Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures os...Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient’s clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.展开更多
Rib fracture is the most common injury in chest trauma.Most of patients with rib fractures were treated conservatively,but up to 50%of patients,especially those with combined injury such as flail chest,presented chron...Rib fracture is the most common injury in chest trauma.Most of patients with rib fractures were treated conservatively,but up to 50%of patients,especially those with combined injury such as flail chest,presented chronic pain or chest wall deformities,and more than 30%had long-term disabilities,unable to retain a full-time job.In the past two decades,surgery for rib fractures has achieving good outcomes.However,in clinic,there are still some problems including inconsistency in surgical indications and quality control in medical services.Before the year of 2018,there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad,focusing on the guidance of the overall treatment decisions and plans;another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures.The Chinese Society of Traumatology,Chinese Medical Association,and the Chinese College of Trauma Surgeons,Chinese Medical Doctor Association organized experts from cardiothoracic surgery,trauma surgery,acute care surgery,orthopedics and other disciplines to participate together,following the principle of evidence-based medicine and in line with the scientific nature and practicality,formulated the Chinese consensus for surgical treatment of traumatic rib fractures(STTRF 2021).This expert consensus put forward some clear,applicable,and graded recommendations from seven aspects:preoperative imaging evaluation,surgical indications,timing of surgery,surgical methods,rib fracture sites for surgical fixation,internal fixation method and material selection,treatment of combined injuries in rib fractures,in order to provide guidance and reference for surgical treatment of traumatic rib fractures.展开更多
Purpose::Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury(ASOI).The purpose of this study was to investigate the correlation of ASOI with ...Purpose::Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury(ASOI).The purpose of this study was to investigate the correlation of ASOI with the number,location,and involved segments of rib fracture(s)in blunt chest trauma.Methods::This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years,who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020.After ethic committee approval,a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected.Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age,gender,injury severity score,trauma mechanism,number and sides of the fractured ribs(left/right/bilateral),rib fracture segments(upper,middle,lower zone)and results of chest and abdominal spiral CT scan were recorded.The correlation between ASOI and the sides,segments and number of rib fracture(s)was assessed by Pearson's correlation coefficient.Results::Altogether 1056 patients with rib fracture(s)were included.The mean age was(42.76±13.35)years and 85.4%were male.The most common mechanism of trauma was car accident(34.6%).Most fractures occurred in the middle rib zone(60.44%)and the most commonly involved ribs were the 6th and 7th ones(15.7%and 16.4%,respectively).Concurrent abdominal injuries were observed in 103 patients(34.91%)and were significantly associated with middle zone rib fractures.Conclusion::There is a significant relationship between middle zone rib fractures and ASOI.Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.展开更多
BACKGROUND Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission.However,pericardial injuries not bad enou...BACKGROUND Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission.However,pericardial injuries not bad enough to dislocate the heart may only cause intermittent electrocardiogram(ECG)changes or be asymptomatic.CASE SUMMARY In this case,we report a blunt pericardial injury undetected on preoperative transthoracic echocardiography and chest computed tomography.We misjudged intermittent ECG changes and blood pressure fluctuations as minor symptoms resulting from cardiac contusion and did not provide intensive treatment.The pericardial injury was found incidentally during surgical stabilization of rib fractures and was successfully repaired.CONCLUSION Post-traumatic blunt pericardial ruptures should be considered in patients with blunt chest trauma showing abnormal vital signs and ECG changes.展开更多
Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its...Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.展开更多
文摘Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient’s clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.
基金supported by the National Trauma Regional Medical Center Major Research Project(co-built by the Municipal Commission)(jjzx2021-gjcsqyylzx01)。
文摘Rib fracture is the most common injury in chest trauma.Most of patients with rib fractures were treated conservatively,but up to 50%of patients,especially those with combined injury such as flail chest,presented chronic pain or chest wall deformities,and more than 30%had long-term disabilities,unable to retain a full-time job.In the past two decades,surgery for rib fractures has achieving good outcomes.However,in clinic,there are still some problems including inconsistency in surgical indications and quality control in medical services.Before the year of 2018,there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad,focusing on the guidance of the overall treatment decisions and plans;another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures.The Chinese Society of Traumatology,Chinese Medical Association,and the Chinese College of Trauma Surgeons,Chinese Medical Doctor Association organized experts from cardiothoracic surgery,trauma surgery,acute care surgery,orthopedics and other disciplines to participate together,following the principle of evidence-based medicine and in line with the scientific nature and practicality,formulated the Chinese consensus for surgical treatment of traumatic rib fractures(STTRF 2021).This expert consensus put forward some clear,applicable,and graded recommendations from seven aspects:preoperative imaging evaluation,surgical indications,timing of surgery,surgical methods,rib fracture sites for surgical fixation,internal fixation method and material selection,treatment of combined injuries in rib fractures,in order to provide guidance and reference for surgical treatment of traumatic rib fractures.
文摘Purpose::Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury(ASOI).The purpose of this study was to investigate the correlation of ASOI with the number,location,and involved segments of rib fracture(s)in blunt chest trauma.Methods::This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years,who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020.After ethic committee approval,a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected.Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age,gender,injury severity score,trauma mechanism,number and sides of the fractured ribs(left/right/bilateral),rib fracture segments(upper,middle,lower zone)and results of chest and abdominal spiral CT scan were recorded.The correlation between ASOI and the sides,segments and number of rib fracture(s)was assessed by Pearson's correlation coefficient.Results::Altogether 1056 patients with rib fracture(s)were included.The mean age was(42.76±13.35)years and 85.4%were male.The most common mechanism of trauma was car accident(34.6%).Most fractures occurred in the middle rib zone(60.44%)and the most commonly involved ribs were the 6th and 7th ones(15.7%and 16.4%,respectively).Concurrent abdominal injuries were observed in 103 patients(34.91%)and were significantly associated with middle zone rib fractures.Conclusion::There is a significant relationship between middle zone rib fractures and ASOI.Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.
文摘BACKGROUND Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission.However,pericardial injuries not bad enough to dislocate the heart may only cause intermittent electrocardiogram(ECG)changes or be asymptomatic.CASE SUMMARY In this case,we report a blunt pericardial injury undetected on preoperative transthoracic echocardiography and chest computed tomography.We misjudged intermittent ECG changes and blood pressure fluctuations as minor symptoms resulting from cardiac contusion and did not provide intensive treatment.The pericardial injury was found incidentally during surgical stabilization of rib fractures and was successfully repaired.CONCLUSION Post-traumatic blunt pericardial ruptures should be considered in patients with blunt chest trauma showing abnormal vital signs and ECG changes.
文摘Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.
