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

Traumatic flail chest is segment of the chest wall, which is caused by multiple fractures or by separation of bone structure (at least three sequential broken ribs or separated into two fracture lines). These injuries are mainly seen in polytrauma patients. Chest trauma is the third most common injury in trauma patients (8). Early surgical intervention, as definedas being within 24-72 hours after the trauma, should be performed, assuming other potentially life-threatening injuries have been treated (9-10). Aim of the Study: Our aim is to show the therapeutic benefits of surgical treatment (operative stabilization) of the flail chest. Material and Methods: We retrospective analyzed patients who underwent surgery at the Clinic for Thoracic Surgery, University Clinical Centre of the Republic of Srpska, Banja Luka, in the period from 01.12.1997. - 31.10.2020. Results: 68 patients with average age of 53.57 years with traumatic flail chest were surgicaly treated in the twenty-three year period at the Clinic of Thoracic Surgery, University Clinical Centre of the Republic of the Srpska, Banja Luka. The average length of a hospital stay was 15 days. Survival rate in the operated group was 91.43%. Conclusion: If conservative measures such as internal stabilization, the use of analgesics, antibiotics, oxygen therapy and airway toilet does not lead to stabilization of respiratory function, surgical chest wall stabilization is necessary.

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Traumatic ribs fracture: how to treat them?

Surgical Techniques Development ◽

10.4081/std.2011.e20 ◽

2011 ◽

Vol 1 (2) ◽

pp. 20

Author(s):

Marco Scarci ◽

Andrea Billè ◽

Imran Zahid ◽

Tom Routledge

Keyword(s):

Mortality Rate ◽

Chest Wall ◽

Pain Control ◽

Chest Trauma ◽

Flail Chest ◽

Rib Fracture ◽

Titanium Clips ◽

New Devices

Flail chest complicates about 10% of patients with chest trauma and is associated with a mortality rate of 10-20% in older series, while a recent one reports no mortality. The majority of the cases are treated conservatively with internal pneumatic stabilization and pain control. In recent years, nevertheless, we assisted in the resurgence of chest wall fixation due to the availability of new devices. We report our experience in the use of mouldable titanium clips (STRACOS, Strasbourg Thoracic Osteosyntheses System; MedXpert, Heitersheim, Germany) to fix traumatic rib fracture. This device presents an advantage over previous strategies, as it is easy to apply and doesn’t require drilling and screwing of the ribs.

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Profile of chest trauma patients at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Health Renaissance ◽

10.3126/hren.v13i3.17933 ◽

2017 ◽

Vol 13 (3) ◽

pp. 107-113

Author(s):

Suresh Prasad Sah ◽

R Agrawal ◽

CS Agrawal ◽

S Koirala

Keyword(s):

Chest Trauma ◽

Road Traffic ◽

Flail Chest ◽

Public Health Problem ◽

Tracheobronchial Tree ◽

Rib Fracture ◽

Chest Injury ◽

Physical Assault ◽

Major Public Health Problem ◽

Trauma Patients

Background: Chest trauma is a major public health problem. It includes injury to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, esophagus, heart and great vessels. It comprises 10-15% of all traumas and 25% of death due to trauma occurs because of chest injury. Chest trauma is seen with increasing frequency in urban hospitals.Methods: A prospective study of all pati with chest injury irrespective of age, sex and mode of injury presenting to BPKIHS emergency were included in this study from 15th March 2007 to 14th March 2008. Results: During the study period of one year total trauma patients presented toemergency were 1524. Out of this 122 patients were of chest injury. It comprises 8% of all trauma patients. Majority of patients belonged to the age group (21-40) years. Out of 122 patients, 57 (46.7%) patients sustained injury due to fall from height and was the commonest cause of trauma in this study followed by road traffic accident which was 38 (31.1%), 15 (12.3%) had physical assault and similar number of 6 patients (4.9%) sustained injury due to gunshot injury and stab injury. Out of 122 patients, 34 (27.9%) patients had associated injury. The most common chest injury was pneumothorax followed by isolated multiple rib fracture, hemothorax, isolated single rib fracture hemopneumothorax, flail chest, subcutaneous emphysema, lung contusion, open pneumothorax and tension pneumothorax.Conclusion: Majority of chest trauma patients were young adults with male preponderance. Blunt trauma chest was most common chest injury. Pneumothorax was the most common chest injury. Majority of patients were managed with tube thoracostomy, analgesics and chest physiotherapy. Health Renaissance 2015;13 (3): 107-113

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Early Non-invasive Ventilation and High-flow Nasal Oxygen Therapy for Preventing Delayed Respiratory Failure in Hypoxemic Blunt Chest Trauma Patients.

Case Medical Research ◽

10.31525/ct1-nct03943914 ◽

2019 ◽

Author(s):

Keyword(s):

Respiratory Failure ◽

Blunt Chest Trauma ◽

Oxygen Therapy ◽

Chest Trauma ◽

High Flow ◽

Trauma Patients ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

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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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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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Average chest wall thickness at two anatomic locations in trauma patients

Injury ◽

10.1016/j.injury.2013.03.027 ◽

2013 ◽

Vol 44 (9) ◽

pp. 1183-1185 ◽

Cited By ~ 20

Author(s):

Elizabeth Schroeder ◽

Carrie Valdez ◽

Andres Krauthamer ◽

Nadia Khati ◽

Jessica Rasmus ◽

...

Keyword(s):

Chest Wall ◽

Wall Thickness ◽

Trauma Patients ◽

Anatomic Locations

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Primary Lung Hernia After Blunt Chest Trauma: Chest Wall Repair Strategies

The American Surgeon ◽

10.1177/00031348211023439 ◽

2021 ◽

pp. 000313482110234

Author(s):

Leonid A. Belyayev ◽

William J. Parker ◽

Emad S. Madha ◽

Elliot M. Jessie ◽

Matthew J. Bradley

Keyword(s):

Decision Making ◽

Chest Wall ◽

Surgical Management ◽

Blunt Chest Trauma ◽

Thoracic Trauma ◽

Chest Trauma ◽

Blunt Thoracic Trauma ◽

Lung Herniation ◽

Lung Hernia

Lung herniation is a rare pathology seen after trauma. A case of acquired lung hernia is presented after blunt thoracic trauma that was repaired primarily. Surgical management and decision-making for this process are discussed.

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