Operative Treatment of Chest Wall Injuries: Indications, Technique, and Outcomes

Lafferty, Paul M.; Anavian, Jack; Will, Ryan; Cole, Peter A.

doi:10.2106/jbjs.i.00696

Cited by 196 publications

(183 citation statements)

References 78 publications

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“…In severe dislocated rib fractures, significantly restrictive deformities of the thoracic wall were observed in the present group, thus disruptive rib hunches in the posterior region, which restricted the mobility of the scapula, and in the anterior region likewise rib hunches next to the sternum which had a painful and cosmetically unfavorable effect (17). The lateral depression of the ribs, on the other hand, was clinically more difficult to visualize, since here a very powerful muscular and soft tissue covering of the region naturally exists.…”

Section: Discussionmentioning

confidence: 45%

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Langenbach¹,

Pinther²,

Krinner³

et al. 2017

chr

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RezumatDate generale: Leziunile cu volet costal (FCI) sunt asociate cu o rată ridicată de morbiditate şi mortalitate. Având în vedere că asocierea unei fracturi de claviculă concomitente cu FCI agravează chiar rezultatul, întrebarea care se pune este cum pot fi aceste leziuni costoclaviculare (CCI) gestionate chirurgical. Metode: 11 pacienţi cu CCI au fost trataţi chirurgical prin osteosinteză a claviculei şi a coastelor subiacente prin placă blocată, prin abordări chirurgicale limitate, sub anestezie generală. Pacienţii au fost urmăriţi la 2, 6, 12, 26 şi 52 de săptămâni. Rezultate: Toţi pacienţii au prezentat o deformare severă a peretelui toracic din cauza fracturilor puternic deplasate ale coastelor şi claviculei. Ei sufereau de durere şi de restrângerea mişcărilor respiratorii. Peretele toracic a putut fi restabilit la forma normală în toate cazurile, cu vindecare lipsită de complicaţii a oaselor şi confort sporit al pacientului. Fracturile claviculei şi celei de-a doua coaste au fost gestionate printr-o abordare inovatoare clavipectorală, iar celelalte prin abordări standard ale peretelui anterolateral şi posterolateral. Doi pacienţi s-au plâns de amorţeală în zona intervenţiei laterale şi de durere periscapulară peristentă. Concluzii: Stabilizarea chirurgicală ar putea reprezenta terapia adecvată în CCI cu fracturi dislocate, deoarece acestea ar putea cauza deformări severe şi pierderea funcţiei peretelui toracic şi a umărului.

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Section: Discussionmentioning

confidence: 45%

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Langenbach¹,

Pinther²,

Krinner³

et al. 2017

chr

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“…Blunt chest trauma such as rib fractures, lung contusion, pneumothorax, and hemothorax have been frequently associated with extrathoracic injuries on the head, the abdomen, and the extremities 1, 8, 14, 15, 18, 19, 20. Of these injuries, it is reported that the four variables, i.e.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for prolonged mechanical ventilation in patients with severe multiple injuries and blunt chest trauma: a single center retrospective case–control study

Okabe¹

2018

Acute Medicine & Surgery

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AimBlunt chest trauma is common and is associated with morbidity and mortality in patients with multiple injuries, frequently requiring invasive mechanical ventilation. The aim of this study was to elucidate risk factors for prolonged mechanical ventilation (PMV).MethodsConsecutive adult patients with multiple severe injuries and blunt chest trauma who treated in Chiba Emergency Medical Center (Chiba, Japan) between January 2008 and December 2015 were enrolled in this retrospective chart‐review study. According to ventilatory time, the patients were divided into PMV (≥7 days) and shortened mechanical ventilation (SMV; <7 days) groups. Thoracic Trauma Severity Score (TTSS) was calculated. To identify risk factors for PMV, univariate and multivariate logistic analyses and receiver operating characteristic analysis were carried out.ResultsEighty‐four and 49 patients were assigned to PMV and SMV groups, respectively. Compared with the SMV group, the PMV group had a significantly larger number of fractured ribs (P < 0.01), higher rate of severe Glasgow Coma Scale (GCS ≤8) (P < 0.05) and flail chest (P < 0.001), higher TTSS (P < 0.001), or longer intensive care unit and hospital stay (both P < 0.001). Logistic analysis showed that severe GCS (odds ratio [OR] = 4.6, P < 0.01), flail chest (OR = 3.0, P < 0.05), and TTSS (OR = 1.2; P < 0.01) were independent significant risk factors. Receiver operating characteristic analyses showed that the area under the curves for TTSS, flail chest, and severe GCS were 0.74, 0.70, and 0.58, respectively. When the three factors were combined, the area under the curve increased to 0.8.ConclusionSevere GCS (≤8), flail chest, or TTSS may be independent risk factors. Combining the three risk factors could provide high predictive performance for PMV.

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“…It may also cause physical deformity of the chest wall and loss of thoracic volume [11]. These in turn lead to decreased lung volume, atelectasis, chest tightness, dyspnea, and chronic pain [12,20].…”

Section: Discussionmentioning

confidence: 99%

“…One of the cornerstones of management of multiple rib fractures and flail chest is appropriate analgesia [11,12,21]. We chose to study the benefits of epidural analgesia in patients with flail chest because we believe that this is an understudied topic and we adopt a more aggressive approach at our center with epidural use.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent review of outcomes and treatment practices from the national trauma databank, Deghan, et al concluded that patients who have sustained a flail chest have significant morbidity (ICU admission, 82%; mechanical ventilation, 59%; need for chest tube, 44%; tracheostomy, 21%; ARDS, 14%; sepsis, 7%) and a high rate of mortality (16%) [10]. In addition, pulmonary contusions, prolonged mechanical ventilation, pneumonia, sepsis and poor pain control are common among patients sustaining flail chest injuries [7,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Traumatic flail chest injuries and the benefits of epidural analgesia

B¹,

Babsail²,

Elhusseini³

et al. 2017

Clin Res Trials

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Introduction: Many poly-trauma patients sustain chest wall injuries. Flail chest is considered one of the uncommon injuries that may happen in traumatized patients and may increase morbidity and mortality in polytrauma patients. Pulmonary contusion, mechanical ventilation, pneumonia, sepsis and poor pain control are expected to be common complications in patients sustaining chest wall injuries. We hypothesize that the use of epidural analgesia can lead to improved clinical outcomes in this group of patients.

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Operative Treatment of Chest Wall Injuries: Indications, Technique, and Outcomes

Cited by 196 publications

References 78 publications

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Risk factors for prolonged mechanical ventilation in patients with severe multiple injuries and blunt chest trauma: a single center retrospective case–control study

Traumatic flail chest injuries and the benefits of epidural analgesia

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