Impalement injuries of the chest

Abstract

SUMMARYImpalement injuries of the chest are uncommon in civilian practice with few reports in the literature. We report three cases of thoracic impalement seen over a 5 year period with unusual underlying mechanisms. In two of the cases, the impalement was obvious; in the third, the impalement was concealed having occurred 5 months earlier. In Case 1, the underlying mechanism was a high-speed road traffic accident. The patient was impaled by a metallic square pipe piled by the roadside. In Case 2, the gun-housing of a locally-made rifle gave way as it was fired and allowed a reverse ejection of the barrel during recoil that impaled the hunter's chest. In Case 3, a domestic assault with an old umbrella caused an impalement injury as one of the umbrella spokes broke off, penetrated and lodged in the left chest going unnoticed for 5 months. Persistent chest pain and haemoptysis led to a request for chest radiographic examination upon which the foreign body was discovered. Massive haemoptysis brought the patient to emergency thoracotomy. All three patients underwent thoracotomy with a successful outcome.Keywords: Impalement injuries, thoracic, mechanisms, debridement, management. CASE REPORTSCase 1 A 22 year-old lady was referred to the National Cardiothoracic Centre (NCTC) with an impalement injury of the left upper chest following a road-traffic accident that morning as a passenger. When the van in which she was travelling skidded off the road, she got impaled on a metallic pipe piled by the roadside. She had chest pain and dyspnoea on admission. Examination showed a metallic square pipe lodged in the left chest in through-and-through fashion antero-posteriorly (Figure 1). She was conscious, alert and haemodynamically stable with a blood pressure of 110/80mmHg and a pulse of 104/minute. Respiratory examination showed signs of a left haemopneumothorax and left lung collapse. Apart from a laceration of the right arm and forearm the rest of the physical examination was normal. A left chest tube was inserted and preparations were made for thoracotomy. Broad-spectrum antibiotic prophylaxis (1 gram ceftriazone and 500mg metronidazole) and tetanus immunoglobulin were administered prior to surgery. Figure 1 Case 1 with impaled metallic objectAt surgery, the foreign body was extracted carefully without sequelae. There was a laceration of the left upper lobe; no major vessel or cardiac injury was found. The injured part of the left lung was debrided and the resulting defect repaired. Debridement of the chest wall at the entry and exit wounds was carried out. The pleural cavity and chest wall wounds were copiously lavaged with saline, a chest tube was passed and the incisions closed primarily. The patient was returned to the Intensive Care Unit. She made an uneventful recovery and was discharged on the 14 th post-operative day.

Complicaciones del Manejo Quirúrgico De Los Pacientes Con Trauma Penetrante De Tórax En Un Hospital Universitario Al Sur De Colombia

“…En el caso del segundo mecanismo las lesiones dependerán del trayecto por el cual ingrese el arma para de esta forma establecer las estructuras potencialmente afectadas 8 finalmente el empalamiento se presenta con mucha menor frecuencia y se produce por penetración de objetos elongados a un órgano. 9 Para el manejo de este tipo de patología traumática va desde las medidas generales de soporte hemodinámico 9 y el manejo quirúrgico. 10 Considerando lo anterior se ha descrito que las complicaciones secundarias al manejo de la patología traumática contribuyen a estancia hospitalaria prolongada y muerte tardía.…”

Management of Thoracic Impalement Injury in Ghana: A Five-Year Experience at the Komfo Anokye Teaching Hospital

“…Typically, the mechanism of injury of such injuries involve an impact between the body and the stationary foreign object which is typical of injuries occurring following road traffic accidents, attacks or falls from height. However, there have been reported cases where the impaling object is mobile [3]. Based on the mechanism of injury, impalement injuries have been divided into type I and type II injuries.…”

“…fits consistently well with the cases presented herein. Thoracic impalement injuries are rare and dramatic occurrences especially in civilian populations with an associated high mortality particularly in the event of cardiac or major vascular involvements[2] [3]. We are presenting seven cases over a period of five years, however Edwin et al in Accra, Ghana presented three cases over a period of same five years[3].…”

Management of Severe Thoracic Impalement Trauma Against Two-Wheeled Horse Carriage: A Case Report and Literature Review

“…To maintain the airway and ventilation, early intubation may be indicated [4]. A chest tube should preferably be placed prior to initiation of mechanical ventilation in anticipation of the possibility of installing a tension pneumothorax, severe and potentially lethal condition [12]. After ventilatory and haemodynamic stabilization, the patient should be transferred to a specialist centre for trauma care, as these lesions typically require complex multidisciplinary treatment.…”