Medicine › Surgery

Trauma Management and Diagnosis

Works Count: 48814

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This cluster of papers focuses on the management and treatment of rib fractures and traumatic chest injuries, including topics such as emergency thoracotomy, pulmonary contusion, flail chest, CT imaging, surgical stabilization, penetrating trauma, and pain management. The papers cover various aspects of diagnosis, treatment techniques, outcomes, and clinical guidelines for managing rib fractures in trauma patients.

Keywords

Rib Fractures; Traumatic Chest Injuries; Emergency Thoracotomy; Pulmonary Contusion; Flail Chest; CT Imaging; Surgical Stabilization; Penetrating Trauma; Pain Management; Clinical Guidelines

Epidemiology of Chest Trauma

1989-02-01

Joseph LoCicero , Kenneth L. Mattox

Survival after emergency department thoracotomy: review of published data from the past 25 years2 2

2000-03-01

Peter Rhee , José Acosta Batlle , Amy Bridgeman +3 more

Soft-Tissue Injuries of the Neck in Automobile Accidents

1974-12-01

Mason Hohl

Five years or more after automobile accidents which caused softtissue injuries of the neck in 146 patients who had no pre-existing cervical degenerative hanges, evaluation revealed statistically significant positive correlations … Five years or more after automobile accidents which caused softtissue injuries of the neck in 146 patients who had no pre-existing cervical degenerative hanges, evaluation revealed statistically significant positive correlations between poor results and the following findings shortly after injury: numbness or pain, or both, in an upper extremity; sharp reversal of the cervical lordosis visible on roentgenograms; restricted motion at one interspace as shown by flexion-extension roentgenograms; need for a cervical collar for more than twelve weeks, or for home traction; and need to resume physical therapy more than once because of recurrence of symptoms. Symptomatic recovery occurred in 57 per cent of the 146 patients, while degenerative changes developed after the injury in 39 per cent.

Aortic injury in vehicular trauma

1994-03-01

James S. Williams , Jonathan A. Graff , Justin M. Uku +1 more

Prospective Study of Blunt Aortic Injury

1997-03-01

Timothy C. Fabian , J. David Richardson , Martin A. Croce +7 more

Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in … Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years.This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma.There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia.Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.

Elderly Trauma Patients with Rib Fractures Are at Greater Risk of Death and Pneumonia

2003-03-01

Éric Bergeron , André Lavoie , David Clas +5 more

Background The purpose of this study was to show that elderly patients admitted with rib fractures after blunt trauma have increased mortality. Methods Demographic, injury severity, and outcome data on … Background The purpose of this study was to show that elderly patients admitted with rib fractures after blunt trauma have increased mortality. Methods Demographic, injury severity, and outcome data on a cohort of consecutive adult trauma admissions with rib fractures to a tertiary care trauma center from April 1, 1993, to March 31, 2000, were extracted from our trauma registry. Results Among 4,325 blunt trauma admissions, there were 405 (9.4%) patients with rib fractures; 113 were aged ≥ 65. Injuries were severe, with Injury Severity Score (ISS) ≥ 16 in 54.8% of cases, a mean hospital stay of 26.8 ± 43.7 days, and 28.6% of patients requiring mechanical ventilation. Mortality (19.5% vs. 9.3%;p < 0.05), presence of comorbidity (61.1% vs. 8.6%;p < 0.0001), and falls (14.6% vs. 0.7%;p < 0.0001) were significantly higher in patients aged ≥ 65 despite significantly lower ISS (p = 0.031), higher Glasgow Coma Scale score (p = 0.0003), and higher Revised Trauma Score (p < 0.0001). After adjusting for severity (i.e., ISS and Revised Trauma Score), comorbidity, and multiple rib fractures, patients aged ≥ 65 had five times the odds of dying when compared with those < 65 years old. Conclusion Despite lower indices of injury severity, even after taking account of comorbidities, mortality was significantly increased in elderly patients admitted to a trauma center with rib fractures.

Emergency department echocardiography improves outcome in penetrating cardiac injury

1992-06-01

Dave Plummer , Doug Brunette , Richard Asinger +1 more

Traumatic rupture of diaphragm

1995-11-01

Rajesh Shah , Sabaratnam Sabanathan , Alan J. Mearns +1 more

Value of Thoracic Computed Tomography in the First Assessment of Severely Injured Patients with Blunt Chest Trauma

1997-09-01

A. Trupka , Christian Waydhas , Klaus Hallfeldt +3 more

Objective The aim of this prospective study was to evaluate whether early thoracic computed tomography (TCT) is superior to routine chest x-ray (CXR) in the diagnostic work-up of blunt thoracic … Objective The aim of this prospective study was to evaluate whether early thoracic computed tomography (TCT) is superior to routine chest x-ray (CXR) in the diagnostic work-up of blunt thoracic trauma and whether the additional information influences subsequent therapeutic decisions on the early management of severely injured patients. Patients and Methods In a prospective study of 103 consecutive patients with clinical or radiologic signs of chest trauma (94 multiple injured patients with chest trauma, nine patients with isolated chest trauma), an average Injury Severity Score of 30 and an average Abbreviated Injury Scale thorax score of 3, initial CXR and TCT were compared after initial assessment in our emergency department of a Level I trauma center. Results In 67 patients (65%) TCT detected major chest trauma complications that have been missed on CXR (lung contusion (n = 33), pneumothorax (n = 27), residual pneumothorax after chest tube placement (n = 7), hemothorax (n = 21), displaced chest tube (n = 5), diaphragmatic rupture (n = 2), myocardial rupture (n = 1)). In 11 patients only minor additional pathologic findings (dystelectasis, small pleural effusion) were visualized on TCT, and in 14 patients CXR and TCT showed the same pathologic results. Eleven patients underwent both CXR and TCT without pathologic findings. The TCT scan was significantly more effective than routine CXR in detecting lung contusions (p < 0.001), pneumothorax (p < 0.005), and hemothorax (p < 0.05). In 42 patients (41%) the additional TCT findings resulted in a change of therapy: chest tube placement, chest tube correction of pneumothoraces or large hemothoraces (n = 31), change in mode of ventilation and respiratory care (n = 14), influence on the management of fracture stabilization (n = 12), laparotomy in cases of diaphragmatic lacerations (n = 2), bronchoscopy for atelectasis (n = 2), exclusion of aortic rupture (n = 2), endotracheal intubation (n = 1), and pericardiocentesis (n = 1). To evaluate the efficacy of all those therapeutic changes after TCT the rates of respiratory failure, adult respiratory distress syndrome, and mortality in the subgroup of patients with Abbreviated Injury Scale thorax score of > 2 were compared with a historical control group, consisting of 84 patients with multiple trauma and with blunt chest trauma Abbreviated Injury Scale thorax score of > 2, prospectively studied between 1986 and 1992. Age (38 vs. 39 years), average Injury Severity Score (33 vs. 38), and the rate of respiratory failure (36 vs. 56%) were not statistically different between the two groups, but the rates of adult respiratory distress syndrome (8 vs. 20%; p < 0.05) and mortality (10 vs. 21%; p < 0.05) were significantly reduced in the TCT group. Conclusions TCT is highly sensitive in detecting thoracic injuries after blunt chest trauma and is superior to routine CXR in visualizing lung contusions, pneumothorax, and hemothorax. Early TCT influences therapeutic management in a significant number of patients. We therefore recommend TCT in the initial diagnostic work-up of patients with multiple injuries and with suspected chest trauma because early and exact diagnosis of all thoracic injuries along with sufficient therapeutic consequences may reduce complications and improve outcome of severely injured patients with blunt chest trauma.

THE MORBIDITY AND MORTALITY OF RIB FRACTURES

1994-12-01

Daniel Ziegler , Nikhileshwer N. Agarwal

The incidence of rib fractures secondary to trauma has not been clearly reported. Of the 7147 patients seen by our trauma service from January 1987 to June 1992, 711 (10%) … The incidence of rib fractures secondary to trauma has not been clearly reported. Of the 7147 patients seen by our trauma service from January 1987 to June 1992, 711 (10%) had rib fractures. Among the patients with rib fractures, 84 (12%) died, 670 (94%) had associated injuries, 274 (32%) had a hemothorax or pneumothorax, and 187 (26%) had a lung contusion. Fifty-five percent of the patients required an immediate operation or admission to the intensive care unit. Thirty-five percent of the patients required discharge to an extended care facility and 35% developed a pulmonary complication. We conclude that rib fractures are a marker of severe injury in which (1) 12% will die because of their injuries, (2) more than 90% will have associated injuries, (3) one half will require operative and ICU care, (4) one third will develop pulmonary complications, and (5) one third will require discharge to an extended care facility.

Blunt Trauma to the Heart and Great Vessels

1997-02-27

René Prêtre , Michael Chilcott

With the increase in the number of high-speed motor vehicle accidents, blunt trauma has become a major health problem. Improvements in the techniques of transporting injured patients and in the … With the increase in the number of high-speed motor vehicle accidents, blunt trauma has become a major health problem. Improvements in the techniques of transporting injured patients and in the care given outside the hospital have increased the number of patients with severe injuries who reach the emergency room alive. Nevertheless, chest injuries are the cause of many deaths.13 Injury to the heart is involved in 20 percent of road-traffic deaths, and the thoracic aorta or arch vessels in 15 percent.47 In clinical series of patients with blunt trauma to the chest, the rate of cardiac injury varies . . .

Anticoagulation Is the Gold Standard Therapy for Blunt Carotid Injuries to Reduce Stroke Rate

2004-05-05

Clay C. Cothren , Ernest E. Moore , Walter L. Biffl +5 more

Aggressive screening, early angiographic diagnosis, and prompt anticoagulation for blunt carotid artery injuries (CAIs) improves neurologic outcome.From January 1, 1996, through December 31, 2002, there were 13 280 blunt trauma … Aggressive screening, early angiographic diagnosis, and prompt anticoagulation for blunt carotid artery injuries (CAIs) improves neurologic outcome.From January 1, 1996, through December 31, 2002, there were 13 280 blunt trauma admissions to our level I center, of which 643 underwent screening angiography for blunt CAI on the basis of a protocol including injury patterns and symptoms. Patients without contraindications underwent anticoagulation immediately for documented lesions.A state-designated, level I urban trauma center.Of the 643 patients undergoing screening angiography, 114 (18%) had confirmed CAI.Early angiographic diagnosis and prompt anticoagulation.Diagnosis, stroke rate, and complications stratified by method of intervention.A CAI was identified in 114 patients during the 7-year study period; the majority were men (71%), with a mean +/- SD age of 34 +/- 1.3 years and a mean +/- SD Injury Severity Score of 29 +/- 1.5. Seventy-three patients underwent anticoagulation after diagnosis (heparin in 54, low-molecular-weight heparin in 2, antiplatelet agents in 17); none had a stroke. Of the 41 patients who did not receive anticoagulation (because of a contraindication in 27, symptoms before diagnosis in 9, and carotid coil or stent in 5), 19 patients (46%) developed neurologic ischemia. Ischemic neurologic events occurred in 100% of patients who presented with symptoms before angiographic diagnosis and those receiving a carotid coil or stent without anticoagulation.Our prospective evaluation of blunt CAIs suggests that early diagnosis and prompt anticoagulation reduce ischemic neurologic events and their disability. The optimal anticoagulation regimen, however, remains to be established.

Appraisal of Early Evaluation of Blunt Chest Trauma: Development of a Standardized Scoring System for Initial Clinical Decision Making

2000-09-01

Hans‐Christoph Pape , D. Remmers , John Jeremy Rice +3 more

Background Current techniques for assessment of chest trauma rely on clinical diagnoses or scoring systems. However, there is no generally accepted standard for early judgement of the severity of these … Background Current techniques for assessment of chest trauma rely on clinical diagnoses or scoring systems. However, there is no generally accepted standard for early judgement of the severity of these injuries, especially in regards to related complications. This drawback may have a significant impact on the management of skeletal injuries, which are frequently associated with chest trauma. However, no convincing conclusions can be determined until standardization of the degrees of chest trauma is achieved. We investigated the role of early clinical and radiologic assessment techniques on outcome in patients with blunt multiple trauma and thoracic injuries and developed a new scoring system for early evaluation of chest trauma. Methods A retrospective investigation was performed on the basis of 4,571 blunt polytrauma (Injury Severity Score [ISS] ≥ 18) patients admitted to our unit. Inclusion criteria were treatment of thoracic injury that required intensive care therapy, initial Glasgow Coma Scale score greater than 8 points, and no local or systemic infection. Patients with thoracic trauma and multiple associated injuries (ISS ≥ 18) were included. In all patients, the association between various parameters of the thoracic injuries and subsequent mortality and morbidity was investigated. Results A total of 1,495 patients fulfilled the inclusion criteria. Patients' medical records and chest radiographs were reevaluated between May 1, 1998, and June 1, 1999. The association between rib fractures and chest-related death was low (> three ribs unilateral, mortality 17.3%, odds ratio 1.01) unless bilateral involvement was present (> three ribs bilateral, mortality 40.9%, odds ratio 3.43). Injuries to the lung parenchyma, as determined by plain radiography, were associated with chest-related death, especially if the injuries were bilateral or associated with hemopneumothorax (lung contusion unilateral, mortality 25.2%, odds ratio 1.82; lung contusion bilateral + hemopneumothorax, mortality 53.3%, odds ratio 5.1). When plain anteroposterior chest radiographs were used, the diagnostic rate of rib fractures (≤ three ribs) increased slightly, from 77.1% to 97.3% during the first 24 hours of admission. In contrast, pulmonary contusions were often not diagnosed until 24 hours after admission (47.3% at admission, 92.4% at 24 h, p = 0.002). A new composite scoring system (thoracic trauma severity score) was developed that combines several variables: injuries to the chest wall, intrathoracic lesions, injuries involving the pleura, admission Pao2/Fio2 ratio, and patient age. The receiver operating characteristic curve demonstrated an adequate discrimination, as demonstrated by a value of 0.924 for the development set and 0.916 for the validation set. The score was also superior to the ISS (0.881) or the thorax Abbreviated Injury Score (0.693). Conclusion Radiographically determined injuries to the lung parenchyma have a closer association with adverse outcome than chest-wall injuries but are often not diagnosed until 24 hours after injury. Therefore, clinical decision making, such as about the choice of surgery for long bone fractures, may be flawed if this information is used alone. A new thoracic trauma severity score may serve as an additional tool to improve the accuracy of the prediction of thoracic trauma–related complications.

The Role of Ultrasound in Patients with Possible Penetrating Cardiac Wounds

1999-04-01

G. S. Rozycki , David V. Feliciano , M. Gage Ochsner +7 more

Background Ultrasound is quickly becoming part of the trauma surgeon's practice, but its role in the patient with a penetrating truncal injury is not well defined. The purpose of this … Background Ultrasound is quickly becoming part of the trauma surgeon's practice, but its role in the patient with a penetrating truncal injury is not well defined. The purpose of this study was to evaluate the accuracy of emergency ultrasound as it was introduced into five Level I trauma centers for the diagnosis of acute hemopericardium. Methods Surgeons or cardiologists (four centers) and technicians (one center) performed pericardial ultrasound examinations on patients with penetrating truncal wounds. By protocol, patients with positive examinations underwent immediate operation. Vital signs, base deficit, time from examination to operation, operative findings, treatment, and outcome were recorded. Results Pericardial ultrasound examinations were performed in 261 patients. There were 225 (86.2%) true-negative, 29 (11.1%) true-positive, 0 false-negative, and 7 (2.7%) false-positive examinations, resulting in sensitivity of 100%, specificity of 96.9%, and accuracy of 97.3%. The mean time from ultrasound to operation was 12.1 +/- 5 minutes. Conclusion Ultrasound should be the initial modality for the evaluation of patients with penetrating precordial wounds because it is accurate and rapid.

Evaluation of Penetrating Injuries of the Neck: Prospective Study of 223 Patients

1997-01-01

Δημήτριος Δημητριάδης , Δ. Θεοδώρου , Edward E. Cornwell +6 more

Morbidity from Rib Fractures Increases After Age 45

2003-04-01

John B. Holcomb , Neil R. McMullin , Rosemary A. Kozar +2 more

Epidural analgesia improves outcome after multiple rib fractures

2004-08-01

Eileen M. Bulger , T. Bradley Edwards , Patricia Klotz +1 more

Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status

2005-09-06

A Granetzny

Through a prospective randomized comparative study, treatment of flail chest by a non-surgical method of packing, strapping, and mechanical ventilation vs. surgical fixation were compared. After management, stability of the … Through a prospective randomized comparative study, treatment of flail chest by a non-surgical method of packing, strapping, and mechanical ventilation vs. surgical fixation were compared. After management, stability of the chest wall occurred in 85% of the patients in the surgical group. Forty-five percent of patients in this group required ventilatory support after fixation for an average of 2 days. Whereas in the conservative group, stability occurred in 50% of their patients, and 35% of patients required ventilatory support for an average of 12 days. Chest wall deformity in the form of stove-in chest and crowding of ribs was still obvious in 9 patients among the conservatively treated group, compared to only one patient who developed chest wall deformity in the surgically treated group. The pulmonary functions tested two months after management indicated that in the surgical group the patients had a significantly less restrictive pattern. Thus, surgical fixation of a flail segment is a method of great value in the treatment of flail chest, in which stability is achieved without deformity of the chest wall and patients have less restrictive impairment of pulmonary functions.

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Rib Fractures in the Elderly

2000-06-01

Eileen M. Bulger , Matthew A. Arneson , Charles Mock +1 more

Background We sought to ascertain the extent to which advanced age influences the morbidity and mortality after rib fractures (fxs), to define the relationship between number of rib fractures and … Background We sought to ascertain the extent to which advanced age influences the morbidity and mortality after rib fractures (fxs), to define the relationship between number of rib fractures and morbidity and mortality, and to evaluate the influence of analgesic technique on outcome. Methods A retrospective cohort study involving all 277 patients ≥ 65 years old with rib fxs admitted to a Level I trauma center over 10 years was undertaken. The control group consisted of 187 randomly selected patients, 18 to 64 years old, with rib fxs admitted over the same time period. Outcomes included pulmonary complications, number of ventilator days, length of intensive care unit and hospital stay (LOS), disposition, and mortality. The specific analgesic technique used was also examined. Results The two groups had similar mean number of rib fxs (3.6 elderly vs. 4.0 young), mean chest Abbreviated Injury Scores (3.0 vs. 3.0), and mean Injury Severity Score (20.7 vs. 21.4). However, mean number of ventilator days (4.3 vs. 3.1), intensive care unit days (6.1 vs. 4.0), and LOS (15.4 vs. 10.7 days) were longer for the elderly patients. Pneumonia occurred in 31% of elderly versus 17% of young (p < 0.01) and mortality was 22% for the elderly versus 10% for the young (p < 0.01). Mortality and pneumonia rates increased as the number of rib fxs increased with and odds ratio for death of 1.19 and for pneumonia of 1.16 per each additional rib fracture (p < 0.001). The use of epidural analgesia in the elderly (LOS >2 days) was associated with a 10% mortality versus 16% without the use of an epidural (p = 0.28). In the younger group (LOS >2 days), mortality with and without the use of an epidural was 0% and 5%, respectively. Conclusion Elderly patients who sustain blunt chest trauma with rib fxs have twice the mortality and thoracic morbidity of younger patients with similar injuries. For each additional rib fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27%. As the number of rib fractures increases, there is a significant increase in morbidity and mortality in both groups, but with different patterns for each group. Further prospective study is needed to determine the utility of epidural analgesia in this population.

Flail chest injuries

2014-01-22

Niloofar Dehghan , Charles de Mestral , Michael D. McKee +2 more

Flail chest injuries are associated with severe pulmonary restriction, a requirement for intubation and mechanical ventilation, and high rates of morbidity and mortality. Our goals were to investigate the prevalence, … Flail chest injuries are associated with severe pulmonary restriction, a requirement for intubation and mechanical ventilation, and high rates of morbidity and mortality. Our goals were to investigate the prevalence, current treatment practices, and outcomes of flail chest injuries in polytrauma patients.The National Trauma Data Bank was used for a retrospective analysis of the injury patterns, management, and clinical outcomes associated with flail chest injuries. Patients with a flail chest injury admitted from 2007 to 2009 were included in the analysis. Outcomes included the number of days on mechanical ventilation, days in the intensive care unit (ICU), days in the hospital, and rates of pneumonia, sepsis, tracheostomy, chest tube placement, and death.Flail chest injury was identified in 3,467 patients; the mean age was 52.5 years, and 77% of the patients were male. Significant head injury was present in 15%, while 54% had lung contusions. Treatment practices included epidural catheters in 8% and surgical fixation of the chest wall in 0.7% of the patients. Mechanical ventilation was required in 59%, for a mean of 12.1 days. ICU admission was required in 82%, for a mean of 11.7 days. Chest tubes were used in 44%, and 21% required a tracheostomy. Complications included pneumonia in 21%, adult respiratory distress syndrome in 14%, sepsis in 7%, and death in 16%. Patients with concurrent severe head injury had higher rates of ventilatory support and ICU stay and had worse outcomes in every category compared with those without a head injury.Patients who have sustained a flail chest have significant morbidity and mortality. More than 99% of these patients were treated nonoperatively, and only a small proportion (8%) received aggressive pain management with epidural catheters. Given the high rates of morbidity and mortality in patients with a flail chest injury, alternate methods of treatment including more consistent use of epidural catheters for pain or surgical fixation need to be investigated with large randomized controlled trials.Epidemiologic/prognostic study, level IV.

Evaluation and Treatment of Penetrating Cervical Injuries

1979-06-01

Anthony J. Roon , N R Christensen

Because the serious nature of penetrating cervical injuries may not be readily apparent on initial evaluation, and since delay in treatment can result in serious complications, a systematic method of … Because the serious nature of penetrating cervical injuries may not be readily apparent on initial evaluation, and since delay in treatment can result in serious complications, a systematic method of evaluation and routine exploration has been employed in treating these injuries. One hundred eighty-nine patients, 49 with gunshot wounds and 140 with stab wounds, were treated in this series. Arteriography was performed in 62 patients (33%) to detect vascular injuries and to aid in the planning of the operative approach in patients with high or low neck wounds. Arteriography was 98% accurate and changed the operative approach in 29% of the positive studies. Of the 154 explorations 72 were positive (47%). There were no deaths and only four complications in the group with negative explorations. The mortality rate for the series was 2.6%. We believe that angiography in selected patients and routine exploration of wounds penetrating the platysma can minimize morbidity and mortality in these injuries.

A New Classification of Thoracolumbar Injuries

2005-10-01

Alexander R. Vaccaro , Ronald A. Lehman , R. John Hurlbert +7 more

A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management.To devise a practical, yet comprehensive, classification system for TL injuries … A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management.To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care and surgical treatment approach in unstable injury patterns.The most appropriate classification of traumatic TL spine injuries remains controversial. Systems currently in use can be cumbersome and difficult to apply. None of the published classification schemata is constructed to aid with decisions in clinical management.Clinical spine trauma specialists from a variety of institutions around the world were canvassed with respect to information they deemed pivotal in the communication of TL spine trauma and the clinical decision-making process. Traditional injury patterns were reviewed and reconsidered in light of these essential characteristics. An initial validation process to determine the reliability and validity of an earlier version of this system was also undertaken.A new classification system called the Thoracolumbar Injury Classification and Severity Score (TLICS) was devised based on three injury characteristics: 1) morphology of injury determined by radiographic appearance, 2) integrity of the posterior ligamentous complex, and 3) neurologic status of the patient. A composite injury severity score was calculated from these characteristics stratifying patients into surgical and nonsurgical treatment groups. Finally, a methodology was developed to determine the optimum operative approach for surgical injury patterns.Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.

The Intravertebral Vacuum Cleft: A Sign of Ischemic Vertebral Collapse

1978-10-01

Baudouin Maldague , Henry M. Noel , Jacques Malghem

A gas-density cleft within a transverse separation of the vertebral body, appearing in extension and disappearing in flexion, was observed in 10 cases of vertebral collapse at the thoraco-lumbar junction. … A gas-density cleft within a transverse separation of the vertebral body, appearing in extension and disappearing in flexion, was observed in 10 cases of vertebral collapse at the thoraco-lumbar junction. The patients were 55 to 83 years old (mean, 68) and 7 of them were on chronic corticosteroid therapy. Such an intravertebral cleft has not been found by the authors in vertebral collapse of tumoral, inflammatory, or traumatic origin and is thought to represent ischemic vertebral fracture. This sign could be helpful in the differential diagnosis of vertebral collapse in elderly patients.

Prospective Study of Blunt Aortic Injury

1998-05-01

Timothy C. Fabian , Kimberly A. Davis , Morris L. Gavant +6 more

There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). … There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of beta-blockers with or without nitroprusside in preventing aortic rupture.Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture.A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of beta-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries.Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100% for HCTT versus 92% for aortography. Specificity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography. Negative predictive value was 100% for HCTT versus 97% for aortography. No patient had spontaneous rupture in this study.HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.

Risk factors that predict mortality in patients with blunt chest wall trauma: A systematic review and meta-analysis

2011-01-23

Ceri Battle , Hayley Hutchings , Phillip Evans

CERIATRIC BLUNT MULTIPLE TRAUMA

1988-07-01

Thomas M. Scalea , Anthony J. Duncan , Nabil Atweh +3 more

s of Papers to be Presented at the 48th Annual Session: American Association for the Surgery of Trauma Westin South Coast Plaza Newport Beach, California October 6–8, 1988: PDF Only s of Papers to be Presented at the 48th Annual Session: American Association for the Surgery of Trauma Westin South Coast Plaza Newport Beach, California October 6–8, 1988: PDF Only

ARDS after Pulmonary Contusion: Accurate Measurement of Contusion Volume Identifies High-Risk Patients

2001-08-01

Preston R. Miller , Martin A. Croce , Tiffany K. Bee +4 more

The pathophysiology of pulmonary contusion (PC) is poorly understood, and only minimal advances have been made in management of this entity over the past 20 years. Improvement in understanding of … The pathophysiology of pulmonary contusion (PC) is poorly understood, and only minimal advances have been made in management of this entity over the past 20 years. Improvement in understanding of PC has been hindered by the fact that there has been no accurate way to quantitate the amount of pulmonary injury. With this project, we examine a method of accurately measuring degree of PC by quantifying contusion volume relative to pulmonary function and outcome.Patients with PC from isolated chest trauma who had admission chest computed tomographic scan were identified from the registry of a Level I trauma center over a 1.5-year period. Subsequently, prospective data on all patients admitted to the intensive care unit with PC during a 5-month period were collected and added to the retrospective database. Using computer-generated three-dimensional reconstruction from admission chest computed tomographic scan, contusion volume was measured and expressed as a percentage of total lung volume. Admission pulmonary function variables (Pao2/FiO2, static compliance), injury descriptors (chest Abbreviated Injury Score, Injury Severity Score, injury distribution), and indicators of degree of shock (admission systolic blood pressure, admission base deficit) were documented. Outcomes included maximum positive end-expiratory pressure, ventilator days, pneumonia, and acute respiratory distress syndrome (ARDS).Forty-nine patients with PC (35 bilateral) were identified. The average severity of contusion was 18% (range, 5-55%). Patients were classified using contusion volume as severe PC (> or =20%, n = 17) and moderate PC (< 20%, n = 32). Injury Severity Score was similar in the severe and moderate groups (23.3 vs. 26.5, p = 0.33), as were admission Glasgow Coma Scale score (12 vs. 13, p = 0.30), admission blood pressure (131 vs. 129 mm Hg, p = 0.90), and admission Pao2/Fio2 (197 vs. 255, p = 0.14). However, there was a much higher rate of ARDS in the severe group as compared with the moderate group (82% vs. 22%, p < 0.001). There was a trend toward higher pneumonia rate in the severe group, with 50% of patients in the severe group developing pneumonia as compared with 28% in the moderate group (p = 0.20).Extent of contusion volumes measured using three-dimensional reconstruction allows identification of patients at high risk of pulmonary dysfunction as characterized by development of ARDS. This method of measurement may provide a useful tool for the further study of PC as well as for the identification of patients at high risk of complications at whom future advances in therapy may be directed.

Blunt Thoracic Trauma Analysis of 515 Patients

1987-08-01

Robert M. Shorr , Michael D. Crittenden , Matthew Indeck +2 more

A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. … A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. Severe chest trauma can be present in the absence of rib or other thoracic bony fractures. Emergency thoracotomies for resuscitation of the patient with blunt chest trauma with absent vital signs proved unsuccessful in 39 of 39 patients. A high index of suspicion for blunt chest injury occurring in blunt trauma, coupled with an aggressive diagnostic and therapeutic approach, remains the cornerstone of treatment to minimize the morbidity and mortality of such injuries.

ULTRASOUND IN BLUNT ABDOMINAL AND THORACIC TRAUMA

1993-04-01

Markus A. Röthlin , Remo Näf , Markus Amgwerd +3 more

Between July 1989 and June 1991, 312 patients with blunt thoracic or abdominal injuries were examined prospectively. Sonographic examination was performed by surgeons in the emergency room using a mobile … Between July 1989 and June 1991, 312 patients with blunt thoracic or abdominal injuries were examined prospectively. Sonographic examination was performed by surgeons in the emergency room using a mobile ultrasound unit. In 113 (36.2%) cases pathologic findings were demonstrated sonographically. These included 47 cases of hemothorax, 11 pericardial effusions, 52 cases of intra-abdominal fluid, 24 lesions of intra-abdominal organs, and 10 cases of retroperitoneal hematoma. Physical examination findings were positive in 96 (30.8%), negative in 63 (20.2%), and equivocal in 153 (49.0%). Two hundred thirty-nine patients had between one and eight injuries in addition to the blunt abdominal or thoracic trauma. These patients had an average Injury Severity Score (ISS) of 19.9 (range, 1 to 75). The 73 patients with isolated blunt trauma of the thorax or abdomen had an ISS of 4.9 (range, 0-25). None of the 66 patients (21.2%) with positive clinical findings and negative sonographic examination results had to be operated on later in the course of treatment, while 5 (36%) of 14 patients (4.5%) with negative physical examination findings and positive sonographic findings had to undergo surgery. The sensitivity for the demonstration of intra-abdominal fluid and organ lesions was 98.1% and 41.4%, respectively. The overall sensitivity and specificity of the ultrasonic examination were 90.0% and 99.5%, respectively.

Battle Injuries of the Arteries in World War II : An Analysis of 2,471 Cases.

1946-04-01

Michael E. DeBakey , Fiorindo A. Simeone

Obesity Is an Independent Risk Factor of Mortality in Severely Injured Blunt Trauma Patients

2004-09-01

Angela Neville , Carlos Brown , Janie Weng +2 more

Obesity is associated with increased morbidity and mortality in critically injured blunt trauma patients.Case-control study of all critically injured blunt trauma patients between January 2002 and December 2002.Academic level I … Obesity is associated with increased morbidity and mortality in critically injured blunt trauma patients.Case-control study of all critically injured blunt trauma patients between January 2002 and December 2002.Academic level I trauma center at a county referral hospital.Two hundred forty-two consecutive patients admitted to the intensive care unit following blunt trauma. Patients were divided into 2 groups by body mass index. The obese group was defined as having a body mass index of 30 kg/m2 or higher, and the nonobese group was defined as having a body mass index lower than 30 kg/m2.Univariate and multivariate analyses were performed to identify risk factors for mortality. Complications and length of stay were also evaluated.Of the 242 patients, 63 (26%) were obese, and 179 (74%) were nonobese. The obese and nonobese groups were similar with regard to age (mean +/- SD, 49 +/- 18 years vs 45 +/- 22 years), male sex (63% vs 72%), Glasgow Coma Scale score (mean +/- SD, 11 +/- 5 vs 11 +/- 5), and injury severity score (mean +/- SD, 21 +/- 13 vs 20 +/- 14). The obese group had a higher body mass index (mean +/- SD, 35 +/- 7 vs 24 +/- 3; P<.001). Mechanisms of injury and injury patterns were similar between groups. The obese group had a higher incidence of multiple organ failure (13% vs 3%; P =.02) and mortality (32% vs 16%; P=.008). Obesity was an independent predictor of mortality with an adjusted odds ratio of 5.7 (95% confidence interval, 1.9-19.6; P=.003).Critically injured obese trauma patients have similar demographics and injury patterns as nonobese patients. Obesity is an independent predictor of mortality following severe blunt trauma.

PRIMARY INTRAMEDULLARY FEMUR FIXATION IN MULTIPLE TRAUMA PATIENTS WITH ASSOCIATED LUNG CONTUSION—A CAUSE OF POSTTRAUMATIC ARDS?

1993-04-01

Hans–Christoph Pape , M. Aufmkolk , Thomas Paffrath +3 more

We investigated whether primary (<24 hours) intramedullary stabilization of femoral shaft fractures in multiple trauma patients with severe thoracic injury might be associated with an increased incidence of adult respiratory … We investigated whether primary (<24 hours) intramedullary stabilization of femoral shaft fractures in multiple trauma patients with severe thoracic injury might be associated with an increased incidence of adult respiratory distress syndrome (ARDS). A total of 766 patients with multiple trauma admitted to Hannover Medical School between January 1, 1982, and December 31, 1991, were investigated retrospectively. Of these, 106 patients met the inclusion criteria: Injury Severity Score >18, femoral midshaft fracture treated by intramedullary nailing, primary admission or referral within 8 hours after injury, and no death from head injury or hemorrhagic shock. Two groups were differentiated according to the presence or absence of chest trauma (severe chest trauma = AIS thorax >, group T; no severe chest trauma = AIS thorax < 2, group N). Selection of subgroups according to the time of femur stabilization was group I <24 hours after trauma, group II >24 hours after trauma. Injury Severity Scores in the four groups were TI: 29.4 (n = 24); TII 31.4 (n = 26); NI 20.1 (n = 33); NII 25.4 (n = 23). In patients without thoracic trauma the ICU time (NI: 7.3 days; NII: 18.0 days) and intubation time (NI: 5.5 days; NII: 11.0 days) were lower in the patients treated primarily (p < 0.05). In patients with severe chest trauma there was a higher incidence of posttraumatic ARDS (33% versus 7.7%) and mortality (21% versus 4%) when early intramedullary femoral nailing was done. In the absence of severe chest trauma primary intramedullary femoral nailing is beneficial. In the presence of pulmonary injury primary intramedullary femoral nailing causes additional pulmonary damage and may trigger ARDS.

Prospective Randomized Controlled Trial of Operative Rib Fixation in Traumatic Flail Chest

2013-02-13

Silvana Marasco , Andrew R. Davies , D. James Cooper +6 more

Traumatic aortic rupture: Twenty-year metaanalysis of mortality and risk of paraplegia

1994-08-01

Ulrich O. von Oppell , Timothy T. Dunne , Mark K. De Groot +1 more

A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management

2003-06-20

Mehmet Sırmalı

A rib fracture secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. In the present study we explored the morbidity and mortality rates and … A rib fracture secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. In the present study we explored the morbidity and mortality rates and the management following rib fractures.Between May 1999 and May 2001, 1417 cases who presented to our clinic for thoracic trauma were reviewed retrospectively. Five hundred and forty-eight (38.7%) of the cases had rib fracture. There were 331 males and 217 females, with an overall mean age of 43 years (range: 5-78 years). These patients were allocated into groups according to their ages, the number of fractured ribs and status, i.e. whether they were stable or unstable (flail chest).The etiology of the trauma included road traffic accidents in 330 cases, falls in 122, assault in 54, and industrial accidents in 42 cases. Pulmonary complications such as pneumothorax (37.2%), hemothorax (26.8%), hemo-pneumothorax (15.3%), pulmonary contusion (17.2%), flail chest (5.8%) and isolated subcutaneous emphysema (2.2%) were noted. 40.1% of the cases with rib fracture were treated in intensive care units. The mean duration of their stay in the intensive care unit was 11.8+/-6.2 days. 42.8% of the cases were treated in the wards whereby their mean duration of hospital stay was 4.5+/-3.4 days, while 17.1% of the cases were followed up in the outpatient clinic. Twenty-seven patients required surgery. Mortality rate was calculated as 5.7% (n=31).Rib fractures can be interpreted as signs of significant trauma. The greater the number of fractured ribs, the higher the mortality and morbidity rates. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is three or more. We also advocate that elderly patients with six or more fractured ribs should be treated in intensive care units due to high morbidity and mortality.

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Acute Pain Management of Patients with Multiple Fractured Ribs

2003-03-01

Manoj K. Karmakar , Anthony M.‐H. Ho

Multiple rib fracture causes severe pain that can seriously compromise respiratory mechanics and exacerbate underlying lung injury and pre-existing respiratory disease, predisposing to respiratory failure. The cornerstone of management is … Multiple rib fracture causes severe pain that can seriously compromise respiratory mechanics and exacerbate underlying lung injury and pre-existing respiratory disease, predisposing to respiratory failure. The cornerstone of management is early institution of effective pain relief, the subject of this review.A MEDLINE search was conducted for the years 1966 through and up to December 2002 for human studies written in English using the keywords "rib fractures", "analgesia", "blunt chest trauma", "thoracic injury", and "nerve block". The reference list of key articles was also searched for relevant articles. The various analgesic techniques used in patients with multiple fractured ribs were summarized.Analgesia could be provided using systemic opioids, transcutaneous electrical nerve stimulation or non steroidal anti-inflammatory drugs. Alternatively, regional analgesic techniques such as intercostal nerve block, epidural analgesia, intrathecal opioids, interpleural analgesia and thoracic paravertebral block have been used effectively. Although invasive, in general, regional blocks tend to be more effective than systemic opioids, and produce less systemic side effects.Based on current evidence it is difficult to recommend a single method that can be safely and effectively used for analgesia in all circumstances in patients with multiple fractured ribs. By understanding the strengths and weaknesses of each analgesic technique, the clinician can weigh the risks and benefits and individualize pain management based on the clinical setting and the extent of trauma.

Tracheal rupture after endotracheal intubation: a literature systematic review

2009-04-15

Eduardo Miñambres , Javier Nistal Burón , M.Á. Ballesteros +3 more

We aim to perform a systematic review and meta-analysis of the cases of postintubation tracheal rupture (PiTR) published in the literature, with the aim of determining the risk factors that … We aim to perform a systematic review and meta-analysis of the cases of postintubation tracheal rupture (PiTR) published in the literature, with the aim of determining the risk factors that contribute to tracheal rupture during endotracheal intubation. A further objective has been to determine the ideal treatment for this condition (surgical repair or conservative management). A MEDLINE review of cases of tracheal rupture after intubation published in the English language and a review of the references in the articles found. The articles included were those that reported at least the demographic data (age and sex), the treatment performed, and the outcome. Those papers that did not detail the above variables were excluded. The search found 50 studies that satisfied the inclusion criteria. These studies included 182 cases of postintubation tracheal rupture. The overall mortality was 22% (40 patients). A statistical analysis was performed determining the relative risk (RR), 95% confidence intervals (95% CI) and/or statistical significance. The analysis was performed on the overall group and after dividing into 2 subgroups: patients in whom the lesion was detected intraoperatively, and other patients. Patient age (p=0.015) and emergency intubation (RR=3.11; 95% CI, 1.81-5.33; p=0.001) were variables associated with an increased mortality. In those patients in whom the PiTR was detected outside the operating theatre (delayed diagnosis), emergency intubation (RR=3.05; 95% CI, 1.69-5.51; p<0.0001), the absence of subcutaneous emphysema (RR=2.17; 95% CI, 1.25-4; p=0.001), and surgical treatment (RR=2.09; 95% CI, 1.08-4.07; p=0.02) were associated with an increased mortality. In addition, age (p=0.1) and male gender (RR=1.89; 95% CI, 0.98-3.63; p=0.13) showed a clear trend towards an increased mortality. PiTR is an uncommon condition but carries a high morbidity and mortality. Emergency intubation is the principal risk factor, increasing the risk of death threefold compared to elective intubation. Conservative treatment is associated with a better outcome. However, the group of patients who would benefit from surgical treatment has not been fully defined. Further studies are required to evaluate the best treatment options.

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Half-a-dozen ribs: The breakpoint for mortality

2005-10-01

B. Flagel , Fred A. Luchette , R. Lawrence Reed +4 more

Airway Management in Adults after Cervical Spine Trauma

2006-05-25

Edward T. Crosby , David C. Warltier

Cervical spinal injury occurs in 2% of victims of blunt trauma; the incidence is increased if the Glasgow Coma Scale score is less than 8 or if there is a … Cervical spinal injury occurs in 2% of victims of blunt trauma; the incidence is increased if the Glasgow Coma Scale score is less than 8 or if there is a focal neurologic deficit. Immobilization of the spine after trauma is advocated as a standard of care. A three-view x-ray series supplemented with computed tomography imaging is an effective imaging strategy to rule out cervical spinal injury. Secondary neurologic injury occurs in 2-10% of patients after cervical spinal injury; it seems to be an inevitable consequence of the primary injury in a subpopulation of patients. All airway interventions cause spinal movement; immobilization may have a modest effect in limiting spinal movement during airway maneuvers. Many anesthesiologists state a preference for the fiberoptic bronchoscope to facilitate airway management, although there is considerable, favorable experience with the direct laryngoscope in cervical spinal injury patients. There are no outcome data that would support a recommendation for a particular practice option for airway management; a number of options seem appropriate and acceptable.

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Chest injury due to blunt trauma

2003-03-01

Şerife Tuba Liman

Given its importance in trauma practice, we aimed to determine the pathologies associated with blunt chest injuries and to analyze the accurate identification of patients at high risk for major … Given its importance in trauma practice, we aimed to determine the pathologies associated with blunt chest injuries and to analyze the accurate identification of patients at high risk for major chest trauma.We reviewed our experience with 1490 patients with blunt chest injuries who were admitted over a 2-year period. Patients were divided into three groups based on the presence of rib fractures. The groups were evaluated to demonstrate the relationship between the number of rib fractures and associated injuries. The possible effects of age and Injury Severity Score (ISS) on mortality were analyzed.Mean hospitalization time was 4.5 days. Mortality rate was 1% for the patients with blunt chest trauma, 4.7% in patients with more than two rib fractures and 17% for those with flail chest. There was significant association between the mortality rate and number of rib fractures, the patient's age and ISS. The rate of development of pneumothorax and/or hemothorax was 6.7% in patients with no rib fracture, 24.9% in patients with one or two rib fractures and 81.4% in patients with more than two rib fractures. The number of rib fractures was significantly related with the presence of hemothorax or pneumothorax.Achieving better results in the treatment of patients with chest wall injury depend on a variety of factors. The risk of mortality was associated with the presence of more than two rib fractures, with patients over the age of 60 years and with an ISS greater than or equal to 16 in chest trauma. Those patients at high risk for morbidity and mortality and the suitable approach methods for them should be acknowledged.

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Practice Management Guidelines for Emergency Department Thoracotomy

2001-09-01

Ad Hoc Subcommittee on Outcomes Working Group

Nonpenetrating Traumatic Injury of the Heart

1958-09-01

Loren F. Parmley , William C. Manion , Thomas W. Mattingly

The misconception that nonpenetrating trauma to the heart is relatively rare, is primarily due to the fact that myocardial contusion or traumatic pericardial lesions are usually well tolerated and the … The misconception that nonpenetrating trauma to the heart is relatively rare, is primarily due to the fact that myocardial contusion or traumatic pericardial lesions are usually well tolerated and the clinical findings transient and often difficult to recognize. However, the sequelae of this type of cardiac trauma may be serious. Therefore, a careful evaluation of every traumatized individual for cardiovascular injury is essential if the more serious complications are to be recognized and treated effectively. The most commonly encountered cardiac lesion at necropsy was myocardial rupture of a septum or a chamber wall. Now that surgical therapy is available for certain types of cardiac rupture, early diagnosis is essential. Thrombosis of a major coronary artery as a direct result of nonpenetrating trauma was not found in this study and is considered rare. Nevertheless, a previously diseased heart appears to be more vulnerable to trauma. Under these circumstances, it is often difficult to assess properly the extent to which trauma may aggravate a pre-existent disease.

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Fat-containing Lesions of the Chest

2002-10-01

Scott C Gaerte , Cristopher A. Meyer , Helen T. Winer-Muram +2 more

Although most lesions that occur in the chest have a nonspecific soft-tissue appearance, fat-containing lesions are occasionally encountered at cross-sectional computed tomography (CT) or magnetic resonance imaging. The various fat-containing … Although most lesions that occur in the chest have a nonspecific soft-tissue appearance, fat-containing lesions are occasionally encountered at cross-sectional computed tomography (CT) or magnetic resonance imaging. The various fat-containing lesions of the chest include parenchymal and endobronchial lesions such as hamartoma, lipoid pneumonia, and lipoma. Endobronchial hamartoma usually appears at CT as a lesion with a smooth edge, focal collections of fat, or fat collections that alternate with foci of calcification. Mediastinal fat-containing lesions include germ cell neoplasms, thymolipomas, lipomas, and liposarcomas. The most frequent CT manifestation of the germ cell neoplasm teratoma is a heterogeneous mass with soft-tissue, fluid, fat, and calcium attenuation. Cardiac lesions with fat content include lipomatous hypertrophy of the interatrial septum and arrhythmogenic right ventricular dysplasia. Diagnosis of the former is made with CT when a smooth, nonenhancing, well-marginated fat-containing lesion is identified in the interatrial septum. Finally, fat may herniate into the chest at several characteristic locations. When such a lesion is identified, the time required for differential diagnosis is significantly reduced, often allowing a definitive radiologic diagnosis. Sagittal and coronal reformatted images can add valuable information by showing diaphragmatic defects and hernia contents.

Blunt tracheobronchial injuries: treatment and outcomes

2001-06-01

Andy C. Kiser , Sean M. O’Brien , Frank C. Detterbeck

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Pulmonary Contusion

1997-05-01

Stephen M. Cohn

Pulmonary contusion is a common lesion occurring in patients sustaining severe blunt chest trauma.Alveolar hemorhage and parenchymal destruction are maximal during the first 24 hours after injury and then usually … Pulmonary contusion is a common lesion occurring in patients sustaining severe blunt chest trauma.Alveolar hemorhage and parenchymal destruction are maximal during the first 24 hours after injury and then usually resolve within 7 days. The diagnosis of traumatic lung injury is usually made clinically with confirmation by chest x-ray films. The chest computed tomography scan is highly sensitive in identifying pulmonary contusion and may help predict the need for mechanical ventilation. Respiratory distress is common after lung trauma, with hypoxemia and hypercarbia greatest at about 72 hours. Although management of patients with pulmonary contusion is supportive, pneumonia and adult respiratory distress syndrome with long-term disability occur frequently.

DELTA SHOULDER PROSTHESIS FOR ROTATOR CUFF RUPTURE

1993-01-01

P Grammont , Emmanuel Baulot

Non penetrating traumatic injury of aorta

1958-01-01

Lf Parmly

Postoperative Recovery of Pulmunory Fuction

1981-01-01

Douglas B. Craig

* Professor, Department of Anesthesia, University of Manitoba, Health Sciences Centre, 700 William Avenue, Winnipeg, Manitoba, Canada, R3E 0Z3. Accepted for publication September IS, 1980. * Professor, Department of Anesthesia, University of Manitoba, Health Sciences Centre, 700 William Avenue, Winnipeg, Manitoba, Canada, R3E 0Z3. Accepted for publication September IS, 1980.

An evidence-based approach to patient selection for emergency department thoracotomy

2015-06-18

Mark J. Seamon , Elliott R. Haut , Kyle J. Van Arendonk +7 more

Within the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, we performed a systematic review and developed evidence-based recommendations to answer the following PICO (Population, Intervention, Comparator, Outcomes) question: … Within the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, we performed a systematic review and developed evidence-based recommendations to answer the following PICO (Population, Intervention, Comparator, Outcomes) question: should patients who present pulseless after critical injuries (with and without signs of life after penetrating thoracic, extrathoracic, or blunt injuries) undergo emergency department thoracotomy (EDT) (vs. resuscitation without EDT) to improve survival and neurologically intact survival?All patients who underwent EDT were included while those involving either prehospital resuscitative thoracotomy or operating room thoracotomy were excluded. Quantitative synthesis via meta-analysis was not possible because no comparison or control group (i.e., survival or neurologically intact survival data for similar patients who did not undergo EDT) was available for the PICO questions of interest.The 72 included studies provided 10,238 patients who underwent EDT. Patients presenting pulseless after penetrating thoracic injury had the most favorable EDT outcomes both with (survival, 182 [21.3%] of 853; neurologically intact survival, 53 [11.7%] of 454) and without (survival, 76 [8.3%] of 920; neurologically intact survival, 25 [3.9%] of 641) signs of life. In patients presenting pulseless after penetrating extrathoracic injury, EDT outcomes were more favorable with signs of life (survival, 25 [15.6%] of 160; neurologically intact survival, 14 [16.5%] of 85) than without (survival, 4 [2.9%] of 139; neurologically intact survival, 3 [5.0%] of 60). Outcomes after EDT in pulseless blunt injury patients were limited with signs of life (survival, 21 [4.6%] of 454; neurologically intact survival, 7 [2.4%] of 298) and dismal without signs of life (survival, 7 [0.7%] of 995; neurologically intact survival, 1 [0.1%] of 825).We strongly recommend that patients who present pulseless with signs of life after penetrating thoracic injury undergo EDT. We conditionally recommend EDT for patients who present pulseless and have absent signs of life after penetrating thoracic injury, present or absent signs of life after penetrating extrathoracic injury, or present signs of life after blunt injury. Lastly, we conditionally recommend against EDT for pulseless patients without signs of life after blunt injury.Systematic review/guideline, level III.

Completely thoracoscopic surgical stabilization of rib fractures: balancing minimally invasive benefits against technique-specific complications: a single-center retrospective study

2025-06-24

Yang Yang , Zexin Xie , Jiantao Zhang +5 more | World Journal of Emergency Surgery

This study aimed to investigate the surgical outcomes and complications of completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) in patients with rib fractures in the posterior chest wall area. … This study aimed to investigate the surgical outcomes and complications of completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) in patients with rib fractures in the posterior chest wall area. A retrospective analysis was conducted on 30 patients who underwent completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) between September 2019 and October 2023. Clinical data were gathered to compare and analyze the clinical outcomes of complications of cTSSRF and open surgical stabilization of rib fractures (oSSRF). A total of 201 rib fractures were repaired in 30 patients, including 79 rib fractures in the posterior chest wall (an average of 2.63 rib fractures/person) that were fixed by cTSSRF, and 122 rib fractures (an average of 4.06 rib fractures/person) fixed by oSSRF. No obvious thoracic collapse deformity was observed postoperatively in any patient. The median duration of chest tube removal after surgery was 3 (3-4) days, and the chest drainage volume was 586.33 ± 232.4 ml. The numeric rating scale score (NRS) was 3 (2-3.25), which was significantly lower than the preoperative score of 7 (6-8), z = -4.826, P < 0.001). The rate of implant displacement of the cTSSRF was 6.33% (5/79), which was significantly higher than that in the oSSRF of 0(0/122), χ2 = 5.53, P = 0.019. The rates of fracture malalignment were high in the cTSSRF (21.52% [20/79] vs2.46% [3/122], P < 0.001). The incidence of postoperative encapsulated pleural effusion-defined as a maximum anteroposterior fluid thickness > 20 mm surrounding the internal fixation device on axial CT scans-was 46.7% (14/30 cases) during the 7-14 day postoperative period. All patients were followed-up in outpatient clinics or by telephone for 6-24 months, and all resumed their work capacity without obvious symptoms of chest discomfort. The application of cTSSRF is a safe, feasible and minimally invasive surgical option, particularly in cases of rib fractures in the posterior chest wall, which are challenging to address using conventional open surgery. However, the postoperative implant displacement and fracture malalignment rates are higher than those observed in conventional surgery, which still needs to require careful evaluation of the risks and benefits of routinely performing cTSSRF.

A Retrospective Review of Gunshot Wounds in Parkland Memorial Hospital

2025-06-24

Aya Hamao-Sakamoto | International Journal of Oral and Maxillofacial Surgery

Profile and management of patients from low-middle socioeconomic status with thoracic trauma

2025-06-24

Heleen van Aswegen , Ronel Roos , Elizma Haarhoff +5 more | South African Journal of Physiotherapy

Background: Pain and shortness of breath (SOB) after thoracic trauma predispose patients to complications and prolonged hospital length of stay (LOS). Patient management after thoracic trauma is seldom reported. Objectives: … Background: Pain and shortness of breath (SOB) after thoracic trauma predispose patients to complications and prolonged hospital length of stay (LOS). Patient management after thoracic trauma is seldom reported. Objectives: To describe patient profiles, symptoms, management, adverse events, complications, discharge destinations and follow-up referral services. Method: Prospective observational design using clinical record review at two university-affiliated hospitals over 18 months. Adults with thoracic trauma diagnosis were consecutively screened for inclusion. Study objectives guided information retrieved from records. Statistical analyses were done with significance at p< 0.05. Results: Most were male (n = 170/179; 95%). Penetrating trauma following assault was common (n = 146/179; 82%). Conservative management included analgesia (n = 176/178; 98%) and intercostal drain insertion (n = 165/179; 92%). Physiotherapists treated patients daily. Management involved functional activities (cycling [n = 71/149; 48%], early mobilisation [n = 120/174; 69%]), lung volume enhancement (deep breathing exercises [n = 97/174; 56%], positive expiratory pressure [n = 98/174; 56%]), secretion removal (active coughing [n = 60/174; 34%]). Shoulder (n = 43/174; 25%) and trunk (n = 6/153; 4%) ROM were seldom done. Blunt trauma caused higher pain during deep breathing (median 7/10; IQR: 3.5–8.0) versus penetrating trauma (median 4/10; IQR: 2.0–7.5; p= 0.04). Most reported ‘slight’ to ‘very slight’ SOB. Time out-of-bed and distance walked increased daily with smokers mobilising away from bed frequently (n = 73/95; 77%). Few adverse events and complications occurred. Mean LOS was 5.5 ± 4.3 days. Most were discharged home (n = 177/179; 99%); two were referred for follow-up physiotherapy. Conclusion: Management is guided by individual patient needs. Treatment comprises early mobilisation, lung volume enhancement, and secretion removal with less attention on ROM exercises and post-discharge services. Clinical implications: Shoulder and trunk ROM should be prioritised. Service delivery approaches need review considering the evidence.

Laparoscopic Repair of Small Bowel Perforation Following Bullock Cart Run-over Injury in a 12-Year-Old Boy: A Case Report

2025-06-24

S. N. Jatal , Sudhir Jatal | Asian Journal of Case Reports in Surgery

Ex Vivo Assessment of the Manubrium Sterni Bone Using Micro Computerized Tomography: A Human Cadaver Study

2025-06-24

M. Dullaart , A. L. Schoen , Michiel W. M. van den Brekel +3 more | International Journal of Oral and Maxillofacial Surgery

Battlefield Neck Injuries: Contemporary Insights From the Israeli National Trauma Registry

2025-06-23

Nir Tsur , Dean Dudkiewicz , Tomer Talmy +7 more | Journal of the American College of Emergency Physicians Open

Intrathoracic Humeral Head Fracture: A Case Report

2025-06-22

Kwan‐Yat Zee , Shiv Patel , Joseph Losh | Cureus

Thoracic Endovascular Aortic Repair (TEVAR) for Grade III Traumatic Thoracic Aortic Injury

2025-06-20

Paola Andrea Rojas Guevara , Elías Gallardo-Navarro , L. León +3 more | Cureus

Travma Sonrası Stres Bozukluğu ile İlişkili Kişilik Eğilimlerinin İncelenmesi

2025-06-18

Berra Bayhantopçu , Filiz Kumova | FSM İlmî Araştırmalar İnsan ve Toplum Bilimleri Dergisi

Bu çalışmanın temel amacı Travma Sonrası Stres Bozukluğu (TSSB) ile ilişkili olan kişilik özelliklerinin araştırıldığı çalışmalar hakkında bir kapsam derlemesi yapmaktır. Bunun için 2016-2024 yılları arasında yayınlanmış çalışmalar, “(TSSB) AND … Bu çalışmanın temel amacı Travma Sonrası Stres Bozukluğu (TSSB) ile ilişkili olan kişilik özelliklerinin araştırıldığı çalışmalar hakkında bir kapsam derlemesi yapmaktır. Bunun için 2016-2024 yılları arasında yayınlanmış çalışmalar, “(TSSB) AND (kişilik)” ve “(PTSD) AND (personality)” anahtar kelimeleri ile “Science Direct”, “Medline”, “Scopus”, “Web of Science” ve “Pubmed” veri tabanlarında taranmıştır. Tarama sonucunda derlemeye toplam 57 çalışma dâhil edilmiştir. Söz konusu araştırmalardan, patolojik kişilik özellikleri ile ilişkilendirilen nevrotiklik ile TSSB ilişkisini araştıranların, tutarlı bir şekilde TSSB’nin nevrotiklik ile pozitif ilişki gösterdiği sonucuna ulaştığı görülmüştür. İncelenen araştırma sonuçları, belirli bir kişilik bozukluğu tanısını işaret etmekten çok, pek çok farklı kişilik bozukluğu ile ilişkili olabilecek tanı ötesi patolojik kişilik özelliklerinin TSSB ile ilişkili olduğunu tutarlı bir biçimde ortaya koymaktadır. Bu bağlamda patolojik kişilik özelliklerinin hepsinin TSSB gelişimi için risk faktörü oluşturduğu söylenebilir. Söz konusu tanı ötesi patolojik kişilik özelliklerinin büyük çoğunluğu psikodinamik perspektiften sınır durum (borderline) ve psikotik kişilik gelişim seviyeleri tarafından da kapsanmaktadır. Bu kapsamda, gelecekteki araştırmaların sınır durum ve psikotik gelişim seviyeleri- TSSB ilişkisini araştırmasının faydalı olacağı düşünülmüştür. Mizaç özellikleri, duygusal zekâ vb. kişilik özellikleri ile ilgili yapılan araştırma sayısı çok kısıtlıdır ve gelecekte farklı kişilik özellikleriyle TSSB ilişkisini araştıran çalışma sayısının artırılması önerilmiştir.

Navigating the Triad of Trauma: A Case Report on Managing Concurrent Pulmonary Contusion, Traumatic Brain Injury, and Cervical Fracture in a Geriatric Patient

2025-06-18

Yasyfie Asykari , Septian Adi Permana , Eko Setijanto | Open Access Indonesian Journal of Medical Reviews

The management of geriatric patients with multiple severe injuries presents a formidable clinical challenge due to reduced physiological reserve and the complex interplay of competing therapeutic goals. This report details … The management of geriatric patients with multiple severe injuries presents a formidable clinical challenge due to reduced physiological reserve and the complex interplay of competing therapeutic goals. This report details the case of a geriatric patient suffering from the triad of pulmonary contusion (PC), moderate traumatic brain injury (TBI), and an unstable cervical spine fracture, highlighting the intricate balance required in neuroprotective and lung-protective ventilatory strategies. A 68-year-old male was admitted following a 10-meter fall, sustaining a moderate TBI with a temporoparietal subdural hemorrhage, a complete C3 vertebral fracture, and significant bilateral pulmonary contusions. His hospital course was marked by acute respiratory distress and neurological deterioration, with a Glasgow Coma Scale (GCS) score of E3V4M5 and hypoxemia requiring intubation and mechanical ventilation in the intensive care unit (ICU). Management focused on the cautious application of positive end-expiratory pressure (PEEP) to improve oxygenation without exacerbating intracranial pressure (ICP), alongside strict cervical spine immobilization and neuro-monitoring. After eight days of complex critical care, the patient’s prolonged need for mechanical ventilation and significant sputum retention necessitated a percutaneous dilational tracheostomy (PDT) to facilitate respiratory weaning and improve pulmonary toilet. In conclusion, this case underscores the profound difficulty of managing concurrent lung and brain injuries in the context of cervical instability. The successful navigation of this trauma triad hinged on a highly individualized, multidisciplinary approach, with judicious ventilator management and timely procedural intervention like PDT being pivotal. It affirms the need for integrated care protocols that can dynamically balance competing organ-system priorities in complex geriatric trauma.

A New Technique for Intramedullary Screw Fixation of Sternal Fractures

2025-06-17

Kazunori Oae , Hokuto Morii , Yasuhisa Ueda +4 more | Injury

Development of novel thoracic retractor for resuscitative thoracotomy

2025-06-17

Shoichiro Urabe , Junya Shimazaki , Toshibumi Izutani +5 more | Scandinavian Journal of Trauma Resuscitation and Emergency Medicine

Abstract Background Resuscitative thoracotomy (RT) is a critical intervention for patients in traumatic cardiac arrest or hemorrhagic shock, where survival is highly dependent on the time required to perform the … Abstract Background Resuscitative thoracotomy (RT) is a critical intervention for patients in traumatic cardiac arrest or hemorrhagic shock, where survival is highly dependent on the time required to perform the procedure. Despite its urgency, RT is still conducted using traditional thoracic retractors originally designed for scheduled surgeries, which pose challenges in emergency settings. To address these limitations, we developed a novel thoracic retractor optimized for RT and evaluated its performance compared to a conventional model. Methods The novel retractor was designed with an arrow-shaped hook for improved intercostal insertion and a continuously rotatable handle to enhance procedural efficiency. A comparative study using excised porcine thoraxes was conducted to assess its performance. Six cm incisions were made in the intercostal spaces bilaterally before retractor insertion. Evaluators inserted the device, performed three handle rotations, and repeated the procedure using the other retractor on the contralateral side. The primary outcome was the time required for three rotations, while secondary outcomes included ease of insertion, ease of rotation, and hook stability, rated on a 6-point scale by evaluators. Results Ten surgeons ( n = 10) performed thoracotomy using both the novel and conventional retractors. Comparison of the time required for three handle rotations between the novel and conventional retractors demonstrated a statistically significant reduction with the novel retractor. The median time to complete three rotations was 16.0 [11.7–19.1] seconds with the novel retractor, compared to 7.0 [5.3–8.5] seconds with the conventional model ( P < 0.01). The ease of insertion was rated significantly higher with the novel retractor compared to the conventional model (6.0 [5.5–6.0] vs. 2.5 [2.0–3.0], P < 0.01). The ease of rotation was also rated significantly higher with the novel retractor than with the conventional model (5.5 [5.0–6.0] vs. 2.5 [1.0–3.5], P < 0.01). In the evaluation of the hook stability, no significant difference was observed between the novel and conventional retractors ( P = 1.0). Conclusions The novel thoracic retractor enables faster and easier thoracotomy compared to conventional model. Given the strong association between time and RT prognosis, this device is well-suited for RT procedures requiring rapid execution.

Penetrating traumatic aortic arch injury: a unique case report presentation

2025-06-16

Rudo Pswarayi , Rubinette Robbertze , Gloria Tshimbidi +1 more | Annals of Medicine and Surgery

Introduction: Penetrating traumatic aortic arch injuries are rare due to the protective effect of surrounding structures. The choice between open surgical repair and endovascular repair depends on several factors including … Introduction: Penetrating traumatic aortic arch injuries are rare due to the protective effect of surrounding structures. The choice between open surgical repair and endovascular repair depends on several factors including the patient’s hemodynamic status, anatomical considerations, and available expertise. However, these injuries remain associated with significant mortality, emphasizing the need for swift intervention and careful patient selection. Long-term follow-up is also essential to monitor potential complications such as stent migration or endoleaks in cases managed with endovascular repair. Importance: This case report highlights the challenges in managing delayed presentations of penetrating traumatic aortic arch injuries, emphasizing the importance of a multidisciplinary approach and the potential for nonoperative management in carefully selected patients. Case presentation: A 38-year-old male presented to a regional hospital 1 day after sustaining a left precordial stab wound. Initial assessment revealed hemodynamic instability (hypotension, tachycardia), and a left-sided hemothorax requiring drainage. Imaging (chest X-ray, computed tomography [CT] angiography) revealed an acute traumatic aortic injury involving the distal aortic arch near the left subclavian artery origin, characterized by an intimal flap, mural thrombus, a small pseudoaneurysm, and a mediastinal hematoma. Clinical discussion: After stabilization and transfer to a Level 1 trauma center, the patient was managed conservatively with serial CT angiography monitoring. Over a period of several weeks, the pseudoaneurysm remained stable without evidence of expansion, ultimately leading to successful nonoperative management. The patient was discharged with ongoing outpatient follow-up. Conclusion: This case demonstrates the successful nonoperative management of a delayed presentation of penetrating traumatic aortic arch injury. Careful patient selection, close multidisciplinary monitoring, and serial imaging are essential components of this approach. While this less invasive strategy avoids the risks associated with open or endovascular procedures, close monitoring for complications and timely intervention remain critical for optimal outcomes. Further research is needed to better define the indications for and outcomes of conservative management in such cases.

Erratum zu: Joint-Statement zur prähospitalen Periarrest-Thorakotomie nach Trauma

2025-06-16

Dan Bieler , Uwe Schweigkofler , Sebastian Imach +1 more | Notfall + Rettungsmedizin

The Impact of Delayed Intubation on Outcomes and Resource Utilization of Patients Sustaining Multiple Rib Fractures

2025-06-15

Junsik Kwon , Bishoy Zakhary , Navpreet K. Dhillon +3 more | The American Surgeon

Background Patients with multiple rib fractures may require mechanical ventilation due to respiratory insufficiency. We hypothesized that delayed intubation leads to worse outcomes compared to early intubation. Methods We analyzed … Background Patients with multiple rib fractures may require mechanical ventilation due to respiratory insufficiency. We hypothesized that delayed intubation leads to worse outcomes compared to early intubation. Methods We analyzed data from the Trauma Quality Improvement Program database (2017-2021) for adults with ≥ 3 rib fractures requiring intubation. Patients were divided into groups of early and delayed intubation (after 24 hours from admission). Outcomes included in-hospital mortality, complications, and tracheostomy need. Resource utilization metrics were compared. Groups were balanced using inverse probability of treatment weighting, and complex samples logistic regression was used to evaluate the effect of delayed intubation on outcomes while controlling for covariates. Results Out of 191,816 patients with ≥3 rib fractures, 5339 underwent early intubation and 4004 underwent delayed intubation. Delayed intubation patients were older, more often female, less severely injured, had fewer bilateral fractures and flail chest, but higher tracheostomy need. Factors associated with delayed intubation included age > 60, ISS < 16, absence of bilateral fractures, smoking, and COPD. After adjustment, delayed intubation was associated with higher mortality (19.7% vs 13.7%), longer hospital and ICU stays, increased mechanical ventilation duration, and fewer ICU- and ventilator-free days. Additionally, delayed intubation was linked to increased ARDS, pulmonary embolism, severe sepsis, and acute kidney injury. It independently increased mortality odds (OR 1.584). Discussion Delayed intubation in patients with multiple rib fractures is associated with worse clinical outcomes and increased resource utilization. This link between delayed intubation and worse outcomes highlights the importance of recognizing at-risk individuals and considering early intubation.

Costal cartilage injuries: Massages that went wrong!

2025-06-14

Aruna R. Patil | Indian Journal of Musculoskeletal Radiology

Costal cartilage injuries are a result of high-energy trauma to the chest. Delayed diagnosis can result in chronic pain, instability, and the healing changes to be misdiagnosed as a more … Costal cartilage injuries are a result of high-energy trauma to the chest. Delayed diagnosis can result in chronic pain, instability, and the healing changes to be misdiagnosed as a more sinister pathology. Massage-related costal cartilage injuries are not adequately addressed in medical literature. Massages done by an inadequately trained person or on a frail chest can result in costal fractures. Imaging plays a vital role in evaluating cartilage injuries. Ultrasound, computed tomography, and magnetic resonance imaging each have their role in the diagnosis and follow-up of such injuries.

The comparison of ultrasound, chest X-ray, and chest CT in the diagnosis of pneumothorax in thoracic trauma patients

2025-06-13

Mehmet Yılmaz , Havva ŞAHİN KAVAKLI | Intercontinental Journal of Emergency Medicine

Aims: Pneumothorax is a critical condition frequently encountered in thoracic trauma that requires prompt diagnosis and management. This study aimed to compare the diagnostic accuracy of ultrasound (USG), chest X-ray … Aims: Pneumothorax is a critical condition frequently encountered in thoracic trauma that requires prompt diagnosis and management. This study aimed to compare the diagnostic accuracy of ultrasound (USG), chest X-ray (CXR), and thoracic computed tomography (CT) in detecting pneumothorax in patients with thoracic trauma. Methods: A prospective study was conducted on patients presenting to the emergency department with thoracic trauma. Each patient underwent an initial ultrasound examination using the Extended Focused Assessment with Sonography for Trauma (E-FAST) protocol, followed by CXR and CT. The sensitivity, specificity, and diagnostic accuracy of USG and CXR were evaluated using CT as the reference standard. Results: CT confirmed pneumothorax in 15 cases (13%) among the studied patients. USG demonstrated a sensitivity of 73.3% and a specificity of 100%, while CXR showed a sensitivity of 0.0% and a specificity of 98.7%. The diagnostic accuracy of USG was significantly superior to that of CXR. Conclusion: USG is a highly specific and efficient bedside tool for diagnosing pneumothorax in thoracic trauma patients. Its implementation in emergency settings can facilitate early detection and management, particularly when CT is unavailable or delayed.

Sternal non-union

2025-06-12

Craig Hacking | Radiopaedia.org

Kafa Travması Sonrası Gelişen Retrobulber Hematom: Olgu Sunumu

2025-06-12

Ibrahim Azimli , Tuncay Küsbeci | İzmir Tıp Fakültesi Dergisi

AMAÇ: Kafa travması sonrası retrobulber hematom gelişen ve tıbbi tedavi ile iyileşen olgunun klinik ve tedavi özelliklerini sunmak. OLGU: 70 yaşında kadın hasta, göz polikliniğimize 2 gün önce sabah aniden … AMAÇ: Kafa travması sonrası retrobulber hematom gelişen ve tıbbi tedavi ile iyileşen olgunun klinik ve tedavi özelliklerini sunmak. OLGU: 70 yaşında kadın hasta, göz polikliniğimize 2 gün önce sabah aniden başlayan sol gözde şişme ve göz kapağı düşüklüğü ile başvurudu. Hasta aynı zamanda 2 gün önce sistemik tansiyonunun 200/110 mmHg a çıktığını ve bununla birlikte yere düşme sonrası acil servise başvurduğunu söyledi. Başvuru sırasında hasta ve yakınları sol gözde ani görme kaybı ve gözde hareketlerde kısıtlılık tarifliyordu. Hastanın yapılan oftalmolojik muayenesinde görme keskinliği sağda 0.2, sol da p- idi. Hastanın yapılan fundus muayenesinde sağ da optik disk doğal, sol da optik disk sınırları silik, disk inferiorunda kıymık hemoraji mevcut idi. Sol göz propitotik ve göz kapağında ptozis mevcuttu. Primer pozisyonda solda ekzotropya mevcuttu. Sol gözde dışa bakışta daha çok olmak üzere 9 kadranda da bakış kısıtlılığı mevcuttu. Hastadan orbita BT istendi. Hasta hospitalize edildi geniş biyokimya ve hemogram istendi, aynı gün iç hastalıkları kliniğince hasta konsulte edildi, sistemik tansiyon takibi yapılması önerildi. Nöroloji kliniğince konsulte edilen olgumuzda ilk etapta retroorbital lezyon düşünüldü. Tarafımızca hastaya steroid tedavisi başlandı. Steroid tedavisi sonrası 3. ay muayenesinde vizyonu p- ve optik diski soluk olmasına rağmen hastanın her yöne bakış kısıtlılığı kaybolmuştu. Hastanın çekilen kontrol BT sinde kitle görüntüde tamamen kaybolmuştu. SONUÇ: Akut retrobulber hematomlar kalıcı vizyon kaybı ile seyreden ciddi oküler patolojiler arasındadır. Tanıda altın standart orbita BT ve Manyetik rezonans (MR) ile görüntülemedir. Birinci basamak tedavi oral steroidler ve uygun olgularda cerrahidir. Anahtar Kelimeler: Retrobulber hematom, ptoz, propitoz, ekzotropya

A Hidden Cause of Chest Pain in Adolescence: First Rib Fracture Without Trauma

2025-06-11

Kota Miura , Rica Tada | Cureus

A case of missed stab wound to the right heart diagnosed by cardiac imaging

2025-06-06

Ruchika Meel , Ricardo Gonçalves | European Heart Journal - Imaging Methods and Practice

Letter Comments on “Combined Latissimus Dorsi Myocutaneous Flap and 3D-printed PEEK Implant for Reconstruction of a Large Full-thickness Chest Wall Defect: A Retrospective Study”

2025-06-04

Renu Sah , Ankita Mathur | Journal of Plastic Reconstructive & Aesthetic Surgery

Postoperative Mediastinitis in Pediatric Cardiac Surgery: Clinical Characteristics, Management and Risk Factors for Mortality

2025-06-03

Ségolène Bernheim , Salim Chıkhı , India Foufa +7 more | The Pediatric Infectious Disease Journal

Objectives: The aim is to describe the clinical features, management and outcomes of postoperative mediastinitis in children following cardiac surgery and to identify risk factors for mortality. Methods: We retrospectively … Objectives: The aim is to describe the clinical features, management and outcomes of postoperative mediastinitis in children following cardiac surgery and to identify risk factors for mortality. Methods: We retrospectively reviewed all cases of mediastinitis in children following congenital heart surgery over a 10-year period (2013–2023) at Necker Hospital, a tertiary care center. Results: Cumulative incidence of mediastinitis was 0.74% [95% confidence interval (CI): 0.56–0.96] with 57 cases of 7665 interventions. Median age at surgery was 12 days (6–146), with 58% of patients younger than 1 month. Thirty-four patients (60%) had delayed sternal closure. The most frequent germs were Staphylococcus spp. (45%), Gram-negative bacteria (36%) and fungi (9%). All patients had surgical debridement: 46 (81%) in the operating room and 11 (19%) in the intensive care unit (ICU). Median length of stay was 21 days (13–30) in the ICU and 35 days (28–48) until hospital discharge. The mortality rate was 27%, with 12 of 15 deaths occurring in the ICU. In univariate analysis, mortality risk factors were surgical revision in the ICU compared with the operating room [odds ratio (OR): 4.9; 95% CI: 1.3–19.9], delayed sternal closure superior to 3 days (OR: 5.0; 95% CI: 1.3–16.5) and fungal mediastinitis (OR: 14.9; 95% CI: 2.0–185.4). In the multivariate analysis, only fungal infection remained a significant risk factor for mortality (OR: 25.4; 95% CI: 2.7–608). Conclusion: Mediastinitis is a rare complication of neonatal cardiac surgery, with a low incidence (0.74%) in this tertiary referral center. However, mortality from this condition remains high, with fungal infections identified as the main mortality risk factor.

Delayed versus Early TEVAR in Grade III Blunt Traumatic Aortic Injury: A 12-Year Single-Center Retrospective Study

2025-06-03

Qi Qin , Lunchang Wang , Quanming Li +4 more | Research Square (Research Square)

<title>Abstract</title> <bold>Background: </bold>This study aimed to summarize a 12-year single-center experience in managing Grade III blunt traumatic aortic injury (BTAI) and compare the safety and efficacy of delayed thoracic endovascular … <title>Abstract</title> <bold>Background: </bold>This study aimed to summarize a 12-year single-center experience in managing Grade III blunt traumatic aortic injury (BTAI) and compare the safety and efficacy of delayed thoracic endovascular aortic repair (TEVAR) with early intervention. <bold>Methods: </bold>A retrospective analysis of 56 patients with Grade III BTAI treated between August 2011 and January 2024 was conducted. Based on clinical condition, patients received early TEVAR (<24h), delayed TEVAR (>24h), or conservative management. Perioperative and follow-up outcomes were assessed. <bold>Results: </bold>Among the 56 patients, 16 underwent early TEVAR, 37 delayed TEVAR, and 3 conservative treatment. The average age was 49.4 years, and 75.0% were male. Motor vehicle collisions were the leading cause (60.7%). Common associated injuries included fractures (94.6%), pulmonary (64.3%), and cranial injuries (41.1%). The early TEVAR group had significantly higher Injury Severity Scores (ISS), shock index >1, and emergency surgery rates (all p<0.01). There were no significant differences in perioperative mortality or endoleak rates. No patients experienced paraplegia, cardiovascular events, or renal impairment. Aortic-related hospital stays were shorter in the early TEVAR group (p<0.001), which also had a higher rate of post-TEVAR surgeries for associated injuries (p=0.006). Follow-up revealed no significant differences in all-cause survival or reoperation rates between groups. No aortic-related deaths occurred in either group. <bold>Conclusion: </bold>Delayed TEVAR is not inferior to early TEVAR for Grade III BTAI in terms of safety and efficacy. Both approaches achieved favorable outcomes when individualized to patient hemodynamic status and injury severity.

Don’t Judge a Book by its Cover: Clamshell-Thorakotomie beim traumatischen Kreislaufstillstand

2025-06-02

| Notarzt

Prähospitale Notfallthorakotomie – lebensrettend für ausgewählte Patienten

2025-06-02

| Notarzt

Spinal gunshot wounds: A systematic review of the literature

2025-06-01

Madhav Sankhyan , S. Amin , Kathleen Botterbush +6 more | North American Spine Society Journal (NASSJ)

Hemothorax and needle thoracostomies in prehospital traumatic cardiac arrest: an autopsy series of 172 cases

2025-06-01

Johannes von Vopelius‐Feldt , Anthony Persaud , Sasha Jones +2 more | Resuscitation Plus

Successful Sternal Cleft Repair With Rib Graft and SurgiMend

2025-06-01

Reem Saleh Alrajhi , Qutaiba N. M. Shah Mardan , Abdullah M. Alzahrani +2 more | Plastic & Reconstructive Surgery Global Open

Early in development, driven by mostly unknown factors, a malformed sternum can manifest as a cleft. This is not innocuous, as surgical repair is required to mitigate the deleterious effects … Early in development, driven by mostly unknown factors, a malformed sternum can manifest as a cleft. This is not innocuous, as surgical repair is required to mitigate the deleterious effects of unprotected thoracic organs, impaired respiratory function, and susceptibility to chest infections. We aimed to enrich the literature on this topic by presenting the case of a 10-month-old boy diagnosed with a sternal cleft who underwent reconstruction using a rib cartilage bridging graft supported with fascia and acellular dermal matrix. Management outcomes are expected to improve as surgical approaches evolve from simple primary sternal closure to using cartilaginous or bony grafts and leveraging adjacent soft tissue for added coverage.

Ergebnisse nach Operation isolierter Verletzungen des lunotriquetralen Bandes

2025-06-01

| Handchirurgie Scan

Guiding rib fracture care with the STUMBL score: acute pain management and intensive care unit referrals

2025-06-01

Nicholas Shearer , Timothy Blakey , Daniel Wornham +2 more | Injury

Computed Tomography-Detected Hemothorax after Blunt Chest Trauma: Does Everyone Need an Intervention? A Retrospective Analysis

2025-06-01

Ismail Mahmood , Ali Alomar , Syed Nabir +7 more | Injury

Innovative Transfer Method for Rib Coaptation Plate in Thoracoscopic Fixation of Rib Fractures

2025-06-01

Maodan Chen , Yang Huang , Yuanzhou Wu +4 more | Annals of Thoracic Surgery Short Reports

Kataraktchirurgie bei extrem kurzem Augapfel

2025-06-01

| Klinische Monatsblätter für Augenheilkunde

Traumatic ventricular septal defect with right ventricular aneurysm in paediatric blunt trauma

2025-06-01

Devi Bavishi , Thaddeus J. Puzio , Jorge D. Salazar +2 more | BMJ Case Reports

Blunt cardiac injury is a rare but potentially a highly lethal complication of blunt thoracic trauma, with a broad spectrum of presentations and structural injuries, including traumatic ventricular septal defects … Blunt cardiac injury is a rare but potentially a highly lethal complication of blunt thoracic trauma, with a broad spectrum of presentations and structural injuries, including traumatic ventricular septal defects (VSDs). We report the case of an early adolescent female who sustained a traumatic VSD and right ventricular aneurysm following a jet ski accident without any traditional signs of cardiac injury on presentation. This case highlights the rarity of traumatic VSDs and right ventricular aneurysms, the challenges in management, and the need for early diagnosis and intervention in preventing further cardiac deterioration.

Post-traumatic interventricular septal hematoma in a dog

2025-06-01

Laura Moretto , Matthias Dennler , Nora Schreiber +1 more | Journal of Veterinary Cardiology