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https://www.readbyqxmd.com/read/29352361/the-modified-ravitch-approach-for-the-management-of-severe-anterior-flail-chest-with-bilateral-sternochondral-dislocations-a-case-report
#1
Gabriel Estremera, Ellen Chieko Omi, Eduardo Smith-Singares
The management of flail chest continues to evolve as scientific evidence and surgical experience accumulates. Flail chest injuries that span the sternum present a rare and complicated injury pattern that can be challenging to manage both medically and surgically. Our patient is a 69-year-old involved in a high-speed motor vehicle crash with respiratory failure secondary to an anterior flail chest. Tomographic examination confirmed a sternal fracture with bilateral sternochondral dislocations and multiple rib fractures...
January 19, 2018: Surgical Case Reports
https://www.readbyqxmd.com/read/29227049/rib-fracture-fixation-in-a-south-african-public-trauma-service
#2
G V Oosthuizen, J De Wet, J L Bruce, D L Clarke
BACKGROUND: Rib fractures and flail chests have traditionally been treated nonoperatively. Current literature suggests that it is not only safe and feasible but also desirable to perform fixation of severe rib fractures. Our unit in the Pietermaritzburg public sector adopted rib fracture fixation in 2014 and in this audit we assess its feasibility in our setting. METHODS AND RESULTS: We audited our first nine cases of rib fracture fixation performed to date, of which seven were males...
November 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/29214444/the-respiratory-rate-a-neglected-triage-tool-for-pre-hospital-identification-of-trauma-patients
#3
John D Yonge, Phillip Kemp Bohan, Justin J Watson, Christopher R Connelly, Lynn Eastes, Martin A Schreiber
BACKGROUND: Under-triaged trauma patients have worse clinical outcomes. We evaluated the capability of four pre-hospital variables to identify this population at the lowest level trauma activation (level 3). METHODS: A retrospective review of adult trauma activations from 2004 to 2014 was completed. Pre-hospital vital signs and Glasgow Coma Scale were converted to categorical variables. Patients were under-triaged based on meeting current level 1 or 2 criteria, or requiring a pre-defined critical intervention...
December 6, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29185785/functional-outcomes-of-motor-vehicle-crash-thoracic-injuries-in-pediatric-and-adult-occupants
#4
Samantha L Schoell, Ashley A Weaver, Jennifer W Talton, Ryan T Barnard, Gretchen Baker, Joel D Stitzel, Mark R Zonfrillo
OBJECTIVE: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs), and compare the functional outcomes between the pediatric and adult populations. METHODS: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2-5 thoracic injuries...
November 29, 2017: Traffic Injury Prevention
https://www.readbyqxmd.com/read/29124273/reduced-invasive-and-muscle-sparing-operative-approaches-to-the-posterolateral-chest-wall-provide-an-excellent-accessibility-for-the-operative-stabilization-minimized-approaches-to-the-posterolateral-chest-wall
#5
A Langenbach, Pascal Oppel, Sina Grupp, Sebastian Krinner, Milena Pachowsky, Thomas Buder, Melanie Schulz-Drost, Friedrich F Hennig, Stefan Schulz-Drost
PURPOSE: Stabilizing techniques for flail chest injuries are described through wide surgical approaches to the chest wall, especially in the most affected posterior and lateral regions. Severe morbidity due to these invasive approaches needs to be considered due to dissection of the scapular guiding muscles and the risk of injuries to neurovascular bundles. This study discusses possibilities for minimized approaches to the posterior and lateral regions. METHOD: Ten fresh-frozen cadavers in lateral decubitus position were observed on both sides...
November 9, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29124026/risk-factors-for-pneumonia-in-ventilated-trauma-patients-with-multiple-rib-fractures
#6
Hyun Oh Park, Dong Hoon Kang, Seong Ho Moon, Jun Ho Yang, Sung Hwan Kim, Joung Hun Byun
Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients...
October 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29123889/a-case-of-non-cardiogenic-pulmonary-edema-provoked-by-intravenous-acetazolamide
#7
Yuichiro Ono, Makiko Morifusa, Satoru Ikeda, Chika Kunishige, Yoshiki Tohma
Case: A 61-year-old man was diagnosed with severe chest trauma after a car accident and had had difficulty in weaning from a ventilator because of flail chest and dilated cardiomyopathy. On the 17th day in the intensive care unit, he received i.v. acetazolamide to increase urine output. One hour after the injection, he suddenly developed severe hypoxia. Chest radiography revealed a butterfly shadow. He received other diuretics and a vasodilator, which seemed slowly to resolve the respiratory failure...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29042090/the-natural-history-of-flail-chest-injuries
#8
Kamil Naidoo, Layth Hanbali, Peter Bates
PURPOSE: Flail chest (FC) injuries represent a significant burden on trauma services because of its high morbidity and mortality. Current gold standard conservative management strategies for FC, are now being challenged by renewed interest in surgical rib fixation. This retrospective epidemiological study sets out to evaluate FC patients, and quantify the natural history of this injury by studying the injury patterns, epidemiology and mortality of patients sustaining FC injuries admitted to a major trauma centre (MTC)...
October 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29037517/comparative-studies-of-different-types-of-osteosynthesis-on-the-human-corpse-preparation-in-bilateral-antero-lateral-flail-chest
#9
Sina Grupp, Veronika Fürst, Thomas Buder, Alexander Fichte, Sebastian Krinner, Roman T Carbon, Friedrich F Hennig, Andreas Langenbach, Stefan Schulz-Drost
INTRODUCTION: Bilateral flail chest injuries are challenging in treatment and comparatively often require an operative stabilization of the anterior chest wall to re-establish normal physiological conditions of the chest wall in shape and statics. Various procedures have been described which are technically sophisticated for the surgeon. Consequently there is an increasing interest in potentials of operative care and their effectiveness on the anterolateral chest wall. MATERIALS AND METHODS: 12 Human cadavers were prepared and the natural Sternum Position (NP) was marked...
October 9, 2017: Injury
https://www.readbyqxmd.com/read/29037487/-chronic-chest-pain-after-rib-fracture-it-can-cause-a-disability
#10
S Rabiou, Y Ouadnouni, M Lakranbi, A Traibi, F Antoini, M Smahi
INTRODUCTION: The rib fractures and instability of the chest wall are the main lesions of closed chest trauma. These lesions can be a source of chronic, often disabling with daily discomfort resulting limitation of some activities. The objective of this study was to assess the prevalence of this phenomenon in order to improve the quality of early care. METHODOLOGY: Through an observational retrospective cohort study on a number of 41 patients supported and monitored for traumatic rib fractures at the Military Hospital of Meknes during the period from October 2010 to March 2016...
October 13, 2017: Revue de Pneumologie Clinique
https://www.readbyqxmd.com/read/29026892/prompt-diagnosis-of-st-elevation-myocardial-infarction-with-papillary-muscle-rupture-by-point-of-care-ultrasound-in-the-emergency-department
#11
Koon Ho Cheung, Colin Graham Alexander
A previously healthy 61-year-old man presented to the emergency department with chest pain and dyspnoea for 6 hours. Examination revealed distress with an apical pansystolic murmur. Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an inferior ST-elevation myocardial infarction. Point-of-care echocardiography in the emergency department showed a flail anterior mitral leaflet and severe mitral regurgitation, leading to a provisional diagnosis of papillary muscle rupture...
September 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28963613/cardiothoracic-injuries-after-cardiopump-cpr-a-report-of-two-cases-and-review-of-the-literature
#12
Martin Kolopp, Angélique Franchi, Patrick Grafiadis, Laurent Martrille
Although many clinical trials have demonstrated its efficacy during active compression-decompression cardiopulmonary resuscitation (ACD-CPR), the Ambu® CardioPump seems likely to cause severe and sometimes lethal injuries. In this paper, we report two cases observed at the Institute of Legal Medicine of Nancy, France. A 67-year-old man collapsed in the street, in the presence of witnesses, and without any sign of trauma. The autopsy revealed a flail chest, a wound of the left ventricle, a rupture of the right ventricle, and a wrenching of the inferior vena cava...
September 29, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/28902086/operative-stabilization-of-flail-chest-injuries-reduces-mortality-to-that-of-stable-chest-wall-injuries
#13
Niloofar Dehghan, Jeffrey M Mah, Emil H Schemitsch, Aaron Nauth, Milena Vicente, Michael D McKee
OBJECTIVE: To determine the prevalence, management and outcomes of patients with flail chest injuries, compared to patients without flail chest injuries (single rib fractures and multiple rib fractures without a flail segment). DESIGN: Retrospective cohort study SETTING:: Ontario, Canada PARTICIPANTS:: Ontario residents over the age of 16 who had been admitted to hospital with a chest wall injury from 2004 to 2015 were identified using administrative health care databases...
August 29, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28852836/indications-for-surgical-stabilization-of-rib-fractures-in-patients-without-flail-chest-surveyed-opinions-of-members-of-the-chest-wall-injury-society
#14
Fredric M Pieracci, Suresh Agarwal, Andrew Doben, Adam Shiroff, Larwence Lottenberg, Sarah Ann Whitbeck, Thomas W White
PURPOSE: There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. METHODS: Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery...
August 29, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28795026/rib-fractures-to-fix-or-not-to-fix-an-evidence-based-algorithm
#15
REVIEW
Michael Bemelman, M W de Kruijf, Mark van Baal, Luke Leenen
Rib fractures are a common injury resulting from blunt chest trauma. The most important complications associated with rib fractures include death, pneumonia, and the need for mechanical ventilation. The development of new osteosynthesis materials has stimulated increased interest in the surgical treatment of rib fractures. Surgical stabilisation, however, is not needed for every patient with rib fractures or for every patient with flail chest. This paper presents an easy-to-use evidence-based algorithm, developed by the authors, for the treatment of patients with flail chest and isolated rib fractures...
August 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28776131/pure-distraction-injury-of-t1-2-with-quad-fever
#16
Jun-Yeong Seo, Chae-Moon Lim, Young-Hoon Kim, Kee-Yong Ha
INTRODUCTION: We report a pure distraction injury of the upper thoracic spine and uncontrolled hyperthermia without an infectious cause. Quad fever appears in the first several weeks to months after a cervical or upper thoracic SCI and is characterized by an extreme elevation in body core temperature beyond 40 °C without an infectious cause. Discriminating between infectious and noninfectious causes is important, and a thorough clinical assessment is required. MATERIALS AND METHODS: A 52-year-old male visited the emergency room complaining of back pain with complete paralysis [American Spinal Injury Association (ASIA) A] of both lower extremities after a pedestrian-motor vehicle accident...
August 3, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28700410/quantifying-and-exploring-the-recent-national-increase-in-surgical-stabilization-of-rib-fractures
#17
MULTICENTER STUDY
Erica D Kane, Elan Jeremitsky, Fredric M Pieracci, Sarah Majercik, Andrew R Doben
BACKGROUND: Surgical stabilization of rib fractures (SSRF) has become pivotal in the management of severe chest injuries. Recent literature supports improved outcomes and mortality in severe fracture and flail chest patients who undergo SSRF compared with nonoperative management (NOM). A 2014 National Trauma Data Bank review provided a point prevalence of 0.7% SSRF in flail patients. We hypothesize that this prevalence is increasing and that temporal, regional, and American College of Surgeons (ACS) trauma designation vary in SSRF utilization...
December 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28631272/a-unique-fatal-moose-attack-mimicking-homicide
#18
Petur Gudmannsson, Johan Berge, Henrik Druid, Göran Ericsson, Anders Eriksson
Fatalities caused by animal attacks are rare, but have the potential to mimic homicide. We present a case in which a moose attacked and killed a woman who was walking her dog in a forest. Autopsy showed widespread blunt trauma with a large laceration on one leg in which blades of grass were embedded. Flail chest was the cause of death. The case was initially conceived as homicide by means of a riding lawn mower. A review of the case by moose experts and analyses of biological trace material that proved to originate from moose, established the true source of injury...
June 20, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28549363/-thoracic-inestability-fixed-with-bioabsorbable-screws-and-plates
#19
A L Nolasco-de la Rosa, R Mosiñoz-Montes, J Matehuala-García, A A Cuautle-Ramírez, E Román-Guzmán, A L Reyes-Miranda, F Quero-Sandoval
BACKGROUND: Flail chest is managed with mechanical ventilation or inhaloteraphy and analgesia. Little has been published on the use of bioabsorbable material and its evolution in flail chest fixation. METHODS: This is a descriptive study of patients with unstable chest undergoing fixation with bioabsorbable plates and screws in a period from February 2009 to December 2011. RESULTS: We report 18 cases, aged 33-74 years (mean 53), three with bilateral involvement; rib fixation was performed between 1-21 days of the accident (mean 1...
November 2016: Acta Ortopédica Mexicana
https://www.readbyqxmd.com/read/28446987/blunt-chest-trauma-is-there-a-place-for-rib-stabilization
#20
REVIEW
John D Mitchell
Rib fractures are a common and highly morbid finding in patients with blunt chest trauma. Over the past decade, a renewed interest in (and instrumentation for) rib fixation in this cohort has occurred. Stabilization of the chest wall in this setting, particularly when a flail segment is present, is associated with significant reductions in the rates of respiratory failure, pneumonia, ICU stay, and mortality. Thoracic surgeons should remain actively involved in this evolving area of our specialty to further optimize patient outcomes...
April 2017: Journal of Thoracic Disease
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