Assessment of thoracic trauma at the 1st Department of Surgery in Brno
(1 January 2011 – 31 December 2015)
Authors:
I. Čapov; A. Peštál; M. Reška; Z. Chovanec; J. Konečný; P. Vlček; M. Benej; M. Páral; L. Veverková; V. Prudius
Authors‘ workplace:
I. chirurgická klinika LF Masarykovy univerzity a FN USA v Brně
přednosta: prof. MUDr. I. Čapov, CSc.
Published in:
Rozhl. Chir., 2017, roč. 96, č. 12, s. 504-509.
Category:
Original articles
Overview
Introduction:
The number of cases of thorax injury increased steadily between 2011 and 2015. This is probably related to a more active lifestyle of the younger generations and also to the increasing average age of citizens. The aim of the study was to show problems connected with thorax injury.
Method:
Our retrospective study evaluated a group of patients with thoracic injury (diagnosis codes S20–S29) in the period from 1 January 2011 to 31 December 2015 who were treated in our Department.
Results:
We evaluated a group of 1,697 patients with thoracic injury were divided into five subgroups: 1) simple contusion of the thorax, 2) simple rib fractures, 3) contusion of the thorax with vertebral fractures, 4) serial, multiple rib fractures, 5) stab and gunshot injuries of the thorax. Each subgroup was analyzed independently and in detail. The number of thoracic injuries increased steadily, year on year. More than 40% of the patients were older than 60 years. In the group with simple rib fractures, the authors found 14 cases of pneumothorax (5.1%), which was drained in only 8 cases. The most common complications in the serial rib fractures group included pneumothorax (33 cases, 20%), hemothorax (28 cases, 16.9%) and lung contusion (15 cases, 9%). Stabilization of the thoracic wall was performed 16 times, out of the total of 26 multiple rib fracture cases (61.5%).
Conclusions:
Thorax injury is routinely encountered by surgeons. The authors recommend to pay particular attention not only to serious, but also to simple thorax injuries in very old patients, for instance those on anticoagulation therapy. Adequate caution also needs to be taken with serial rib fractures and flail chest and their treatment.
Key words:
thorax injury – rib fractures – hemothorax – pneumothorax
Sources
1. Hwang EG, Lee Y. Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures. JER 2016;12:637−41.
2. Barrett – Connor E, Nelson CM, Orwoll E, et al. Epidemiology of rib fractures in older men: osteoporotic fractures in men, prospective cohort study. BMJ 2010, Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839084/
3. Zaw AA, Murry J, Hoang D, et al. Epidural analgesia after rib fractures. Am Surg 2015;81:950−4.
4. Vodička J, et al. Traumatologie hrudníku. První vydání. Praha, Galén 2015.
5. Nirula R, Diaz JJ Jr, Trunkey DD, et al. Rib fracture repair: indications, technical issues, and future directions. World J Surg 2009; 33:14−22.
6. Sharma OP, Oswanski MF, Jolly S, et al. Period of rib fractures. Am Surg 2008;74:310−4.
7. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and metaanalysis. Injury 2012;4: 8−17.
8. Zreik NH, Francis I, Ray A, et al. Blunt chest trauma: soft tissue injury in the thorax. BJHM 2016;77:78−93.
9. Barnea Y, Kashtan H, Skornick Y, et al. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg 2002;45:626−31.
10. Unsworth A, Curtis K, Aha SE. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015;23:1−9.
11. LoCicero J III, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am 1989;69:15−9.
12. Kleber C, Giesecke MT, Tsokos M, et al. Trauma-related preventable death in Berlin 2010: need to change prehospital management strategies and trauma management education. World J Surg 2013;37:1154−61.
13. Sirmali H, Türüt H, Topcu S, et al. A comprehensive analysis of traumatic rib fractures morbidity, mortality and management. Eur J Cardiothorac Surg 2003;24:133−8.
14. Rodriguez RM, Anglin D, Langdorf MI, et al. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg 2013;148:940−6.
15. Agladioglu K, Serinkem M, Dal O, et al. Chest X-rays in detecting injuries caused by blunt trauma. World J Emerg Med 2016;1:55−8.
16. Alkadhi H, Wildermuth S, Marincek B, et al. Accuracy and time efficiency for the detection of thoracic cage fractures: volume rendering compared with transverse computed tomography images. J Comput Assist Tomogr 2004;28:378−85.
17. Pulley BR, Taylor BC, Fowler TT, et al. Utility of three-dimensional computed tomography for the surgical management of rib fractures. J Trauma Acute Care Surg 2015;78:530−4.
18. Talbot BS, Gange ChP jr, Chaturvedi A, et al. Traumatic rib injury: Patterns, imaging pitfalls, complications and treatment. Radiographics 2017;2:1−24.
19. Uil SM, van den Berg JWK. A prospective, randomised trial of pneumothorax therapy. Respiratory Medicine 2012;106:1600−5.
20. Vodička J, Špidlen V, Šafránek J, et al. Penetrující poranění hrudníku – sedmileté zkušenosti s diagnostikou a léčbou. Rozhl Chir 2007;86:120−5.
21. Symbas PN. Acute traumatic hemothorax. Ann Thorac Surg 1978;26:195−6.
22. De Lesquen H, Avaro JP, Gust L, et al. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries). Interact Cardiovasc Thorac Surg 2015;20:399−408.
23. Bosman A, de Jong MB, Debeij J, van den Broek PJ, et al. Systematic review and meta-analysis of antibiotic prophylaxis to prevent infections from chest drains in blunt and penetrating thoracic injuries. Br J Surg 2012;99:506−13.
24. Yeh DD, Kutcher ME, Knudson MM, et al. Epidural analgesia for blunt thoracic injury. Which patients benefit most? Injury 2012;43:1667−71
25. Pressley CM, Fry WR, Philp AS, et al. Predicting outcome of patients with chest wall injury. Am J Surg 2012;204:910−3.
26. Chen J, Jeremitsky E, Philp F, et al. A chest trauma scoring system to predict outcomes. Surgery 2014;156:988−93.
27. Chapman BC, Herbert B, Rodil M, et al. RibScore: A novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy. J Trauma Acute Care Surg 2016;80:95−101.
28. Fabrucci P, Nocentini L, Secci S, et al. Video-assisted thoracoscopy in the early diagnosis and management of post-traumatic pneumothorax and hemothorax. Surg Endosc 2008;22:1227−31.
29. Vassiliu P, Velmahos GC, Toutouzas KG. Timing, safety and efficacy of thoracoscopic evacuation of undrained post-traumatic hemothorax. Am Surg 2001;67:1165−9.
30. Smith JW, Franklin GA, Harbrecht BG, et al. Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma 2011;71:102−5,Discussion 105−7.
31. Navsaria PH, Vogel RJ, Nicol AJ. Thoracoscopic evacuation of retained posttraumatic hemothorax. Ann Thorac Surg 2004;78:282−6.
32. Villacicencio RT, Aucar JA, Wall MJ Jr. Analysis of thoracoscopy in trauma. Surg Endosc 1999;13:3−9.
33. Vyhnánek F. Principy ošetření poranění hrudní stěny. Rozhl Chir 2011;90:637−41.
34. Vyhnánek F. Diagnostické a léčebné postupy u torakoabdominálních poranění – současný stav. Rozhl Chir 2007; 86:397−403.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2017 Issue 12
Most read in this issue
- Pulmonary contusion
- Ruptures of the diaphragm
- Myxoid liposarcoma localised in the peritoneal cavity − case report
- Chest injuries in polytraumatized children