Rib Fracture Stabilization in Patients Sustaining Blunt Chest Injury

Nirula, Ram; Allen, Brian C.; Layman, Ralph; Falimirski, Mark E.; Somberg, Lewis B.

doi:10.1177/000313480607200405

Cited by 130 publications

(55 citation statements)

References 11 publications

(15 reference statements)

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“…Surgical rib fixation (SRF) is a treatment for flail chest as it provides chest wall stability. Retrospective studies have noted a significant decrease in mechanical ventilation requirements after surgical fixation [ 22 , 25 , 27 ]. Through decreasing the time required on mechanical ventilation, surgical fixation prevents ventilator-acquired pneumonia [ 25 , 28 ], a common complication of prolonged intubation [ 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery

Unsworth

Curtis

Asha

2015

Scand J Trauma Resusc Emerg Med

112

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Blunt chest trauma is associated with a high risk of morbidity and mortality. Complications in blunt chest trauma develop secondary to rib fractures as a consequence of pain and inadequate ventilation. This literature review aimed to examine clinical interventions in rib fractures and their impact on patient and hospital outcomes. A systematic search strategy, using a structured clinical question and defined search terms, was performed in MEDLINE, EMBASE, CINAHL and the Cochrane Library. The search was limited to studies of adult humans from 1990-March 2014 and yielded 977 articles, which were screened against inclusion/exclusion criteria. A hand search was then performed of the articles that met the eligibility criteria, 40 articles were included in this review. Each article was assessed using a quantitative critiquing guideline. From these articles, interventions were categorised into four main groups: analgesia, surgical fixation, clinical protocols and other interventions. Surgical fixation was effective in patients with flail chest at improving patient outcomes. Epidural analgesia, compared to both patient controlled analgesia and intravenous narcotics in patients with three or more rib fractures improved both hospital and patient outcomes, including pain relief and pulmonary function. Clinical pathways improve outcomes in patients ≥ 65 with rib fractures. The majority of reviewed papers recommended a multi-disciplinary approach including allied health (chest physiotherapy and nutritionist input), nursing, medical (analgesic review) and surgical intervention (stabilisation of flail chest). However there was a paucity of evidence describing methods to implement and evaluate such multidisciplinary interventions. Isolated interventions can be effective in improving patient and health service outcomes for patients with blunt chest injuries, however the literature recommends implementing strategies such as clinical pathways to improve the care and outcomes of thesetre patients. The implementation of evidence-practice interventions in this area is scarce, and evaluation of interventions scarcer still.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0091-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery

Unsworth

Curtis

Asha

2015

Scand J Trauma Resusc Emerg Med

112

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“…During the treatment there were no pleural complications. There are methods for flail chest surgical fixation and studies demonstrating the benefit of surgical treatment of severe chest wall injuries [20][21][22][23][24] , but they are not widely accepted due to the lack of evidence. Flail chest treatment requires longterm mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Flail chest in a polytraumatized patient: Management and treatment - case report

et al. 2017

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Introduction. Management of a polytraumatized patient is a problem that requires a multidisciplinary approach, in order to optimise patient's outcome. The purpose of this study was to show the approach in the treatment of a patient with a severe life-threatening polytrauma, including a personalized healthcare approach with the positive outcome after the inadequate initial treatment. Case report. We presented a case of a young polytraumatized patient with trauma as a result of road traffic accident. The patient had chest, abdominal and right arm injuries. He was diagnosed of hepatic rupture with conquasation and retroperitoneal hematoma and the patient underwent liver tamponade. Chest trauma due to bilateral serial rib fracture with flail chest was treated by chest drainage. After the adequate multidisciplinary interventions for the patient, the patient was discharged. Conclusion. This case report is of great importance since it shows that severe polytraumatized patients with bad initial prognosis can successfully receive a lifesaving treatment.

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“…Nirula et al 28 descreveram que os pacientes com traumas torácicos graves, submetidos à intervenção cirúrgica, necessitaram de menos cuidados com relação à ventilação.…”

Section: Fraturas De Arcos Costaisunclassified

Estado atual das fraturas dos arcos costais

Pereira¹,

Carvalho

Valenti

et al. 2010

Arq. Bras. Ciên. Saúde

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ResumoOs traumas torácicos são uma importante causa de hospitalização, morbidade e mortalidade na população jovem. Em muitas ocasiões, esses traumas torácicos se associam às fraturas dos arcos costais, consideradas benignas na maioria das vezes, mas que podem determinar uma maior gravidade em seus portadores, principalmente idosos. Neste trabalho de revisão, concluiu-se que o diagnóstico correto das fraturas deve ser realizado inclusive com o apoio da tomografia computadorizada, uma vez que a radiologia simples não é suficiente para a precisão diagnóstica. Em relação ao tratamento, muitos autores advogam a terapêutica cirúrgica, objetivando uma recuperação mais rápida dos pacientes internados com fratura de arcos costais.Palavras-chave: Fraturas ósseas; costelas; fraturas das costelas. AbstractThe thoracic trauma is an important cause of hospitalization, morbidity and mortality in young population. In many occasions, this trauma is associated with rib fractures, considered as a benign problem, but they can determine a bigger gravity in its carriers, mainly in elderly. In this review, the authors concluded that the correct diagnosis of the fractures must be carried through with the support of computerized tomography scan, since simple radiology is not enough for the diagnostic precision. In relation to the treatment, many authors defend the surgical approach to obtain a faster recovery of the hospitalized patients with breaking of costal arcs. Keywords IntroduçãoOs traumas torácicos são uma importante causa de hospitalização, morbidade e mortalidade na população jovem. Os acidentes de trânsito constituem a principal causa 1 .Em muitas ocasiões, esses traumas torácicos se associam às fraturas dos arcos costais, consideradas benignas na maioria das vezes.Apesar de promoverem o aparecimento de dor, muitas vezes intensa, consolidam-se bem e raramente promovem complicações, exceto quando decorrentes de traumas de maior energia, nos quais a ocorrência de fraturas de múltiplos arcos costais interfere de forma dramática no quadro respiratório do indivíduo.A identificação de pacientes com alto risco de morte nos traumas torácicos é fator fundamental nos protocolos de atendimento dos sistemas de trauma. Pacientes com seis ou mais fraturas de costelas são três vezes mais propensos ao óbito dentro das primeiras 24 horas da admissão, quando comparados a pacientes com fratura de apenas uma costela 2 .A idade e o escore de severidade do trauma são fatores de risco para pneumonia e mortalidade em pacientes com fraturas de costelas

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Rib Fracture Stabilization in Patients Sustaining Blunt Chest Injury

Cited by 130 publications

References 11 publications

Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery

Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery

Flail chest in a polytraumatized patient: Management and treatment - case report

Estado atual das fraturas dos arcos costais

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