to resolve the hemothorax fail, then open thoracotomy may be indicated.
Collapse
|
45
|
Liebsch C, Seiffert T, Vlcek M, Beer M, Huber-Lang M, Wilke HJ. Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases. PLoS One 2019; 14:e0224105. [PMID: 31856165 PMCID: PMC6922429 DOI: 10.1371/journal.pone.0224105] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/04/2019] [Indexed: 01/19/2023] Open
Abstract
Rib fractures represent the most common bone fracture, occurring in 10-20% of all blunt trauma patients and leading to concomitant injuries of the inner organs in severe cases. The purpose of this study was to identify specific serial rib fracture patterns after blunt chest trauma. 380 serial rib fracture cases were investigated. Fractures were assigned to five different locations within the transverse plane. Rib level, fracture type, and dislocation grades were recorded and related to the cause of accident. In total, 3735 rib fractures were identified (9.8 per patient). 54% of the rib fractures were detected on the left thorax. Rib fracture distribution exhibited a hotspot at rib levels 4 to 7 in the lateral and posterolateral segments. On average, most rib fractures occurred in crush/burying injuries (15.8, n = 13) and pedestrian accidents (12.8, n = 13), least in car/truck accidents (8.9, n = 75). In the car/truck accident group, 47% of all rib fractures were in the lateral segment, in case of frontal collision (n = 24) even 60%. Fall injuries (n = 141) entailed mostly posterolateral rib fractures (35%). In case of falls >3 m (n = 45), 48% more rib fractures were detected on the left thorax. In cardiopulmonary resuscitation related serial rib fractures (n = 33), 70% of all rib fractures were located anterolaterally. Infractions were the most observed fracture type (44%), followed by oblique (25%) and transverse (18%) fractures, while 46% of all rib fractures were dislocated (15% ≥ rib width). Serial rib fractures showed distinct fracture patterns depending on the cause of accident. When developing a serial rib fracture classification system, data regarding patterns, fracture types, dislocation grades, and associated fractures should be included.
Collapse
Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Tina Seiffert
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Markus Vlcek
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Centre, Ulm, Germany
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma Immunology, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
- * E-mail:
| |
Collapse
|
46
|
Chung J, Berguson M, Mendelson A, Barnett R, Schwenk ES, Evans NR, Cowan SW, Goldhammer JE. Cross-Field Ventilation for Treatment of Harlequin Syndrome in Traumatic Tracheobronchial Injury Repair Using Intraoperative Venoarterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2019; 33:3090-3094. [DOI: 10.1053/j.jvca.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/11/2022]
|
47
|
Regional analgesia for patients with traumatic rib fractures: A narrative review. J Trauma Acute Care Surg 2019; 88:e22-e30. [DOI: 10.1097/ta.0000000000002524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
48
|
Marini CP, Petrone P, Soto-Sánchez A, García-Santos E, Stoller C, Verde J. Predictors of mortality in patients with rib fractures. Eur J Trauma Emerg Surg 2019; 47:1527-1534. [DOI: 10.1007/s00068-019-01183-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022]
|
49
|
Martin TJ, Eltorai AS, Dunn R, Varone A, Joyce MF, Kheirbek T, Adams C, Daniels AH, Eltorai AEM. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury 2019; 50:1159-1165. [PMID: 31047683 DOI: 10.1016/j.injury.2019.04.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/21/2019] [Indexed: 02/02/2023]
Abstract
Rib fractures are common injuries associated with significant morbidity and mortality, largely due to pulmonary complications. Despite equivocal effectiveness data, incentive spirometers are widely utilized to reduce pulmonary complications in the postoperative setting. Few studies have evaluated the effectiveness of incentive spirometry after rib fracture. Multiple investigations have demonstrated incentive spirometry to be an important screening tool to identify high-risk rib fracture patients who could benefit from aggressive, multidisciplinary pulmonary complication prevention strategies. This review evaluates the epidemiology of rib fractures, their associated pulmonary complications, along with the evidence for optimizing their clinical management through the use of incentive spirometry, multimodal analgesia, and surgical fixation.
Collapse
Affiliation(s)
- Thomas J Martin
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | - Ashley Szabo Eltorai
- Department of Anesthesia, Yale University, New Haven, CT, United States; Yale University School of Medicine, New Haven, CT, United States.
| | - Ryan Dunn
- Mayo Clinic College of Medicine and Science, Rochester, MN, United States.
| | - Andrew Varone
- The Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Surgery, Brown University, Providence, RI, United States.
| | - Maurice F Joyce
- The Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Anesthesiology, Brown University, Providence, RI, United States.
| | - Tareq Kheirbek
- The Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Surgery, Brown University, Providence, RI, United States; Division of Trauma and Critical Care, Department of Surgery, Brown University, Providence, RI, United States.
| | - Charles Adams
- The Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Surgery, Brown University, Providence, RI, United States; Division of Trauma and Critical Care, Department of Surgery, Brown University, Providence, RI, United States.
| | - Alan H Daniels
- The Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Orthopedics, Brown University, Providence, RI, United States.
| | - Adam E M Eltorai
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.
| |
Collapse
|
50
|
Sutherland T, Parsons S, Cordner S, O'Donnell C. Tension pneumopericardium following blunt chest trauma. J Med Imaging Radiat Oncol 2019; 63:358-359. [DOI: 10.1111/1754-9485.12890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tom Sutherland
- Medical Imaging Department St Vincent's Hospital Fitzroy Victoria Australia
- Faculty of Medicine Dentistry and Health Science University of Melbourne Melbourne Victoria Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine Melbourne Victoria Australia
- Department of Forensic Medicine Monash University Melbourne Victoria Australia
| | - Stephen Cordner
- Victorian Institute of Forensic Medicine Melbourne Victoria Australia
- Department of Forensic Medicine Monash University Melbourne Victoria Australia
| | - Chris O'Donnell
- Victorian Institute of Forensic Medicine Melbourne Victoria Australia
- Department of Forensic Medicine Monash University Melbourne Victoria Australia
| |
Collapse
|