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rib fracture management

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https://www.readbyqxmd.com/read/28700410/quantifying-and-exploring-the-recent-national-increase-in-surgical-stabilization-of-rib-fractures
#1
Erica Kane, Elan Jeremitsky, Fredric M Pieracci, Sarah Majercik, Andrew R Doben
INTRODUCTION: 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 to non-operative management (NOM). A 2014 National Trauma Data Bank (NTDB) 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...
July 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28697083/multiple-rib-nonunion-open-reduction-and-internal-fixation-and-iliac-crest-bone-graft-aspirate
#2
Daniel J Kaplan, John Begly, Nirmal Tejwani
PURPOSE: Rib fractures are a common chest injury that can typically be treated nonoperatively. However, a percentage of these will go on to nonunion, either because of unique characteristics of the fracture itself or because of a variety of poor healing factors of the host. If a patient has continued symptomology beyond 3 months, surgeons may consider operative management. METHODS: Although isolated resection of fibrous scar tissue from the nonunion site may be sufficient in some cases, it may also be necessary to provide additional structural integrity to the rib depending on the extent of the fracture pattern and resection...
August 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28660136/sternal-metastasis-the-forgotten-column-and-its-effect-on-thoracic-spine-stability
#3
REVIEW
Robert Pearse Piggott, Mark Curtin, Sudarshan Munigangaiah, Mutaz Jadaan, John Patrick McCabe, Aiden Devitt
Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management: (1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and (2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column...
June 18, 2017: World Journal of Orthopedics
https://www.readbyqxmd.com/read/28654439/unusual-cause-of-thoracic-wall-pain-in-a-kayaker-a-case-report
#4
Guy Morgan Evans, Gurjit Bhogal
Chest wall injuries are common in paddle-based sports such as kayaking. We present the case of a 46-year-old amateur kayaker who presented with signs and symptoms in keeping with a rib stress response or fracture. The patient failed to respond to conservative management and subsequent imaging revealed an obstructed left kidney with associated hydronephrosis. This case report highlights the importance of considering the wider differential diagnoses when managing athletes participating in paddle-based sports, especially when symptoms fail to settle with appropriate conservative management...
June 22, 2017: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
https://www.readbyqxmd.com/read/28635359/thoracic-paravertebral-block-versus-intravenous-patient-controlled-analgesia-for-pain-treatment-in-patients-with-multiple-rib-fractures
#5
Ge Yeying, Yuan Liyong, Chen Yuebo, Zhang Yu, Ye Guangao, Ma Weihu, Zhao Liujun
Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management and preservation of pulmonary function compared with intravenous, patient-controlled analgesia (IVPCA) in patients with multiple rib fractures (MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study and randomly assigned to the TPVB or IVPCA group. The visual analogue scale (VAS) pain score, blood gas analysis, and bedside spirometry were measured and recorded at different time points after analgesia...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28593092/aortic-injury-due-to-paragliding-a-case-report
#6
Kazuhiko Omori, Kei Jitsuiki, Takashi Majima, Ikuto Takeuchi, Toshihiko Yoshizaw, Kouhei Ishikawa, Hiromichi Ohsaka, Keiichi Tambara, Youichi Yanagawa
A 64-year-old male fell from an altitude of 10 m while paragliding after stalling due to the wind. The purpose of this case report is to describe the outcomes after multiple injuries sustained during a paragliding accident, including a potentially life-threating injury to the thoracic aorta. The subject sustained a bite wound on his tongue, injuries to his chest (left side) and back, and a right forearm deformity. Enhanced whole body computed tomography (CT) revealed fractures of the bilateral laminae of the second and third cervical bones, right first rib, the tenth thoracic vertebral body (compression type), second lumbar vertebral body (burst type) and the right radius, Other injuries included an injury to the thoracic aortic arch and the presence of intraabdominal fluid collection without perforation of the digestive tract...
June 2017: International Journal of Sports Physical Therapy
https://www.readbyqxmd.com/read/28591509/-double-pneumotorax-secondary-to-single-proyectile-weapon-one-case-report-and-review-of-literature
#7
Mario Quintero-Amaya, Francisco Flores-Orozco, José Herrera-Maldonado, Jorge Miño-Bernal, Edna López-Morales, Abigail Juárez-Ugalde, Marisol Flores-Gonzaga, Débora Aguilar-Sánchez
BACKGROUND: The 25% of traumatic deaths are due to chest trauma with a mortality of 28%, and closed trauma is the most common mechanism of injury. The use of firearms increases the relative risk of death. The five more frequent specific chest injuries are lung contusion (31.8%), hemothorax/pneumothorax (19.4%), rib fractures (13.2%), and diaphragmatic injury (7.5%). CLINICAL CASE: Patient of 25 years with a single firearm projectile wound in the chest who assisted to the emergency room (ER) with significant respiratory distress and meriting surgical emergency airway, documenting double pneumothorax, aortic laceration and rupture of the trachea, which required management in the ER with bilateral chest tube placement and subsequent surgical repair...
July 2017: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/28549363/-thoracic-inestability-fixed-with-bioabsorbable-screws-and-plates
#8
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/28525509/analgesic-choice-in-management-of-rib-fractures-paravertebral-block-or-epidural-analgesia
#9
Mahdi Malekpour, Ammar Hashmi, James Dove, Denise Torres, Jeffrey Wild
BACKGROUND: Rib fractures are commonly encountered in the setting of trauma. The aim of this study was to assess the association between the clinical outcome of rib fracture and epidural analgesia (EA) versus paravertebral block (PVB) using the National Trauma Data Bank (NTDB). METHODS: Using the 2011 and 2012 versions of the NTDB, we retrieved completed records for all patients above 18 years of age who were admitted with rib fractures. Primary outcome was in-hospital mortality...
June 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28494679/first-rib-fracture-treatment-should-focus-on-other-injuries
#10
(no author information available yet)
Management of patients with fractures of the first rib should focus on identifying and treating associated life-threatening injuries, says a study in Emergency Medicine Journal.
May 12, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28457826/the-clinical-implications-of-severe-low-rib-fracture-in-the-management-of-diaphragm-injury-a-case-control-study
#11
Seongyup Kim, Woo Jin Choi, Kawng Ho Lee, Chun Sung Byun, Keum Seok Bae, Il Hwan Park
BACKGROUND: The objective of this study was to analyze the differences in clinical presentation and characteristics with regard to diaphragmatic injury between blunt trauma patients with severe low rib fractures and those without severe low rib fractures. METHODS: The medical records of all patients with diaphragmatic injuries who were surgically treated at this level I trauma center, between January 2004 and December 2016 were reviewed. Patient notes, radiologic findings, and operative reports were evaluated...
June 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28446982/management-of-chest-trauma
#12
REVIEW
Corinna Ludwig, Aris Koryllos
Trauma is the leading cause of death worldwide. Approximately 2/3 of the patients have a chest trauma with varying severity from a simple rib fracture to penetrating injury of the heart or tracheobronchial disruption. Blunt chest trauma is most common with 90% incidence, of which less than 10% require surgical intervention of any kind. Mortality is second highest after head injury, which underlines the importance of initial management. Many of these deaths can be prevented by prompt diagnosis and treatment...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28427480/lessons-from-a-large-trauma-center-impact-of-blunt-chest-trauma-in-polytrauma-patients-still-a-relevant-problem
#13
REVIEW
Konstantina Chrysou, Gabriel Halat, Beatrix Hoksch, Ralph A Schmid, Gregor J Kocher
BACKGROUND: Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients' mortality. METHODS: In this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014...
April 20, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28424138/comparative-analysis-of-the-paravertebral-analgesic-pump-catheter-with-the-epidural-catheter-in-elderly-trauma-patients-with-multiple-rib-fractures
#14
COMPARATIVE STUDY
Brian S Shapiro, Tarik Wasfie, Mathew Chadwick, Kimberly R Barber, Raquel Yapchai
Presently, trauma guidelines recommend epidural analgesia as the optimal modality of pain relief from rib fractures. They are not ideally suited for elderly trauma patients and have disadvantages including bleeding risk. The paravertebral analgesic pump (PVP) eliminates such disadvantages and includes ease of placement in the trauma setting. This study compares pain control in patients treated by EPI versus PVP. This is a retrospective, historical cohort study comparing two methods of pain management in the trauma setting...
April 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28420038/retrospective-evaluation-of-coyote-attacks-in-dogs-154-cases-1997-2012
#15
Virginia M Frauenthal, Philip Bergman, Robert J Murtaugh
OBJECTIVE: To describe the clinical presentation and outcome of known attacks in client-owned dogs caused by the common coyote, Canis latrans. DESIGN: Retrospective observational study. SETTING: Private referral hospital. ANIMALS: One hundred fifty-four client-owned dogs known to be attacked by coyotes. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Records from a private referral hospital from May 1997 through December 2012 were reviewed...
May 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/28387164/rectus-abdominis-motor-nerves-as-donor-option-for-free-functional-muscle-transfer-a-cadaver-study-and-case-series
#16
Aaron B Mull, Michael C Nicoson, Amy M Moore, Dan A Hunter, Thomas H Tung
BACKGROUND: Current management of brachial plexus injuries includes nerve grafts and nerve transfers. However, in cases of late presentation or pan plexus injuries, free functional muscle transfers are an option to restore function. The purpose of our study was to describe and evaluate the rectus abdominis motor nerves histomorphologically and functionally as a donor nerve option for free functional muscle transfer for the reconstruction of brachial plexus injuries. METHODS: High intercostal, rectus abdominis, thoracodorsal, and medial pectoral nerves were harvested for histomorphometric analysis from 4 cadavers from levels T3-8...
April 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28363365/chest-wall-trauma
#17
REVIEW
Sarah Majercik, Fredric M Pieracci
Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management...
May 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/28291768/case-report-of-serratus-plane-catheter-for-pain-management-in-a-patient-with-multiple-rib-fractures-and-an-inferior-scapular-fracture
#18
Peter Fu, Paul D Weyker, Christopher A J Webb
We placed a superficial serratus anterior plane catheter in an elderly woman with dementia and elevated clotting times who presented with multiple rib fractures after a mechanical fall. She was not a surgical candidate, and treatment consisted of conservative management with physical therapy and pain control. She was not a candidate for a patient-controlled analgesia regimen because of her dementia. Given her elevated international normalized ratio, thoracic epidural and paravertebral analgesia was also contraindicated...
March 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28246564/false-positive-findings-on-i-131-wbs-and-spect-ct-in-patients-with-history-of-thyroid-cancer-case-series
#19
Zeina C Hannoush, Juan D Palacios, Russ A Kuker, Sabina Casula
Introduction. Although whole body scan (WBS) with I-131 is a highly sensitive tool for detecting normal thyroid tissue and metastasis of differentiated thyroid cancer (DTC), it is not specific. Additional information, provided by single photon emission computed tomography combined with X-ray computed tomography (SPECT/CT) and by the serum thyroglobulin level, is extremely useful for the interpretation of findings. Case Presentation. We report four cases of false positive WBS in patients with DTC: ovarian uptake corresponding to an endometrioma, scrotal uptake due to a spermatocele, rib-cage uptake due to an old fracture, and hepatic and renal uptake secondary to a granuloma and simple cyst, respectively...
2017: Case Reports in Endocrinology
https://www.readbyqxmd.com/read/28242408/a-rare-entity-traumatic-thoracic-aortic-injury-in-a-patient-with-aberrant-right-subclavian-artery
#20
Hiten Mohanbhai Patel, Shubhabrata Banerjee, Shahzad Bulsara, Tapish Sahu, Virender K Sheorain, Tarun Grover, Rajiv Parakh
BACKGROUND: Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5 to 2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury, which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure...
May 2017: Annals of Vascular Surgery
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