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This study confirms the high incidence of chronic pain after a traumatic rib fracture. While the majority of the patients can manage this pain without interference of their quality of life, a few do suffer from life style/work interference and may have to resort to regular analgesic usage.

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Young motorcycle casualties have a significantly higher mortality rate than older motorcycle casualties. Young passengers have the highest mortality rate and contribute significantly to the death rate among young motorcycle casualties.

Prompt and early surgery for traumatic gastrointestinal perforation is advised. Any abnormal CT scans warrants either surgery or close monitoring. Direct repair of the perforation is preferred, if possible.

Management of blunt splenic injury (BSI) has evolved with a focus on nonoperative management (NOM) and spleen preservation. Factors predictive of failure of NOM are yet ill defined. We report our experience of outcomes of NOM of BSI and evaluate factors that predict failure. This is a retrospective study from a prospective trauma registry of a university-affiliated major trauma center over a 4 ½-year period. All the patients admitted with BSI from January 2004 to May 2009 were included in this study. Demographic, clinical, operative, and outcome data were studied. Forty-five patients (51.1%) with a mean age of 38 years (range, 16–77 years) were admitted for NOM. The majority of patients was male (88.9%). Mean Injury Severity Score (ISS) was 25.2 ± 12.7 and the majority of the patients (42.2%) had Grade II BSI. Three patients (6.7%) underwent splenic artery angioembolization. Three patients (6.7%) failed NOM and required splenectomy. The overall splenic salvage rate was 93.3%. The median hospital stay was 7 days (range, 2–66 days) and there was no mortality. Lower hemoglobin on admission (15.9 versus 10.1 g/dL, P = 0.006), hematocrit <30.0% on admission (P = 0.04), higher ISS (39.3 versus 24.2, P = 0.04) and Grade V injury (P = 0.003) predicted failure of NOM. NOM for BSI is safe, feasible, and it increases splenic salvage. Splenic artery angioembolization is a useful adjunct. Low hemoglobin, hematocrit <30%, high ISS, and grade V splenic injury predicts failure of NOM. Grade V splenic injury should be considered for routine angioembolization if NOM is contemplated.

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