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Flail chest

Sonofu Taketani, Yoshifumi Makimoto, Masafumi Kunitake, Tomoyuki Anegawa
A 84-year-old man who had experienced cardiac arrest in the ambulance was brought to the emergency room. He had been followed at outpatient after surgery for colon cancer and known to be suffered from mild renal impairment. The cardio pulmonary arrest was likely to be caused by acute exacerbation of that. He was resuscitated and immediately recovered without severe hypoxic encephalopathy or deterioration of renal function. However, the flail chest by manual cardiac compression sustained. It urged him to be managed under the ventilator and he seemed difficult to leave from that within a couple of weeks...
November 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Chun Sung Byun, Il Hwan Park, Wan Jin Hwang, Yeiwon Lee, Hyun Min Cho
BACKGROUND: Sternal fractures are relatively rare, and caused mainly by blunt anterior chest wall trauma. In most cases, sternal fractures are treated conservatively. However, if the patient exhibits problematic symptoms such as intractable chest wall pain or bony crepitus due to sternal instability, surgical correction is indicated. But no consensus exists regarding the most appropriate surgical method. We analyzed the results of surgical fixation in cases of sternal fracture in order to identify which surgical method led to the best outcomes...
October 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Joanne May Jenkins, Joel Norton, Timothy Hampton, Robert Weeks
A 55-year-old man was working in a trench when the wall collapsed in on him, pinning him to the wall. On arrival in the emergency department the patient began reporting of right-sided headache. Neurological examination revealed left-sided reduced sensation with weakness. Whole-body CT scan showed right-sided flail chest and bilateral haemothorax as well as loss of flow and thinning of the distal right internal carotid artery (ICA) and loss of grey white matter differentiation in keeping with traumatic ICA dissection with a right middle cerebral artery (MCA) infarct...
2016: BMJ Case Reports
T Kyriss, U Lenz, G Friedel
This overview reviews the current literature to compare the functional results after surgical and conservative treatment of patients with flail chest and multiple rib fractures. Regarding functional aspects, patients in the early phase after a thoracic trauma are those that benefit most from the stabilisation of the chest wall by internal fixation of the ribs. Patients recover faster from restrictive respiratory disorders, have less pain and return to the workplace earlier after an operation compared with those that receive conservative treatment...
September 2016: Zentralblatt Für Chirurgie
Yosuke Morodomi, Tatsuro Okamoto, Tetsuzo Tagawa, Fumihiro Shoji, Masakazu Katsura, Takatoshi Fujishita, Tetsuhiro Fujiyoshi, Tomohiko Akahoshi, Mitsuhiro Yasuda, Yoshihiko Maehara
No abstract text is available yet for this article.
November 2016: Journal of Trauma and Acute Care Surgery
Jaap Schuurmans, J C Goslings, T Schepers
PURPOSE: Flail chest is a life-threatening complication of severe chest trauma with a mortality rate of up to 15 %. The standard non-operative management has high comorbidities with pneumonia and often leads to extended Intensive Care Unit (ICU) stay, due to insufficient respiratory function and complications. The aim of this literature study was to investigate how operative management improves patient care for adults with flail chest. METHODS: Randomized-controlled trials comparing operative management versus non-operative management of flail chest were included in this systematic review and meta-analysis...
August 29, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
T A Coughlin, J W G Ng, K E Rollins, D P Forward, B J Ollivere
AIMS: Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management. PATIENTS AND METHODS: A systematic search of the literature was carried out to identify randomised controlled trials (RCTs) which compared the clinical outcome of patients with a traumatic flail chest treated by surgical stabilisation of any kind with that of non-operative management...
August 2016: Bone & Joint Journal
Jaclyn Farquhar, Yahya Almahrabi, Gerard Slobogean, Bronwyn Slobogean, Naisan Garraway, Richard K Simons, S Morad Hameed
BACKGROUND: Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. METHODS: Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols...
September 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Rizwan Q Attia, Katharina L Schulte, Donald C Whitaker
No abstract text is available yet for this article.
August 2016: Interactive Cardiovascular and Thoracic Surgery
Benjamin C Taylor, T Ty Fowler, Bruce G French, Neysa Dominguez
INTRODUCTION: Recent reported success in surgical stabilization of flail chest has been described in small series, but scant evidence exists for this procedure in the orthopaedic literature. METHODS: We reviewed 88 consecutive patients who underwent surgical stabilization of flail chest, along with 88 consecutive patients with flail chest who underwent traditional closed management before initiation of our algorithm change to surgical management. RESULTS: Surgical stabilization of flail chest injuries led to statistically significant decreases in hospital length of stay, ventilator-dependency time, pneumonia, tracheostomy, and mortality rate...
August 2016: Journal of the American Academy of Orthopaedic Surgeons
Eva-Corina Caragounis, Monika Fagevik Olsén, David Pazooki, Hans Granhed
BACKGROUND: Multiple rib fractures and unstable thoracic cage injuries are common in blunt trauma. Surgical management of rib fractures has received increasing attention in recent years and the aim of this 1-year, prospective study was to assess the long-term effects of surgery. METHODS: Fifty-four trauma patients with median Injury Severity Score 20 (9-66) and median New Injury Severity Score 34 (16-66) who presented with multiple rib fractures and flail chest, and underwent surgical stabilization with plate fixation were recruited...
2016: World Journal of Emergency Surgery: WJES
Nagaraj Pandharikar, Anil Sachdev, Neeraj Gupta, Suresh Gupta, Dhiren Gupta
Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients...
April 2016: Indian Journal of Critical Care Medicine
Sung Kwang Lee, Do Kyun Kang
Flail chest is a life-threatening situation that paradoxical movement of the thoracic cage was caused by multiply fractured ribs in two different planes, or a sternal fracture, or a combination of the two. The methods to achieve stability of the chest wall are controversy between surgical fixation and mechanical ventilation. We report a case of a 33-year-old man who fell from a high place with fail chest due to multiple rib fractures bilaterally and horizontal sternal fracture. The conventional surgical stabilization using metal plates by access to the front of the sternum could not provide stability of the flail segment because the fracture surface was obliquely upward and there were multiple bilateral rib fractures adjacent the sternum...
June 2016: Journal of Thoracic Disease
K Uchida, T Nishimura, H Takesada, T Morioka, N Hagawa, T Yamamoto, S Kaga, T Terada, N Shinyama, H Yamamoto, Y Mizobata
PURPOSE: The purpose of this study was to assess the effects of recent surgical rib fixation and establish its indications not only for flail chest but also for multiple rib fractures. METHODS: Between 2007 and 2015, 187 patients were diagnosed as having multiple rib fractures in our institution. After the propensity score matching was performed, ten patients who had performed surgical rib fixation and ten patients who had treated with non-operative management were included...
June 6, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Matthew W Pennington, Anthony M Roche, Richard J Bransford, Fangyi Zhang, Armagan Dagal
Two patients with unstable thoracic spine and flail segment rib fractures initially failed prone positioning on a Jackson spinal table used for posterior spinal instrumentation and fusion surgery. Both patients experienced rapid hemodynamic collapse. We developed a solution using the anterior portions of a thoracolumbosacral orthosis brace as chest supports to use during prone positioning, allowing both patients to undergo uncomplicated posterior spinal instrumentation and fusion surgeries with greater hemodynamic stability...
July 1, 2016: A & A Case Reports
Samil Gunay, Huseyin Candan, Rahsan Yılmaz, Irfan Eser, Umit Aydoğmus
Background Rib fracture is the most common result of thoracic traumas. Intrapulmonary shunt, alveolar capillary membrane damage, intra-alveolar hemorrhage, and hypoxia may develop following rib fractures. Therefore, prompt treatment is important. The aim of this experimental study was to analyze the effects of platelet-rich plasma (PRP) on rib fractures to secure a speedier and more efficient treatment method. Materials and Methods The study involved 18 New Zealand white rabbits, randomly divided into three groups as Group 1, the sham group with no surgical intervention; Group 2, the control group in which simple rib fractures were applied and no treatment; and Group 3, in which rib fractures were applied and then PRP treatment was administered...
May 5, 2016: Thoracic and Cardiovascular Surgeon
Nikolay Bugaev, Janis L Breeze, Majid Alhazmi, Hassan S Anbari, Sandra S Arabian, Reuven Rabinovici
Displacement patterns of rib fractures (RF) and their association with thoracic coinjuries and outcomes are unknown. This is a retrospective review of adult patients with blunt closed RF who underwent chest CT at a Level I trauma center (2007-2012). Displacement patterns of RF were compared among the three-dimensional planes using CT images. An analysis of receiver operating characteristic (ROC) curves was performed to identify displacements in each plane most strongly associated with chest coinjuries. Univariate analysis was used to find association of displaced RF with hospital course and outcome...
March 2016: American Surgeon
S Schulz-Drost, S Grupp, M Pachowsky, P Oppel, S Krinner, A Mauerer, F F Hennig, A Langenbach
PURPOSE: Stabilizing techniques of flail chest injuries usually need wide approaches to the chest wall. Three main regions need to be considered when stabilizing the rib cage: median-anterior with dissection of pectoral muscle; lateral-axillary with dissection of musculi (mm) serratus, externus abdominis; posterior inter spinoscapular with division of mm rhomboidei, trapezius and latissimus dorsi. Severe morbidity due to these invasive approaches needs to be considered. This study discusses possibilities for minimized approaches to the shown regions...
March 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Angela De Palma, Francesco Sollitto, Domenico Loizzi, Francesco Di Gennaro, Daniele Scarascia, Annalisa Carlucci, Giuseppe Giudice, Andrea Armenio, Rossana Ludovico, Michele Loizzi
BACKGROUND: We report short and long-term results with the dedicated Synthes(®) titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. METHODS: We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16-83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]...
March 2016: Journal of Thoracic Disease
Katharina Schulte, Donald Whitaker, Rizwan Attia
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with acute flail chest does surgical rib fixation improve outcomes in terms of morbidity and mortality? Using the reported search criteria, 137 papers were found. Of these, 11 papers (N = 1712) represent the best evidence to answer the clinical question, and include one meta-analysis, two randomized, controlled trials (RCTs), five retrospective cohort studies and two case-control series...
August 2016: Interactive Cardiovascular and Thoracic Surgery
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