Imaging manifestations and the related clinical characteristics of chest trauma during the Yushu Earthquake

The purpose of this study was focused on the imaging features of the chest trauma and its relation to clinical characteristics. All the injured patients were from the Yushu Earthquake areas on days April 14 - 23,2010. After an initial treatment,the injurers were rapidly transported from Yushu at an altitude of 4 000 m via air to Xining at 2 260 m within 6~8 h,and promptly admitted to Qinghai Provincial People’s Hospital. A total of 130 wounded injurers who had high suspicion of chest injuries all had examinations of Chest X-ray and computed tomography(CT)images. Of them 63 injurers presented at least one of the features of the chest trauma in imaging with a positive rate of 48.5 %. Of these,37 cases (28.5 %) were multi-system with multiple injuries ,33 cases (25.4 %) were chest trauma with multi-injury types,which included thoracic fractures in 54 cases (85.7 %),pleural injury in 56 cases (88.9 %),lung injury in 54 cases (85.7 %),lungs complications in 37 cases (58.7 %),and extrapulmonary complications of 35 cases (55.6 %). The radiological data were analyzed retrospectively. The features of chest trauma in Yushu Earthquake,the complications of chest injuries,and the relation between imaging findings and clinical manifestations,as well as the differences of chest trauma between Yushu Earthquake and Wenchuan Earthquake were discussed in detail.

胸部穿透伤286例救治体会

目的总结286例胸部穿透伤临床救治体会。方法回顾分析286例胸部穿透伤病例，14例伤口清创缝合，57例伤口清创缝合＋胸腔闭式引流，36例剖腹＋膈肌修补＋胸部伤口清创缝合＋胸腔闭式引流，170例剖胸手术，9例胸腔镜治疗。结果共死亡8例，2例心脏破裂、6例胸腹腔多处锐器伤出血过多死亡，余均存活。结论早期诊断胸腹腔脏器损伤，尽快手术治疗、控制出血是胸部穿透伤救治成功的关键。

Polytrauma with thoracic and/or abdominal injuries: experience in 1 540 cases

Objective ：To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries. Methods： The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively. Results： In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% （181/1 206） and 79.9% （ 612/766 ） in patients with thoracic and abdominal injury （ P 〈 0.01 ）, 5.2 % （39/758） and 31.7% （142/448） in patients with blunt and penetrating chest trauma （P〈0.01）, and 72.4% （359/496） and 93.7 % （253/270） in patients with blunt and penetrating abdominal injuries （P〈0.01）, respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9 % （75/950） and 3.6 % （21/590）, respectively （P〈0.01）. Most patients died from exsanguination. Conclusions： The first ＂golden hour＂ after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.

Effect of seawater immersion on plasma osmotic pressure and electrolyte balance following open chest trauma

Objective: To explore the effect of seawater immersion on serum osmotic pressure and electrolytes balance following chest trauma in dogs. Methods: Twenty five healthy adult dogs were used in the experiment. A canine model of right open pneumothorax was established by chest puncturing on all animals. Animals were divided into three groups: a control group (n=10) with chest trauma without any immersion; a seawater group (n=10) immersed in seawater after chest trauma and a normal saline group (n=5) immersed in normal saline solution following chest trauma. Blood samples were taken at different time intervals to determine plasma osmotic pressure and electrolytes. The hemodynamic changes were also recorded. Results: Mortality in the seawater group was much higher than that of the control group and the normal saline group. The mean survival time in the seawater group lasted only 45 minutes, while in the control group and the normal saline group the average survival time was more than 4 hours (P< 0.01 ). One of the most important causes of death was hypernatremia and high osmolality. Severe electrolytes imbalance was observed in seawater group. Hypernatremia and high osmolality were the most significant factors of high mortality in the seawater group. Conclusions: Seawater immersion after chest trauma appears to be associated with severe electrolyte imbalance as well as high osmotic pressure. These may be the risk factors leading to fatal outcome.

Management of multiple trauma with mainly thoracic and abdominal injuries： a report of 1166 cases

Objective： To discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries. Methods： A retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries. Results： Of 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% （119/804） and 83.5% （710/850） respectively （ x^2=780.683, P 〈0.01）. The operation rates of blunt and penetrating thoracic injuries was 6.8% （42/617） and 40.6% （76/187） respectively （ x^2=131.701, P〈0.01）. The operation rates of blunt and penetrating abdominal injuries were 77.1% （434/563） and 96.1% （276/287） respectively （ x^2=50.302, P〈0.01）. The operation rates of blunt thoracio-abdominal injuries were 6.8% （42/617） in thoracic region and 77.1% （434/563） in abdomen respectively （x^2=544.043, P〈0.01 ）. Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% （39/41）. Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% （62/854） and 2.9% （9/312） （ x^2=6.51, P〈0.005）. The deaths were mainly due to large volume of blood loss. Conclusions： When both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.

Thoracic cord compression caused by contiguous multilevel ossification of ligamentum flavum in Chinese patients

Objective： To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum. Methods. Medical notes and imaging data of 18 Chinese patients （14 males and 4 females, aged 43-72 years, mean： 57 years ） with myelopathy caused by contiguous multilevel ossification of ligamentum flavum were studied retrospectively in this article. The diagnosis was based on clinical examination, X-ray films, computerized tomography （CT） and magnetic resonance imaging （MRI） scanning results and pathological results. Sixteen patients were treated by laminectomy and two by laminoplasty, The average follow-up duration was 34 months （range, 28-49 months ）. The outcome was evaluated by Japanese Orthopaedics Association （JOA） Score. Results： The average time for occurring clinical symptoms was 7.5 months （range, 2 days-16 months）. All the 18 cases presented with clinical evidences of chronic and progressive thoracic spinal cord compression, which included bilateral leg weakness, spastic gait, numbness in lower limbs, paresthesia in terminal and perineum, and urinary incontinence. Neurological examination revealed severe spastic paraparesis, absence of abdominal reflexes, and reduction of the sensory function below the compression level. The mean JOA score before operation was 3. 6 （range, 0-6 ）. MRI and CT scans of the thoracic spine confirmed the presence of contiguous multilevel ossification of the ligamentum flavum. The mean recovery rate after surgery in terms of JOA score was 66.3 % （ range, 33.3 %- 100% ）, with a mean final JOA score of 8. 3. Thoracic decompression laminectomy or laminoplasty could result in a good postoperative outcome. Conclusions ： Contiguous multilevel ossification of the ligamentum flavum is not a common cause of myelopathy in Chinese population and should be treated as early as possible. MRI and CT scan examinations may diagnose the presence of thoracic ossification of ligamentum flavum （OLF）. Posterior decompression, especially with en bloc dissection of the laminae, can obtain satisfactory results.

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases

Objective: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. Methods: A total of 2 165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. Results: After treatment, 2024 ( 93.49%) cases survived and the other 141 ( 6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 ( 46.71%) and 53 ( 24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%- 65.96% and 28.57% respectively, indicating a significant difference (P< 0.05). Conclusions: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Scapular dislocation from trivial trauma： a rare case

Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event.Scapulothoracic dissociation though has been reported,usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury,etc.Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition.Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature.It is a distinct clinical entity and needs to be differentiated from other similar conditions.Here,we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a l0 years old girl.The patient had a recurrence of the dislocation before presenting to us.But she did not have any pre-existing condition for scapular dislocation.

Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

Objective：Thoracic injuries are responsible for 25% of deaths of blunt traumas.Chest X-ray （CXR） is the first diagnostic method in patients with blunt trauma.The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy （CT） in hemodynamically stable patients with blunt chest trauma.Methods：Study was conducted at the emergency department of S ina Hospital from March 2011 to March 2012.Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included.All patients underwent the same diagnostic protocol which consisted of physical examination,CXR and CT scan respectively.Results：Two hundreds patients （84% male and 16% female） were included with a mean age of（37.9±13.7） years.Rib fracture was the most common finding of CXR （12.5%） and CT scan （25.5%）.The sensitivity of CXR for hemothorax,thoracolumbar vertebra fractures and rib fractures were 20%,49% and 49%,respectively.Pneumothorax,foreign body,emphysema,pulmonary contusion,liver hematoma and sternum fracture were not diagnosed with CXR alone.Conclusion：Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

Study on pedestrian thorax injury in vehicle-to-pedestrian collisions using finite element analysis

Objective： To explore the relationship between the collision parameters of vehicle and the pedestrian thorax injury by establishing the chest simulation models in car-pedestrian collision at different velocities and angles. Methods： 87 cases of vehicle-to-pedestrian accidents, with detailed injury information and determined vehicle impact parameters, were included. The severity of injury was scaled in line with the Abbreviated Injury Scale （AIS）. The chest biomechanical response parameters and change characteristics were obtained by using Hyperworks and LS-DYNA computing. Simulation analysis was applied to compare the characteristics of injuries. Results： When impact velocities at 25, 40 and 55 km/h, respectively, 1） the maximum values of thorax velocity criterion （VC） were for 0.29, 0.83 and 2.58 m/s; and at the same collision velocity, the thorax VC from the impact on pedestrian＇s front was successively greater than on his back and on his side; 2） the maximum values of peak stress on ribs were 154,177 and 209 MPa; and at the same velocity, peak stress values on ribs from the impact on pedestrian＇s side were greater than on his front and his back. Conclusion： There is a positive correlation between the severity and risk of thorax injury and the collision velocity and angle of car-thorax crashes. At the same velocity, it is of greater damage risk when the soft tissue of thorax under a front impact; and there is also a greater risk of ribs fracture under a side impact of the thorax. This result is of vital significance for diagnosis and protection of thorax collision injuries.

Scapular fractures and concomitant injuries

Objective： The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods： A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients＇ demographics, injury mechanism, associated injuries, Injury Severity Score （ISS）, and survival outcomes were recorded. The manage- ment of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results： Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases （1.1%）. The mean age was （37.98±15.21） years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases （60.7%）.Seventyour patients （88.1%） suffering from scapular fractures had associated injuries： 5 （6.0%） had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients （2.4%） with scapular fractures died. Factors determining the likelihood of mortality were： （1） ISS〉25 （LR=8.5, P〈0.05）; （2） significant associated chest injury （AIS〉3, LR=5.3, P〈0.05） and （3） significant associated abdominal injury （AIS〉3, LR=5.3, P〈0.05）. Conclusion： A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.

Thoracic spinal trauma associated with closed thoraco-abdominal injury

Objective: To explore the management of thoracic spinal trauma (TST) associated with closed thoraco abdominal injuries (CTAI). Methods: A retrospective study was made on 259 patients with TST admitted to our department as an emergency treatment from January 1996 to June 2001. We summarized the clinical features of TST associated with CTAI. Results: Among 259 patients with thoracic spinal trauma, 112 were associated with CTAI. Traffic accident was the most common cause. The force causing upper TST was more violent than that causing the lower. Pulmonary complications were the leading cause of death in this group. Surgery could not improve neurological function for completely paraplegic patients. Conclusions: The reason that upper TST has the tendency to be associated with CTAI is its special anatomical feature. Routine ultrasonic examination can avoid misdiagnosis of latent closed abdominal injuries associated with spinal injury. The presence of potential injuries, especially CTAI, should be considered when deciding whether or not to perform surgery early.

Assessment of internal mammary artery injury after blunt chest trauma: a literature review

The occurrence, bleeding, and treatment of internal mammary artery（IMA） injury after blunt chest trauma have not been well described in the literature. We reviewed articles published from July 1977 to February 2014 describing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriovenous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent surgical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as well as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury.

The dynamic response of heart and its injury involving chest impact

Objective: The dynamic response of the heart during chest impact and the characteristics of heart injuries were investigated to further understand the mechanisms of heart impact injuries. Methods: Eleven dogs and thirty four rabbits were subjected to front thoracic impact with different impact velocities and compression response. The accelerated movement of thoracic wall during the impact period was monitored. The pathological examination of the injured heart was done and the dynamic responses and mechanisms of injuries were analyzed with mathematics models. Results: The analysis of mathematics model and experimental results showed that the injury severity of heart was well correlated with the viscous criterion. The thoracic wall was involved in bi directional movement of compression and expansion. The injured heart showed spotty or stripy hemorrhages in the ventricle endocardium. Light microscopic examination showed interstitial bleeding and rupture of the myocardial fibers in the contusion area. The biomechanical analysis indicated that there was a large deformation caused by the stress concentration on the lateral ventricle wall. Conclusions: There is a high speed and excessive deformation of the heart during the impact period, which might be the key mechanism of heart injury. The strong impact and press coming from both sternum and vertebral column and the rapid elevation of pressure in the ventricle are the main cause of deformation.