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rib fracture management

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https://www.readbyqxmd.com/read/29766123/orthopaedic-traumatology-fundamental-principles-and-current-controversies-for-the-acute-care-surgeon
#1
REVIEW
Shad K Pharaon, Shawn Schoch, Lucas Marchand, Amer Mirza, John Mayberry
Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29744222/chest-wall-stabilization-in-trauma-patients-why-when-and-how
#2
REVIEW
Jose Ribas Milanez de Campos, Thomas W White
Blunt trauma to the chest wall and rib fractures are remarkably frequent and are the basis of considerable morbidity and possible mortality. Surgical remedies for highly displaced rib fractures, especially in cases of flail chest, have been undertaken intermittently for more than 50 years. Rib-specific plating systems have started to be used in the last 10 years. These have ushered in the modern era of rib repair with chest wall stabilization (CWS) techniques that are safer, easier to perform, and more efficient...
April 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29714650/real-time-view-of-anesthetic-solution-spread-during-an-ultrasound-guided-thoracic-paravertebral-block
#3
Domenico P Santonastaso, Annabella de Chiara, Marco Rispoli, Giovanni Musetti, Vanni Agnoletti
BACKGROUND: Thoracic paravertebral block is a technique for perioperative analgesia in patients undergoing thoracic, chest wall, or breast surgery, or for pain management with rib fractures, which can be performed with or without ultrasound guidance. The ultrasound guidance technique can be used to identify the thoracic paravertebral space, guide needle placement, monitor the spread of local anesthetic (LA) solution, and reduce complications such as pleural puncture and pneumothorax. The possibility of assessing anesthetic spread in real time using ultrasound guidance during paravertebral block offers numerous advantages, including the immediate and accurate identification of the extent of nervous block, with a consequent reduction of LA dose...
March 1, 2018: Tumori
https://www.readbyqxmd.com/read/29703028/osteoporosis-and-fracture-after-gastrectomy-for-stomach-cancer-a-nationwide-claims-study
#4
Gi Hyeon Seo, Hae Yeon Kang, Eun Kyung Choe
This study was planned to evaluate the incidence and risk factors of osteoporosis and fracture after gastrectomy for stomach cancer using a nationwide claims database in South Korea.Data from 41,512 patients (50-79 years) who underwent gastrectomy for stomach cancer from 2008 to 2010 with at least 5 years of follow-up were obtained from the Health Insurance Review and Assessment Service database. Patients diagnosed with osteoporosis and prescribed bisphosphonate or raloxifene or who experienced osteoporotic fractures after gastrectomy were operationally defined as osteoporosis...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29682123/a-case-of-traumatic-retrograde-type-a-aortic-dissection-accompanied-by-multiorgan-injuries
#5
Katsuaki Tsukioka, Tetsuya Kono, Kohei Takahashi, Hiromu Kehara, Shuichi Urashita, Kazunori Komatsu
A 75-year-old woman was involved in a traffic accident and suffered retrograde type A aortic dissection, multiple rib fractures, and grade II hepatic injury accompanied by intraperitoneal bleeding. We performed total arch replacement using an open stent graft with cardiopulmonary bypass and circulatory arrest. This procedure requires anticoagulation and hypothermia, which are principally contraindicated in severe trauma patients. However, this situation was resolved by managing the patient non-operatively for 7 days, confirming the stabilization of other injured organs, and then performing the surgery...
March 25, 2018: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29655592/development-of-a-blunt-chest-injury-care-bundle-an-integrative-review
#6
REVIEW
Sarah Kourouche, Thomas Buckley, Belinda Munroe, Kate Curtis
BACKGROUND: Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes. OBJECTIVE: To review and integrate the BCI management interventions to inform the development of a BCI care bundle. METHODS: A structured search of the literature was conducted to identify studies evaluating interventions for patients with BCI...
April 7, 2018: Injury
https://www.readbyqxmd.com/read/29644297/negative-pressure-in-treatment-of-persistent-post-traumatic-subcutaneous-emphysema-with-respiratory-failure-case-report-and-literature-review
#7
Jakov Mihanović, Ivan Bačić, Nina Sulen
Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Since the first report of negative pressure wound therapy for the treatment of severe subcutaneous emphysema in 2009, only few publications on use of commercially available sets were published...
February 2018: Trauma Case Reports
https://www.readbyqxmd.com/read/29644288/massive-bilateral-chylothorax-post-blunt-trauma
#8
Christina Kozul, Karishma Jassal, Rodney Judson
Chylothorax caused by blunt trauma is extremely rare. We present a case of bilateral massive chylothorax post blunt trauma and a review of the literature regarding the identification and management of this rare diagnosis. An eighteen-year-old male was involved in a motor vehicle crash where he sustained multiple injuries including a right, moderate to large, haemopneumothorax, a small left haemopneumothorax, left T8, T9, L1 and L2 acute transverse process fractures and fractures of bilateral 11th ribs. An intercostal catheter was inserted on the right side which initially drained blood-stained fluid however milky colour fluid was noted to be draining 11 h post insertion...
December 2017: Trauma Case Reports
https://www.readbyqxmd.com/read/29644031/the-use-of-magnetically-controlled-growing-rods-in-paediatric-osteogenesis-imperfecta-with-early-onset-progressive-scoliosis
#9
A Gardner, J Sahota, H Dong, V Saraff, W Högler, N J Shaw
Osteogenesis Imperfecta (OI) is a condition of bone fragility and can present with early onset scoliosis that can cause respiratory complications in later life. The fear of instrumenting the spine in OI is the possibility of fracture either on primary insertion or subsequent lengthening. Magnetically controlled growing rods were inserted to control a scoliosis in a 6-year old with OI type IV. Fixation was obtained using pedicle screws proximally and distally with sublaminar bands around the ribs proximally...
March 2018: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/29607659/ketamine-as-an-analgesic-adjuvant-in-adult-trauma-intensive-care-unit-patients-with-rib-fracture
#10
Mary K Walters, Joseph Farhat, James Bischoff, Mary Foss, Cory Evans
BACKGROUND: Rib fracture associated pain is difficult to control. There are no published studies that use ketamine as a therapeutic modality to reduce the amount of opioid to control rib fracture pain. OBJECTIVE: To examine the analgesic effects of adjuvant ketamine on pain scale scores in trauma intensive care unit (ICU) rib fracture. METHODS: This retrospective, case-control cohort chart review evaluated ICU adult patients with a diagnosis of ≥1 rib fracture and an Injury Severity Score >15 during 2016...
March 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29581683/an-analysis-of-presentation-pattern-and-outcome-of-chest-trauma-patients-at-an-urban-level-1-trauma-center
#11
Rajasekhar Narayanan, Subodh Kumar, Amit Gupta, Virinder Kumar Bansal, Sushma Sagar, Maneesh Singhal, Biplab Mishra, Sanjeev Bhoi, Babita Gupta, Shivanand Gamangatti, Adarsh Kumar, Mahesh Chandra Misra
Chest trauma is an important public health problem accounting for a substantial proportion of all trauma admissions and deaths. It directly account for 20-25 % of deaths due to trauma. Therefore, this study was conducted to analyze the presentation, patterns, and outcome of chest trauma in a level-1 urban trauma center. It was a prospective observational study of all patients presented with chest trauma to an urban level 1-trauma center over a period of 3 years. Demographic profile, mechanism of injury, injury severity scores (ISS), associated injuries, hospital stay, etc...
February 2018: Indian Journal of Surgery
https://www.readbyqxmd.com/read/29563370/successful-surgical-fixation-using-bio-absorbable-plates-for-frail-chest-in-a-severe-osteoporotic-octogenarian
#12
Ryuichi Waseda, Isao Matsumoto, Yasuhiko Tatsuzawa, Akinori Iwasaki
We present a case of a severe osteoporotic octogenarian who sustained serious flail chest from a traffic accident. The 3rd-9th ribs of the right chest wall were fractured. Non-operative management was unsuccessful. We performed a surgical fixation using a bio-absorbable and bio-active mini-plating set. This plating set is unsintered hydroxyapatite (u-HA) particles/poly-L-lactide (PLLA) composite osteosynthesis device commonly used for cranial, oral, and maxillofacial surgeries. The use of the u-HA/PLLA device for chest wall reconstruction has previously been reported, but no long-term results have been included...
March 22, 2018: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29525055/geriatric-g60-trauma-patients-with-severe-rib-fractures-is-muscle-sparing-minimally-invasive-thoracotomy-rib-fixation-safe-and-does-it-improve-post-operative-pulmonary-function
#13
Francis Ali-Osman, Alicia Mangram, Joseph Sucher, Gina Shirah, Van Johnson, Phillip Moeser, Natasha K Sinchuk, James K Dzandu
BACKGROUND: Patient outcomes after muscle sparing minimally invasive thoracotomy rib fixation (MSMIT-ORF) in geriatric G60 trauma patients remain poorly studied. This study determined the effect of MSMIT-ORF on pulmonary function (PFT). Non-operatively managed (NOM) patients were also described. METHODS: Medical records of G60 patients with severe rib fractures with PFTs measured before and after MSMIT-ORF were examined. Patient outcomes (MSMIT-ORF vs NOM) were adjusted in a multivariate logistic regression model...
February 20, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29514343/imaging-of-combat-related-thoracic-trauma-blunt-trauma-and-blast-lung-injury
#14
John P Lichtenberger, Andrew M Kim, Dane Fisher, Peter S Tatum, Brian Neubauer, P Gabriel Peterson, Brett W Carter
Introduction: Combat-related thoracic trauma (CRTT) is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries are the most common mechanisms of trauma to the chest. Imaging plays a key role in the battlefield management of CRTT casualties. This work discusses the imaging manifestations of thoracic injuries from blunt trauma and blast injury, emphasizing epidemiology and diagnostic clues seen during OEF and OIF...
March 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29500508/-single-port-vats-assisted-internal-fixation-of-serial-rib-fractures
#15
REVIEW
M T Berninger, F Kellermann, A Woltmann, V Bühren, M Lang
This article describes the operative stabilization of a flail chest due to traumatic serial rib fractures with extensive chest wall deformation and respiratory insufficiency. Initial conservative treatment including systemic and regional pain management and non-invasive positive pressure ventilation did not improve the pain or ventilation. Therefore, a single-port video-assisted thoracoscopic surgery (VATS) assisted internal fixation of the ribs was performed. The thoracoscopy enabled easy repositioning of the ribs and additionally an estimation of intrathoracic injuries...
April 2018: Der Unfallchirurg
https://www.readbyqxmd.com/read/29493501/-surgical-stabilization-of-multiple-rib-fractures-can-shorten-inpatient-stay
#16
Rikke Halberg, Kirsten Neckelmann
Flail chest is a common complication in patients with blunt chest wall traumas resulting in high mortality rates. In this case report a 43-year-old woman was stepped on by a horse, thereby receiving multiple rib fractures and pneumohaemothorax. She was not able to wean from epidural analgesia after ten days and maintained a "thoracic floating feeling". In opposition to the non-operative management previously preferred, a surgical stabilization was then performed in the patient, who was discharged only five days later...
February 19, 2018: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29491521/erector-spinae-plane-block-may-aid-weaning-from-mechanical-ventilation-in-patients-with-multiple-rib-fractures-case-report-of-two-cases
#17
Amar Nandhakumar, Amritha Nair, V Kiran Bharath, Sriraam Kalingarayar, Balaji P Ramaswamy, D Dhatchinamoorthi
Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anaesthesia (epidural and paravertebral) is better than systemic and oral analgesics. The erector spinae plane block (ESPB) is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is simple to perform and without major complications. We report a case series where ESPB helped in weaning the patients from mechanical ventilation...
February 2018: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29411048/comparison-of-analgesic-interventions-for-traumatic-rib-fractures-a-systematic-review-and-meta-analysis
#18
Jesse Peek, Diederik P J Smeeing, Falco Hietbrink, Roderick M Houwert, Marije Marsman, Mirjam B de Jong
PURPOSE: Many studies report on outcomes of analgesic therapy for (suspected) traumatic rib fractures. However, the literature is inconclusive and diverse regarding the management of pain and its effect on pain relief and associated complications. This systematic review and meta-analysis summarizes and compares reduction of pain for the different treatment modalities and as secondary outcome mortality during hospitalization, length of mechanical ventilation, length of hospital stay, length of intensive care unit stay (ICU) and complications such as respiratory, cardiovascular, and/or analgesia-related complications, for four different types of analgesic therapy: epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks...
February 6, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29403245/machined-cervical-interfacet-allograft-spacers-for-the-management-of-atlantoaxial-instability
#19
Mazda K Turel, Mena G Kerolus, Vincent C Traynelis
Background: The use of cervical interfacet spacers (CISs) to augment stability and provide solid arthrodesis at the atlantoaxial joint has not been studied in detail. The aim of this work is to report the outcomes with the use of machined allograft CISs at C1-2. Methods: A retrospective review of 19 patients who underwent an atlantoaxial fusion with the use of CISs was performed. All patients had instability documented with flexion and extension lateral radiographs...
October 2017: Journal of Craniovertebral Junction and Spine
https://www.readbyqxmd.com/read/29368085/selective-nonoperative-management-of-liver-gunshot-injuries
#20
Pradeep Navsaria, Andrew Nicol, Jake Krige, Sorin Edu, Sharfuddin Chowdhury
PURPOSE: Nonoperative management (NOM) of gunshot liver injuries (GLI) is infrequently practiced. The aim of this study was to assess the safety of selective NOM of GLI. METHODS: A prospective, protocol-driven study, which included patients with GLI admitted to a level 1 trauma center, was conducted over a 52-month period. Stable patients without peritonism or sustained hypotension with right-sided thoracoabdominal (RTA) and right upper quadrant (RUQ), penetrating wounds with or without localized RUQ tenderness, underwent contrasted abdominal CT scan to determine the trajectory and organ injury...
January 24, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
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