Unilateral chest wall paradoxical motion mimicking a flail chest in a patient with hemilateral C7 spinal injury

Flail chest is a life-threatening clinical entity which can be complicated by respiratory insufficiency. Paradoxical motion of a part of chest wall is the basic cause to put the blame on. Consequently, stabilization of the chest wall is occasionally of paramount importance to achieve early extubation in a patient with post-trauma respiratory insufficiency. Hereby, a simple, low cost, harmless and effective approach of external stabilization is presented.

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Rib fracture fixation in a patient on veno-venous ECMO for severe blunt thoracic trauma

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7108 ◽

2021 ◽

Author(s):

D Whittaker ◽

C Edmunds ◽

I Scott ◽

M Khalil ◽

I Stevenson

Keyword(s):

Chest Wall ◽

Fracture Fixation ◽

Flail Chest ◽

Ecmo Support ◽

Rib Fracture ◽

Respiratory Compromise ◽

Respiratory Dysfunction ◽

Rib Fixation ◽

Chest Wall Trauma ◽

The Right

Thoracic chest wall trauma is a common injury in patients admitted to hospital following injury and is associated with high mortality. British Orthopaedic Association Standards for Trauma and Orthopaedics guidelines recommend consideration of rib fracture fixation in patients with flail chest wall injuries with respiratory compromise or uncontrollable pain. Veno-venous extracorporeal membrane oxygenation (ECMO) can be utilised in patients with severe respiratory dysfunction and we present the case of a patient who underwent rib fracture fixation while receiving ECMO. A 32-year-old male was admitted to our department following a 4.5m fall. He sustained significant thoracic injuries with multiple ribs fractures and a flail segment from the right fourth to ninth ribs. Treatment consisted of bilateral chest drains, ECMO support, tracheostomy and rib fracture fixation to the eighth and ninth ribs. The patient made a rapid recovery following surgery and ECMO support was ceased 2.5 days postoperatively. The case shows that a well-prepared, combined specialty surgical team can safely perform rib fixation for a patient on ECMO.

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Operative chest wall stabilization in flail chest—outcomes of patients with or without pulmonary contusion

Journal of the American College of Surgeons ◽

10.1016/s1072-7515(98)00142-2 ◽

1998 ◽

Vol 187 (2) ◽

pp. 130-138 ◽

Cited By ~ 138

Author(s):

Gregor Voggenreiter ◽

Friedrich Neudeck ◽

Michael Aufmkolk ◽

Udo Obertacke ◽

Klaus-Peter Schmit-Neuerburg

Keyword(s):

Chest Wall ◽

Flail Chest ◽

Pulmonary Contusion

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A new method of treating the flail chest wall

The American Journal of Surgery ◽

10.1016/s0002-9610(65)80014-9 ◽

1965 ◽

Vol 109 (5) ◽

pp. 604-610 ◽

Cited By ~ 4

Author(s):

Octav Constantinescu

Keyword(s):

Chest Wall ◽

Flail Chest ◽

New Method

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Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04148-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tsung-Han Yang ◽

Huan-Jang Ko ◽

Alban Don Wang ◽

Wo-Jan Tseng ◽

Wei-Tso Chia ◽

...

Keyword(s):

Chest Wall ◽

Hospital Readmission ◽

Clavicle Fracture ◽

Flail Chest ◽

Fracture Repair ◽

Rib Fractures ◽

Readmission Rates ◽

Hospital Readmission Rates ◽

Chest Wall Injury ◽

The Impact

Abstract Background The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI. Methods A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. A CWI and no-CWI group were distinguished, and the CWI group was subdivided into the minor-CWI (three or fewer rib fractures without flail chest) and complex-CWI (flail chest, four or more rib fractures) subgroup. Demographic data, classification of the clavicle fracture, number of rib fractures, and associated injuries were recorded. Overall complications included surgery-related complications and unplanned hospital readmissions. Univariate analysis and stepwise backward multivariate logistic regression were used to identify potential risk factors for complications. Results A total of 314 patients undergoing 316 clavicle fracture operations were studied; 28.7% of patients (90/314) occurred with associated CWI. Patients with associated CWI showed a significantly higher age, body mass index, and number of rib fractures. The overall and surgical-related complication rate were similar between groups. Unplanned 30-day hospital readmission rates were significantly higher in the complex-CWI group (p = 0.02). Complex CWI and number of rib fractures were both independent factor for 30-day unplanned hospital readmission (OR 1.59, 95% CI: 1.00–2.54 and OR 1.33, 95% CI: 1.06–1.68, respectively). Conclusion CWI did not affect surgery-related complications after clavicle fracture repair. However, complex-CWI may increase 30-day unplanned hospital readmission rates.

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Our Experience in the Treatment of Severe Thoracic Trauma.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i1.20 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Fadil Gradica ◽

Daniela Xhemalaj ◽

Agron Dogjani ◽

Lutfi Lisha ◽

Dhimitraq Argjiri ◽

...

Keyword(s):

Mortality Rate ◽

Chest Wall ◽

Thoracic Trauma ◽

Flail Chest ◽

Penetrating Trauma ◽

Gunshot Wounds ◽

Morbidity Rate ◽

Tracheal Rupture ◽

Chest Wall Trauma ◽

Thoracoabdominal Approach

Background: Severe thoracic trauma is main cause of deaths in US about 10-20 % of deaths. Causes of severe thoracic Trauma are :Penetrating trauma,Gunshot wounds,Stab wounds ;Lower mortality rate less massive, less multiorgan injury Gunshot wounds on the chest is the most lethal – 50% .Only 7-10% undergoes hospitalization prior to death .Death due to heart & great vessel injuries. Aim of study: Analyses of patients with Severe Thoracic Trauma ,Initial Evaluation and Management analyses of our cases period of time 2004-2017 treated in thoracic surgery service Material and methods: 95 patients are treated in our hospital during July 2004- July 2017 timeframe. Male to female was ratio 3:1. Age of presentation 9-71 years old, mean age presentation 49 years old. Blunt chest wall trauma 36 (38%) and penetraiting chest wall trauma 59 (62%) patients. Ribs and sternal fractures , two or more costal fractures in 15 (15.7%) patients (flail chest 7 patients );unilateral pneumothorax 34 (35.7%) patients ,bilaterally pmeumothorax 10 (10.5%) patients;massive hemothorax 12 (12.6%) patients , pneumomediastin et subcutaneous emphysema 6 (6.31%) patients Hammans syndrome, lung contusion and parenchimal pulmonary hemathoma in 15 (15.7%) patients; bronchial rupture 2 (2.1%) patients ,tracheal rupture 1 (1%) patient. Results: Only medical treatment in 22 (23%) patients,unilateral pleural tub drainage 42 (44%) patients, bilateral chest drainage 18 (18.9%) patients ;thoracotomy in 29(30.5%) patients ,wedge resection,lung hemostasis and aerostasis from lung lacerations, bronchial lobar rupture left lower lob 1 (1%) patient, bilateral thoracotomy 3 (3%) patients, clamshell incision in 1 (1%) patient;,thoracoabdominal approach 2 ( 2%) patients. flail chest wall stabilization 7 (7.3%) patients by vicryl suture ,steel wire suture 3(3%)patients,titanium plate 3(3%) patient.By VATS are treated 2(2.1%) patients.Mean hospital stay was 11 days (average 3-36 days).Morbidity rate in 6 (6.3%)patients , mortality was on 5 (5%)patients. Conclusion: Most common injury locations was lung and chest wall and less common abdominal and cranial trauma.Surgical and intensive treatment are very important and with low mortality rate.

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Chest Wall Disease: Flail Chest

Small Animal Surgical Emergencies ◽

10.1002/9781118487181.ch38 ◽

2015 ◽

pp. 362-364

Author(s):

Eric Monnet

Keyword(s):

Chest Wall ◽

Flail Chest

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Indication and Timing of Surgery Are Essential in Stabilization of the Chest Wall in Flail Chest Trauma Patients

Open Journal of Thoracic Surgery ◽

10.4236/ojts.2018.84014 ◽

2018 ◽

Vol 08 (04) ◽

pp. 79-85 ◽

Cited By ~ 1

Author(s):

Ali Imad El-Akkawi ◽

Frank Vincenzo de Paoli ◽

Morten Bendixen ◽

Thomas Decker Christensen

Keyword(s):

Chest Wall ◽

Chest Trauma ◽

Flail Chest ◽

Timing Of Surgery ◽

Trauma Patients

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Long-Term Morbidity, Vain, and Disability after Repair of Severe Chest Wall Injuries

The American Surgeon ◽

10.1177/000313480907500508 ◽

2009 ◽

Vol 75 (5) ◽

pp. 389-394 ◽

Cited By ~ 42

Author(s):

John C. Mayberry ◽

Andrew D. Kroeker ◽

L. Bruce Ham ◽

Richard J. Mullins ◽

Donald D. Trunkey

Keyword(s):

Health Status ◽

General Population ◽

Chest Wall ◽

Flail Chest ◽

Fracture Repair ◽

Mcgill Pain Questionnaire ◽

Intractable Pain ◽

Long Term Outcomes ◽

Chest Wall Injury

Long-term morbidity after severe chest wall injuries is common. We report our experience with acute chest wall injury repair, focusing on long-term outcomes and comparing our patients’ health status with the general population. We performed a retrospective medical record review supplemented with a postal survey of long-term outcomes including the McGill Pain Questionnaire (MPQ) and RAND-36 Health Survey. RAND-36 outcomes were compared with reference values from the Medical Outcomes Study and from the general population. Forty-six patients underwent acute chest wall repair between September 1996 and September 2005. Indications included flail chest with failure to wean from the ventilator (18 patients), acute, intractable pain associated with severely displaced rib fractures (15 patients), acute chest wall defect/deformity (5 patients), acute pulmonary herniation (3 patients), and thoracotomy for other traumatic indications (5 patients). Three patients had a concomitant sternal fracture repair. Fifteen patients with a current mean age of 60.6 years (range 30-91) responded to our surveys a mean of 48.5 ± 22.3 months (range 19-96) postinjury. Mean long-term MPQ Pain Rating Index was 6.7 ± 2.1. RAND-36 indices indicated equivalent or better health status compared with references with the exception of role limitations due to physical problems when compared with the general population. The operative repair of severe chest wall injuries is associated with low long-term morbidity and pain, as well as health status nearly equivalent to the general population. Both the MPQ and the RAND-36 surveys were useful tools for determining chest wall pain and disability outcomes.

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