scholarly journals The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®

2021 ◽  
Author(s):  
Mustafa Sinan Bakir ◽  
Andreas Langenbach ◽  
Melina Pinther ◽  
Rolf Lefering ◽  
Sebastian Krinner ◽  
...  
Keyword(s):  
Clavicle Fracture ◽  
Flail Chest ◽  
Spinal Column ◽  
Rib Fractures ◽  
Inclusion Criteria ◽  
Concomitant Injuries ◽  
Chest Injuries ◽  
Thorax Trauma ◽  
Hospital Stays ◽  
Clavicle Fractures

Abstract Purpose Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax. Methods A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF. Results 73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF. Conclusion Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.

Operative Treatment of Rib Fractures in Flail Chest Injuries

2017 ◽  
Vol 31 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Eric Swart ◽  
Joseph Laratta ◽  
Gerard Slobogean ◽  
Samir Mehta
Keyword(s):  
Operative Treatment ◽  
Flail Chest ◽  
Rib Fractures ◽  
Chest Injuries

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

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.

Concomitant Sternal Fracture in Flail Chest: An Analysis of 21,741 Polytrauma Patients from the TraumaRegister DGU®

2017 ◽  
Vol 65 (07) ◽  
pp. 551-559 ◽  
Author(s):  
Sebastian Krinner ◽  
Andreas Langenbach ◽  
Pascal Oppel ◽  
Rolf Lefering ◽  
Dominic Taylor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Trauma Center ◽  
Injury Severity ◽  
Flail Chest ◽  
Inclusion Criteria ◽  
Sternal Fracture ◽  
Spine Injuries ◽  
Thorax Trauma ◽  
Polytrauma Patients ◽  
Sternal Fractures

Background Isolated sternal fractures (SFs) rarely show complications, but their influence in a thorax trauma of the seriously injured still remains unclear. Methods A retrospective analysis of the TraumaRegister DGU® was performed involving the years 2009 to 2013 (Injury Severity Score [ISS] ≥ 16, primary admission to a trauma center). Cohort formation: Unilateral and bilateral flail chest (FC) injuries with and without a concomitant SF, respectively. Results In total, 21,741 patients (25% female) met the inclusion criteria, with 3,492 (16.1%) showing SF. Unilateral FC patients were on average 53.6 ± 18.4 years old, and bilateral FC patients were on average 55.2 ± 17.7 years old. The ISS in unilateral FC and bilateral FC amounted to 31.2 ± 13.0 and 43.4 ± 13.1 points, respectively. FC with an SF occurred more frequently as an injury to car occupants and less frequently as an injury to motorcyclists or in injuries due to falls. Conclusion Patients with an SF additional to an FC had longer hospital and intensive care unit stays and were longer artificially respirated than those patients without an SF. SF indicates possible cardiac and thoracic spine injuries.

Multiple rib fractures: does flail chest matter?

2021 ◽  
pp. emermed-2020-210999
Author(s):  
Yaakov Daskal ◽  
Maya Paran ◽  
Alexander Korin ◽  
Vladislav Soukhovolsky ◽  
Boris Kessel
Keyword(s):  
Intensive Care ◽  
Injury Severity ◽  
Medical Center ◽  
Unit Length ◽  
Flail Chest ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Chest Injuries ◽  
Reliable Marker

BackgroundRecent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.MethodsThis study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010–2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Patients with and without radiologically defined flail chest were compared with regard to demographics, Injury Severity Score (ISS), GCS, systolic blood pressure (SBP) on admission, radiological evidence of flail chest, associated chest injuries, length of stay in intensive care unit, length of hospitalisation and mortality.ResultsThe study included 407 patients, of which 79 (19.4%) had flail chest. Overall, pneumothorax and haemothorax were more common among patients with flail chest (p<0.05). When comparing patients with three to five rib fractures, there was no difference in length of intensive care and length of hospitalisation or mortality; however, there was a higher incidence of pneumothorax (24.6% vs 50.0%, p<0.05). When comparing patients with six or more rib fractures, no difference was found between patients with and without flail chest.ConclusionIn patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.

Effect of Surgical Versus Pharmacological Decompression of Ludwig’s Angina on Airway Compromise among Nigerian Patients

2020 ◽  
Author(s):  
Ekaniyere EB
Keyword(s):  
Length Of Hospital Stay ◽  
Surgical Decompression ◽  
Airway Compromise ◽  
Inclusion Criteria ◽  
Hospital Stays ◽  
Ludwig’S Angina ◽  
The Mean ◽  
The University ◽  
Ludwig's Angina ◽  
Gender Type

Background: Even though the decompression of the cellulitis phase of Ludwig’s angina (LA) by surgical or pharmacological approach is well documented, it is unclear which approach is more effective. Objective: We aim to compare the outcome of treatment between surgical versus pharmacological decompression in patients with LA. Subjects and Methods: A retrospective cohort study was designed. Data were collected from the case notes of patients that met the inclusion criteria from 2004 to 2018 at the University of Benin Teaching Hospital, Nigeria.The data were age, gender, type of decompression approach, length of hospital stay (LOS) and airway compromise. Result: A total of 62 patients comprising 37(59.7%) surgical decompression group and 25(40.3%) pharmacological decompression group were studied. Thirty-six (58.1%) males and 26 (41.9%) females were studied. Their mean age and standard deviation were 40.6 years and 11.9 years respectively. The mean length of hospital stays between the pharmacological and surgical decompression groups were 8.05 days and 13.8 days respectively. The incidence of airway compromise in the surgical decompression group was 19.9% lower than that of the pharmacological decompression group (P=0.47), which was not significant. The type of decompression approach also failed to influence the incidence of airway compromise (P = 0.41). Conclusion: The use of surgical versus pharmacological decompression does not significantly alter the incidence of airway compromise in the management of LA. The Patients that had surgical decompression had a shorter stay in the hospital as compared to those who had pharmacological decompression. This was not statistically significant.

scholarly journals Epidemiology of Clavicle Fractures Sustained at a Colorado Ski Resort

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110067
Author(s):  
Lauren Oberle ◽  
Lauren Pierpoint ◽  
Jack Spittler ◽  
Morteza Khodaee
Keyword(s):  
Medical Center ◽  
Descriptive Analysis ◽  
Clavicle Fracture ◽  
Sports Injury ◽  
Common Mechanism ◽  
Ski Resort ◽  
Incidence Data ◽  
Injury Mechanisms ◽  
Fracture Diagnosis ◽  
Clavicle Fractures

Background: Although clavicle fractures are a common sports injury, there are limited studies on the incidence and causes of clavicle fractures among winter sports athletes. Purpose: To evaluate the characteristics and injury mechanisms associated with clavicle fractures among patients evaluated at a Colorado ski resort. Study Design: Descriptive epidemiology study. Methods: This was a retrospective descriptive analysis of patients with clavicle fractures at the Denver Health Winter Park Medical Center during the 2012-2013 to 2016-2017 ski seasons. Chart review was performed on the patient cohort to confirm clavicle fracture diagnosis and to evaluate factors associated with clavicle fracture. Results: A total of 393 clavicle fractures (6.2% of total clinic visits) occurred during the study period, corresponding to an overall clavicle fracture incidence of 8.4 per 100,000 participant-visits. The mean patient age was 26.4 years (range, 5-73 years). The majority were middle-third fractures (85.5%), occurring mainly in men (87.3%). More than half of the fractures were comminuted (54.5%) and occurred in snowboarders (55.0%). The most common mechanism of injury was a fall onto snow while skiing or snowboarding (92.4%). Women sustained more clavicle fractures while skiing compared with snowboarding (82.0% vs 18.0%; P < .001), while men sustained more fractures while snowboarding compared with skiing (60.3% vs 39.7%; P < .001). Conclusion: Clavicle fractures are relatively common, but there are scant incidence data for clavicle fractures in mountain sports. Consistent with prior studies, clavicle fractures were more common in younger patients and men. The most common anatomic fracture location was the midclavicle. A greater proportion of clavicle fractures among men were sustained during snowboarding and among women during skiing.

scholarly journals Operative treatment of multiple costochondral dislocations in a patient with severe rib fractures and a flail chest following trauma

2021 ◽  
Vol 14 (3) ◽  
pp. e239511
Author(s):  
Jonne T H Prins ◽  
Mathieu M E Wijffels
Keyword(s):  
Operative Treatment ◽  
Flail Chest ◽  
High Energy ◽  
Pulmonary Complications ◽  
Chest Ct ◽  
Rib Fractures ◽  
Daily Activities ◽  
Fracture Classification ◽  
Operative Fixation ◽  
Chest Ct Scan

A 73-year-old male patient underwent operative treatment for dislocation of multiple costochondral junctions alongside multiple bony rib fractures and a flail chest following high-energy trauma. During the operative fixation of the flail chest, the costochondral lesions were surgically stabilised with plates and screws, which were fixated on the osseous anterior rib, sternum or the rib cartilage. The patient experienced no pulmonary complications during the primary admission. At 7 months after the trauma, the chest CT scan showed full consolidation of all fixated rib fractures, including the costochondral lesions, without hardware dislocation or complications. The patient did not require any pain medication and had no pain during daily activities, at rest or at night. Although being a biomechanically demanding region, which is often not defined in current rib fracture classification, operative treatment of costochondral lesions is feasible with outcome similar to the treatment of bony rib fractures.

scholarly journals Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fangning Hu ◽  
Xi Liu ◽  
Fanxiao Liu ◽  
Honglei Jia ◽  
Xiaolong Lv ◽  
...  
Keyword(s):  
Blood Loss ◽  
Rating Scale ◽  
Clavicle Fracture ◽  
Operation Time ◽  
Clinical Results ◽  
Intraoperative Blood Loss ◽  
Traditional Group ◽  
Significant Difference ◽  
Clavicle Fractures ◽  
Displaced Clavicle Fracture

Abstract Purpose The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. Methods From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups. Conclusion The use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.

Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

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