Combined disruption of the thoracic spine and costal arch fracture: An indicator of a severe chest trauma

Abstract Background Blunt high-energy trauma increase the risk of associated thoracic and accompanying abdominal organ injuries in chest trauma. A higher overall injury severity has been shown for sternovertebral injuries caused by a flexion-compression mechanism. Literature for a hyperextension-distraction mechanism equivalent to a costal arch fracture combined with a thoracic spinal fracture is sparse. Therefore, we want to show the clinical significance of this entity. Methods A retrospective analysis of our level-one trauma center collective of severely injured patients was performed. Patients from 2013 to 2019 that involved an Injury Severity Score (ISS) ≥16 were screened for the combined thoracovertebral injury entity and analyzed concerning its accident mechanism, the injury spectrum, and the clinical course. Results The thoracovertebral injury entity is rare. Three male patients (50–65 years old) with ISS of 57, 41, and 20 could be observed from over 1000 severely injured. All patients suffered from high-energy trauma and from tearing of the thoracic vertebrae regions 7–9. The costal arch was torn in the anterior area. All cases showed a posterolateral serial rib fracture, a traumatic intercostal pulmonary hernia, and an avulsion of the diaphragm. Two patients sustained further life-threatening injuries, such as severely bleeding avulsion to the azygos vein and a rupture of the spleen. The physicians performed exploratory thoracotomy, closure of the pulmonary hernia, re-fixation of the diaphragm and angle-stable plate osteosynthesis of the fractured ribs, including the costal arch. The spine was fixed dorsally using a screw-rod system. The patients were discharged home with independent mobility and without neurological damage. Conclusions This thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Injuries to the costal arch can act as an indicator of severe trauma. They should be detected thorough clinical examination and assessment of the trauma CT in the soft tissue window.

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Scapulothoracic dissociation

British Journal of Radiology ◽

10.1259/bjr.20190090 ◽

2019 ◽

Vol 92 (1101) ◽

pp. 20190090

Author(s):

Kimia Khalatbari Kani ◽

Felix S Chew

Keyword(s):

Differential Diagnosis ◽

Shoulder Girdle ◽

High Energy ◽

Imaging Evaluation ◽

Acute Setting ◽

High Energy Trauma ◽

Diagnosis And Management ◽

Life Threatening ◽

Spectrum Imaging ◽

Scapulothoracic Dissociation

Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.

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Traumatic infra-renal aortic dissection after a high-energy trauma: a case report of a primary missed diagnosis

Orthopedic Reviews ◽

10.4081/or.2014.5031 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 3

Author(s):

Holger Godry ◽

Guido Rölleke ◽

Achim Mumme ◽

Thomas A. Schildhauer ◽

Martin Gothner

Keyword(s):

Aortic Dissection ◽

Ct Scan ◽

High Energy ◽

The Body ◽

Trauma Patients ◽

Traumatic Injuries ◽

High Energy Trauma ◽

Missed Injuries ◽

Lumbar Vertebral Body ◽

Life Threatening

A traumatic infra-renal aortic dissection is a rare but life-threatening injury that follows deceleration injuries. The mechanism of blunt abdominal aortic injury involves both direct and indirect forces. The successful management of patients with traumatic injuries depends on a prompt suspicion of the injury and early diagnosis and therapy. Missed injuries in trauma patients are well-described phenomena and implementation of the ATLS® trauma schedule led to a decrease in the number of missed injuries, but trauma computed tomography (CT) scans in injured patients are still not standard. We report on a 54-year old Caucasian female patient who was involved in a car accident. The fellow passenger of the car was seriously injured. The patient had been previously treated at two different hospitals, and a dislocated acetabular fracture had been diagnosed. Because of this injury, the patient was transferred to our institution, a level 1 trauma-center where, according to the nature of the accident as a high-energy trauma, a complete polytrauma management was performed at the time of admission. During the body check, a moderate tension of the lower parts of the abdomen was detected. During the CT scan, an aneurysm of the infra-renal aorta with a dissection from the height of the second lumbar vertebral body to the iliac artery was observed. The patient required an operation on the day of admission. After 19 days post-trauma care the patient was able to leave our hospital in good general condition. Therefore, missed injuries in multiple injury patients could be fatal, and it is essential that the orthopedic surgeon leaves room for suspicion of injuries based on the nature of the trauma. Traumatic injuries of the abdominal aorta are rare. According to the ATLS® trauma schedule, all of the patients who have experienced high-energy trauma and associated fractures should undergo routine screening using a trauma CT scan with contrast agents to detect potential life-threatening injuries. In case of abdominal trauma, an aortic dissection, which can easily be overlooked, has to be considered.

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Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Journal of Clinical Medicine ◽

10.3390/jcm9092752 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2752 ◽

Cited By ~ 1

Author(s):

Thurid Eckhardt ◽

Klemens Horst ◽

Philipp Störmann ◽

Felix Bläsius ◽

Martijn Hofman ◽

...

Keyword(s):

Body Weight ◽

Survival Benefit ◽

Multivariate Regression ◽

Chest Trauma ◽

Injury Severity ◽

Severely Injured ◽

Regression Analyses ◽

Severely Injured Patients ◽

Multiple Factors ◽

Injured Patients

The morbidity and mortality of severely injured patients are commonly affected by multiple factors. Especially, severe chest trauma has been shown to be a significant factor in considering outcome. Contemporaneously, weight-associated endocrinological, haematological, and metabolic deviations from the norm seem to have an impact on the posttraumatic course. Therefore, the aim of this study was to determine the influence of body weight on severely injured patients by emphasizing chest trauma. A total of 338 severely injured patients were included. Multivariate regression analyses were performed on patients with severe chest trauma (AIS ≥ 3) and patients with minor chest trauma (AIS < 3). The influence of body weight on in-hospital mortality was evaluated. Of all the patients, 70.4% were male, the median age was 52 years (IQR 36–68), the overall Injury Severity Score (ISS) was 24 points (IQR 17–29), and a median BMI of 25.1 points (IQR 23–28) was determined. In general, chest trauma was associated with prolonged ventilation, prolonged ICU treatment, and increased mortality. For overweight patients with severe chest trauma, an independent survival benefit was found (OR 0.158; p = 0.037). Overweight seems to have an impact on the mortality of severely injured patients with combined chest trauma. Potentially, a nutritive advantage or still-unknown immunological aspects in these patients affecting the intensive treatment course could be argued.

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Accuracy of the field triage protocol in selecting severely injured patients after high energy trauma

Injury ◽

10.1016/j.injury.2013.12.010 ◽

2014 ◽

Vol 45 (5) ◽

pp. 869-873 ◽

Cited By ~ 23

Author(s):

J.J.E.M. van Laarhoven ◽

K.W.W. Lansink ◽

M. van Heijl ◽

R.A. Lichtveld ◽

L.P.H. Leenen

Keyword(s):

High Energy ◽

Severely Injured ◽

Severely Injured Patients ◽

High Energy Trauma ◽

Field Triage ◽

Triage Protocol ◽

Injured Patients

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Transverse process fractures of the thoracic vertebrae—the significance of this injury in the context of medicolegal opinions on high-energy trauma cases

International Journal of Legal Medicine ◽

10.1007/s00414-019-02161-7 ◽

2019 ◽

Vol 134 (4) ◽

pp. 1431-1440

Author(s):

Aleksandra Borowska-Solonynko ◽

Victoria Prokopowicz

Keyword(s):

Test Group ◽

Transverse Process ◽

High Energy ◽

Thoracic Vertebrae ◽

Postmortem Computed Tomography ◽

High Energy Trauma ◽

Additional Information ◽

Strong Force ◽

Mechanism Of Trauma ◽

Type Of Injury

Abstract Thoracic transverse process fractures (TTPFs) are injuries that go unnoticed during traditional autopsies, as demonstrated by a lack of medicolegal publications regarding TTPFs. However, postmortem computed tomography (PMCT) has made detection of this type of injury easy. Thus, the goal of our study was to analyze the significance of TTPFs in the context of medicolegal opinions. Forensic autopsy reports and PMCT scans of 116 people who had died from high-energy trauma were analyzed. TTPFs were found in 34.48% (n = 40) of the total test group. The highest proportions of TTPFs were found in drivers (50%, n = 8) and in victims of falls from heights (41%, n = 14). Among seven car passengers, only one victim had suffered TTPFs. In comparison with persons without TTPFs, persons with TTPFs demonstrated more severe general injuries, especially to the chest and abdomen, and more often (in 90% of cases) died at the scene of injury (all these differences were statistically significant; p < 0.0001). Pedestrian TTPFs were present only in victims struck from their front or back. TTPFs in victims of falls were found only in those cases in which the height of the fall was at least 9 m. The presence of TTPFs indicates that the application of a very strong force leads to injuries that, in most cases, result in death at the scene of the event. Detecting TTPFs provides additional information about the mechanism of trauma, especially in pedestrians, drivers, passengers, and victims of falls from heights.

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Lunate dislocations: anatomy, diagnosis and management

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0025 ◽

2021 ◽

pp. 1-10

Author(s):

Madeleine Garner ◽

Branavan Rudran ◽

Amir Khan ◽

Quen Tang ◽

Philip Mathew

Keyword(s):

Injury Severity ◽

Life Support ◽

High Energy ◽

Acute Onset ◽

Advanced Trauma Life Support ◽

Diagnosis And Management ◽

Energy Mechanism ◽

Permanent Loss ◽

Life Threatening ◽

Mechanism Of Trauma

Lunate dislocation is an uncommon but serious wrist injury, often resulting from a high energy mechanism of trauma. Advanced trauma life support protocols should be followed to diagnose and treat concomitant life-threatening pathology. Thorough neurovascular and soft tissue examination is required to identify open wounds and median nerve dysfunction, including acute onset carpal tunnel syndrome. Imaging is undertaken to appreciate injury severity, which is graded by the Mayfield classification. Closed reduction in the emergency department is the initial management, which alleviates pressure on neurovascular structures. Definitive management is surgical, most commonly via open reduction and direct ligamentous stabilisation. The aims of surgery are to restore anatomical carpal alignment and maintain stability, allowing repair and healing of the important wrist ligaments. Medium-to long-term functional outcomes are adequate, with most patients returning to work within 6 months. However, progressive radiographic midcarpal arthrosis is common, as well as permanent loss of grip strength, range of motion and chronic pain. This article considers the anatomy, diagnosis and management of acute lunate and perilunate dislocations.

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High-Energy Trauma and Damage Control in the Lower Limb

10.21236/ada554076 ◽

2010 ◽

Cited By ~ 1

Author(s):

Charles J. Fox ◽

Peter Kreishman

Keyword(s):

Lower Limb ◽

Damage Control ◽

High Energy ◽

High Energy Trauma

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Lung ultrasound in blunt chest trauma: A clinical review

Ultrasound ◽

10.1177/1742271x21994604 ◽

2021 ◽

pp. 1742271X2199460

Author(s):

Serena Rovida ◽

Daniele Orso ◽

Salman Naeem ◽

Luigi Vetrugno ◽

Giovanni Volpicelli

Keyword(s):

Blunt Chest Trauma ◽

Chest Trauma ◽

Lung Ultrasound ◽

Lung Parenchyma ◽

Trauma Patients ◽

Minor Trauma ◽

Major Life ◽

Diagnostic Modality ◽

Life Threatening ◽

Sternal Fractures

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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