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rib fracture management

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https://www.readbyqxmd.com/read/28186860/traumatic-rib-injury-patterns-imaging-pitfalls-complications-and-treatment
#1
Brett S Talbot, Christopher P Gange, Apeksha Chaturvedi, Nina Klionsky, Susan K Hobbs, Abhishek Chaturvedi
The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures...
February 10, 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28144607/clinical-utility-of-chest-computed-tomography-in-patients-with-rib-fractures-ct-chest-and-rib-fractures
#2
Brandon C Chapman, Douglas M Overbey, Feven Tesfalidet, Kristofer Schramm, Robert T Stovall, Andrew French, Jeffrey L Johnson, Clay C Burlew, Carlton Barnett, Ernest E Moore, Fredric M Pieracci
BACKGROUND: Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. OBJECTIVES: The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. METHODS: Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest...
December 2016: Archives of Trauma Research
https://www.readbyqxmd.com/read/28119351/are-first-rib-fractures-a-marker-for-other-life-threatening-injuries-in-patients-with-major-trauma-a-cohort-study-of-patients-on-the-uk-trauma-audit-and-research-network-database
#3
Ian Ayenga Sammy, Hridesh Chatha, Fiona Lecky, Omar Bouamra, Marisol Fragoso-Iñiguez, Abdo Sattout, Michael Hickey, John E Edwards
BACKGROUND: First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. METHODS: Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network...
January 24, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28100942/potential-benefits-of-rib-fracture-fixation-in-patients-with-flail-chest-and-multiple-non-flail-rib-fractures
#4
Meiguang Qiu, Zhanjun Shi, Jun Xiao, Xuming Zhang, Shishui Ling, Hao Ling
The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest (n = 38) and multiple non-flail rib fracture groups (n = 124)...
December 2016: Indian Journal of Surgery
https://www.readbyqxmd.com/read/28030506/rib-fracture-fixation-in-the-65-year-and-older-population-a-paradigm-shift-in-management-strategy-at-a-level-i-trauma-center
#5
Michael T Fitzgerald, DennisW Ashley, Hesham Abukhdeir, D Benjamin Christie
BACKGROUND: Rib fractures after chest wall trauma are a common injury, however carry a significant morbidity and mortality risk. The impact of rib fractures in the ≥ 65yo patient population has been well documented as have the mortality and pneumonia rates. We hypothesize that patients ≥ 65yo receiving rib plating have decreased mortality, complication rates, and an accelerated return to normal functional states when compared to controls. METHODS: With IRB approval, a retrospective review analyzed patients ≥ 65yo with rib fractures admitted from 2009-2015 receiving rib plating(RP group)(n=23) compared to non-operative, injury-matched controls admitted from 2003-2008(NO group)(n=50)...
December 23, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28030502/operative-fixation-of-rib-fractures-after-blunt-trauma-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
#6
George Kasotakis, Erik A Hasenboehler, Erik W Streib, Nimitt Patel, Mayur B Patel, Louis Alarcon, Patrick L Bosarge, Joseph Love, Elliott R Haut, John J Como
BACKGROUND: Rib fractures are identified in 10% of all injury victims and are associated with significant morbidity (33%) and mortality (12%). Significant progress has been made in the management of rib fractures over the last few decades, including operative reduction and internal fixation (rib ORIF); however, the subset of patients that would benefit most from this procedure remains ill-defined. The aim of this project was to develop evidence-based recommendations. METHODS: Population, intervention, comparison and outcome (PICO) questions were formulated for patients with and without flail chest...
December 23, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27913383/traumatic-haemopneumothorax-and-whole-body-subcutaneous-emphysema-successful-use-of-a-small-bore-chest-drain
#7
Benjamin Hardy, Nicholas Sunderland, Mevan Perera, Kathryn Channing
A 56-year-old man presented having had two falls at home. He had a background of multiple sclerosis. After his second fall, during which he had fallen onto the toilet injuring his right chest, he was brought into the emergency department reporting pleuritic chest discomfort. Immediately evident was extensive swelling from his forehead to his thighs, which on palpation was found to be subcutaneous emphysema. A chest X-ray showed a large right-sided pneumothorax for which a chest drain was inserted. A CT revealed extensive surgical emphysema, pneumomediastinum, pneumoperitoneum and gas within the spinal canal...
December 2, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27893505/rib-fracture-protocol-advancing-the-care-of-the-elderly-patient
#8
Susan Leininger
This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients with fracture.
January 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/27793168/physical-function-and-pain-after-surgical-or-conservative-management-of-multiple-rib-fractures-a-follow-up-study
#9
Monika Fagevik Olsén, Margareta Slobo, Lena Klarin, Eva-Corina Caragounis, David Pazooki, Hans Granhed
BACKGROUND: There is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients. METHODS: A consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia...
October 28, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27779590/western-trauma-association-critical-decisions-in-trauma-management-of-rib-fractures
#10
Karen J Brasel, Ernest E Moore, Roxie A Albrecht, Marc deMoya, Martin Schreiber, Riyad Karmy-Jones, Susan Rowell, Nicholas Namias, Mitchell Cohen, David V Shatz, Walter L Biffl
This is a recommended management algorithm from the Western Trauma Association addressing the management of adult patients with rib fractures. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, these recommendations are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithm and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers...
January 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27770081/thoracic-outlet-syndrome-in-a-volleyball-player-due-to-nonunion-of-the-first-rib-fracture
#11
Kathleen T Puttmann, Bhagwan Satiani, Patrick Vaccaro
Fracture of the first rib with ensuing callus formation is a rare cause of thoracic outlet syndrome. We report a case of a 17-year-old female volleyball player who presented with months of chronic arm pain. Radiographic imaging demonstrated nonunion fracture of the first rib. Physical therapy had been unsuccessful in relieving the pain, and surgical management was performed with resection of the first rib through a transaxillary approach with complete resolution of symptoms. Inflammation surrounding such fractures may destroy tissue planes, making dissection more technically difficult...
October 20, 2016: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27716425/flank-pseudohernia-following-posterior-rib-fracture-a-case-report
#12
Adam M Butensky, Leah P Gruss, Zachary L Gleit
BACKGROUND: A pseudohernia is an abdominal wall bulge that may be mistaken for a hernia but that lacks the disruption of the abdominal wall that characterizes a hernia. Thus, the natural history and treatment of this condition differ from those of a hernia. This is the first report of a pseudohernia due to cough-associated rib fracture. CASE PRESENTATION: A case of pseudohernia due to fractures of the 10(th) and 11(th) ribs in a 68-year-old white woman is presented...
October 1, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/27696695/blunt-chest-trauma-in-a-non-specialist-centre-right-treatment-right-place
#13
Lesley Maher, Sisira Jayathissa
OBJECTIVES: To compare patient characteristics, management and outcomes for patients admitted with isolated blunt chest trauma, managed by medical or surgical teams. METHODS: We reviewed adult patients admitted with blunt chest trauma between 1 September 2006 and 31 August 2011 to a secondary hospital in New Zealand. Inclusion criteria were: blunt chest trauma, with at least one radiologically demonstrated rib fracture. The primary outcome was in-hospital mortality, and secondary outcomes were development of pneumonia, and use of analgesia...
December 2016: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/27624630/cough-augmentation-techniques-in-the-critically-ill-a-canadian-national-survey
#14
Louise Rose, Neill K Adhikari, Joseph Poon, David Leasa, Douglas A McKim
BACKGROUND: Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficiency. Our objective was to describe use, indications, contraindications, interfaces, settings, complications, and barriers to use across Canada. METHODS: An e-mail survey was sent to nominated local survey champions in eligible Canadian units (ICUs, weaning centers, and intermediate care units) with 4 telephone/e-mail reminders...
October 2016: Respiratory Care
https://www.readbyqxmd.com/read/27582999/primum-non-nocere-a-case-of-a-humeral-fracture-in-a-patient-with-fibrodysplasia-progressiva-ossificans
#15
Alun Yewlett, Jeff Kitson, Andrew Redfern, Chris Smith
Fibrodysplasia progressiva ossificans (FPO) is an extremely rare condition characterized by abnormal heterotopic bone formation. The condition is eponymously known as 'stoneman' disease because patients can become effectively entombed within abnormal heterotopic bone. We present the first known case of a diaphyseal humeral fracture managed conservatively in an adult patient with this condition. This patient already had a pre-existing bony bar from a fusion mass involving the thoracic spine, scapula and ribs to her proximal humerus splinting the arm in a position of adduction with the palm of her hand facing towards her groin...
January 2016: Shoulder & Elbow
https://www.readbyqxmd.com/read/27572897/operative-management-versus-non-operative-management-of-rib-fractures-in-flail-chest-injuries-a-systematic-review
#16
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
https://www.readbyqxmd.com/read/27552936/-management-of-blunt-renal-trauma-in-paediatric-patients
#17
L Brouwers, M Bemelman, W L M Kramer, F H W M van der Heijden
- In 90% of children, blunt abdominal trauma is the cause of renal, splenic or hepatic injury or an injury affecting a combination of these organs.- Because children's kidneys are anatomically less protected than those of adults, potential renal injury following direct trauma affecting the child's flank, for example by a handlebar or knee should be considered.- Symptoms of renal trauma include excoriations or haematoma on the flank, a 'seatbelt-sign', macroscopic haematuria and fractures of the ribs and vertebra...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27550958/improved-outcomes-associated-with-the-liberal-use-of-thoracic-epidural-analgesia-in-patients-with-rib-fractures
#18
Courtney D Jensen, Jamie T Stark, Lewis L Jacobson, Jan M Powers, Michael F Joseph, Jeffrey M Kinsella-Shaw, Craig R Denegar
OBJECTIVE: Each year, more than 150,000 patients with rib fractures are admitted to US trauma centers; as many as 10% die. Effective pain control is critical to survival. One way to manage pain is thoracic epidural analgesia. If this treatment reduces mortality, more frequent use may be indicated. METHODS: We analyzed the patient registry of a level II trauma center. All patients admitted with one or more rib fractures (N = 1,347) were considered. Patients who were not candidates for epidural analgesia (N = 382) were eliminated...
August 22, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27540552/ketamine-infusion-therapy-as-an-alternative-pain-control-strategy-in-patients-with-multi-trauma-including-rib-fracture-case-report-and-literature-review
#19
Ashley K Losing, Justin M Jones, Adis Keric, Steven E Briggs, David D Leedahl
Ketamine is a promising alternative agent for pain control that offers benefit to traditional strategies, particularly in the setting of rib fracture. Current pharmacologic therapies have clear adverse effects, and other options may be invasive, cost prohibitive, or marginally effective. We describe three consecutive patients with traumatic injuries including rib fracture for which a ketamine infusion was utilized as part of their pain control strategy.  For each patient, use of a ketamine infusion trended toward reduced opioid requirements with stable pain scores...
July 2016: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/27495253/an-assessment-of-outcomes-with-intramedullary-fixation-of-fractured-ribs
#20
Silvana Marasco, Margaret Quayle, Robyn Summerhayes, Ilija D Šutalo, Petar Liovic
BACKGROUND: Surgical management of fractured ribs with internal fixation is an increasingly accepted therapy. Concurrently, specific rib fixation prostheses are being developed which should improve results and minimise hardware and rib/splint construct failures. The Synthes titanium intramedullary splint lends itself to difficult to access areas such as posterior rib fractures and fractures under the scapula. We analyse a case series of patients in whom this rib fixation prosthesis has been used...
August 5, 2016: Journal of Cardiothoracic Surgery
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