Subpectorial parasternal plane block catheters for the management of sternal fractures in the context of chest trauma: A case series

Introduction Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. Topic Description We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms ‘trauma’, ‘lung contusion’, ‘pneumothorax’, ‘hemothorax’ and ‘lung ultrasound’. The latest articles were reviewed and this article was written using the most current and validated information. Discussion Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. Conclusion Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.

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Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽

10.1177/1460408620988116 ◽

2021 ◽

pp. 146040862098811

Author(s):

Anith Nadzira Riduan ◽

Narasimman Sathiamurthy ◽

Benedict Dharmaraj ◽

Diong Nguk Chai ◽

Narendran Balasubbiah

Keyword(s):

Blunt Trauma ◽

Chest Trauma ◽

Surgical Intervention ◽

Case Series ◽

Trauma Patients ◽

Lung Collapse ◽

Comprehensive Management ◽

Lung Capacity ◽

Management Algorithm ◽

Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

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Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211010804 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110108

Author(s):

Andrea Bardos ◽

Sanjeeve Sabhrawal ◽

Graham Tytherleigh-Strong

Keyword(s):

Ct Scan ◽

Constant Score ◽

Case Series ◽

Sternal Fracture ◽

Elite Level ◽

The Mean ◽

Mean Time ◽

Time From Injury ◽

Sternal Fractures

Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported. Purpose: To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture. Study Design: Case series; Level of evidence, 4. Methods: Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan. Results: Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ P < .05]), Constant score (from 84 to 96.4 [ P < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ P < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications. Conclusion: Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.

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Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series

Pain Practice ◽

10.1111/papr.12833 ◽

2019 ◽

Vol 20 (2) ◽

pp. 197-203

Author(s):

Thibault Martinez ◽

Thibaut Belveyre ◽

Alexandre Lopez ◽

Chloe Dunyach ◽

Zina Bouzit ◽

...

Keyword(s):

Pain Control ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Case Series

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Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01505-y ◽

2020 ◽

Author(s):

Dorine S. Klei ◽

F. Cumhur Öner ◽

Luke P. H. Leenen ◽

Karlijn J. P. van Wessem

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Significant Risk ◽

Case Series ◽

Spinal Fractures ◽

Thoracic Wall ◽

Fracture Treatment ◽

Total Study Population ◽

Conservative And Operative Treatment ◽

Sternal Fractures

Abstract Purpose Combined sternal and spinal fractures are rare traumatic injuries with significant risk of spinal and thoracic wall instability. Controversy remains with regard to treatment strategies and the biomechanical need for sternal fixation to achieve spinal healing. The present study aimed to assess outcomes of sternovertebral fracture treatment. Methods A systematic review of literature on the treatment of traumatic sternovertebral fractures was conducted. Original studies published after 1990, reporting sternal and spinal healing or stability were included. Studies not reporting treatment outcomes were excluded. Results Six studies were included in this review, with a total study population of 98 patients: 2 case series, 3 case reports, and 1 retrospective cohort study. 10 per cent of sternal fractures showed displacement. Most spinal fractures were located in the thoracic spine and were AOSpine type A (51%), type B (35%), or type C (14%). 14 per cent of sternal fractures and 49% of spinal fractures were surgically treated. Sternal treatment failure occurred in 5% of patients and biomechanical spinal failure in 8%. There were no differences in treatment failure between conservative and operative treatment. Conclusion Literature on traumatic sternovertebral fracture treatment is sparse. Findings indicate that in most patients, sternal fixation is not required to achieve sternal and spinal stability. However, results of the current review should be cautiously interpreted, since most included studies were of poor quality.

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Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2015.07.075 ◽

2016 ◽

Vol 34 (4) ◽

pp. 758.e1-758.e3 ◽

Cited By ~ 5

Author(s):

Huai-min Liang ◽

Qiu-lin Chen ◽

Er-yong Zhang ◽

Jia Hu

Keyword(s):

Cardiac Tamponade ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Sternal Fractures

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Challenges of diagnosis of COVID-19 in trauma patients: A case series

Trauma ◽

10.1177/1460408620950602 ◽

2020 ◽

pp. 146040862095060

Author(s):

Golnar Sabetian ◽

Farnia Feiz ◽

Alireza Shakibafard ◽

Hossein Abdolrahimzadeh Fard ◽

Sepideh Sefidbakht ◽

...

Keyword(s):

Ct Scan ◽

Trauma Center ◽

Chest Trauma ◽

Case Series ◽

Chest Ct ◽

Lung Contusion ◽

Trauma Patients ◽

Type B ◽

Chest Ct Scan ◽

Pcr Test

Background Diagnosis of COVID-19 can be challenging in trauma patients, especially those with chest trauma and lung contusion. Methods We present a case series of patients from February and March 2020 who were admitted to our trauma center at Rajaee Hospital Trauma Center, in Shiraz, Iran and had positive SARS-CoV-2 PCR test or chest CT scan suggestive of COVID-19 and were admitted to the specific ICU for COVID-19. Results Eight COVID-19 patients (6 male) with mean age of 40 (SD = 16.3) years old, were presented. All patients were cases of trauma injuries, with multiple injuries including chest trauma and lung contusion, admitted to our trauma center for management of their injuries, but they were diagnosed with COVID-19 as well. Two of them had coinfection of influenza type-B and SARS-CoV-2. All patients were treated for COVID-19 and three of them died; the rest were discharged from hospital. Conclusion Since PCR for SARS-CoV-2 is not always sensitive enough to confirm the cause of pneumonia, chest CT manifestations can be helpful, though, they are not always differentiable from lung contusion. Therefore, both the CT scan and the clinical and paraclinical presentation and course of improvement can be beneficial in diagnosing COVID-19 in the trauma setting.

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Down a Slippery Slope

Pediatric Traumatic Emergencies ◽

10.1093/med/9780190946623.003.0005 ◽

2020 ◽

pp. 41-48

Author(s):

Jennifer E. Melvin

Keyword(s):

Thoracic Trauma ◽

Chest Trauma ◽

Pediatric Population ◽

Pediatric Trauma ◽

Tracheobronchial Tree ◽

Pulmonary Contusion ◽

Common Cause ◽

Isolated Injury ◽

Clinically Significant ◽

Sternal Fractures

Trauma is the most common cause of morbidity and mortality in the pediatric population. Although chest trauma represents less than 10% of all pediatric traumas, it accounts for 14% of all pediatric trauma-related deaths. Thoracic trauma includes injuries to the chest wall, lungs, heart, tracheobronchial tree, diaphragm, and aorta. The most common injuries include pneumothorax, hemothorax, pulmonary contusion, and rib fractures. Sternal fractures occur less commonly and may be seen in cases of isolated or severe chest trauma. Although chest trauma may result from a direct force and therefore result in an isolated injury, when present, it is most often secondary to an extreme mechanism and associated with other clinically significant injuries.

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