-
Chinese Journal of Traumatology =... Jun 2020Physical 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... (Review)
Review
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 importance 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 pulmonary injuries, and these require urgent intervention. 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 patient, it is important to understand the treatment 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.
Topics: Flail Chest; Hemothorax; Humans; Lung Injury; Pain Management; Pneumothorax; Rib Fractures; Thoracic Injuries; Thoracic Wall; Wounds, Nonpenetrating
PubMed: 32417043
DOI: 10.1016/j.cjtee.2020.04.003 -
Pediatric Radiology Aug 2018Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history,... (Review)
Review
Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.
Topics: Child; Child Abuse; Child, Preschool; Consensus; Craniocerebral Trauma; Hematoma, Subdural; Humans; Infant; Infant, Newborn; Retinal Hemorrhage; Rib Fractures; Societies, Medical; Spinal Injuries
PubMed: 29796797
DOI: 10.1007/s00247-018-4149-1 -
JAMA Surgery Nov 2022Unstable chest wall injuries have high rates of mortality and morbidity. In the last decade, multiple studies have reported improved outcomes with operative compared...
IMPORTANCE
Unstable chest wall injuries have high rates of mortality and morbidity. In the last decade, multiple studies have reported improved outcomes with operative compared with nonoperative treatment. However, to date, an adequately powered, randomized clinical trial to support operative treatment has been lacking.
OBJECTIVE
To compare outcomes of surgical treatment of acute unstable chest wall injuries with nonsurgical management.
DESIGN, SETTING, AND PARTICIPANTS
This was a multicenter, prospective, randomized clinical trial conducted from October 10, 2011, to October 2, 2019, across 15 sites in Canada and the US. Inclusion criteria were patients between the ages of 16 to 85 years with displaced rib fractures with a flail chest or non-flail chest injuries with severe chest wall deformity. Exclusion criteria included patients with significant other injuries that would otherwise require prolonged mechanical ventilation, those medically unfit for surgery, or those who were randomly assigned to study groups after 72 hours of injury. Data were analyzed from March 20, 2019, to March 5, 2021.
INTERVENTIONS
Patients were randomized 1:1 to receive operative treatment with plate and screws or nonoperative treatment.
MAIN OUTCOMES AND MEASURES
The primary outcome was ventilator-free days (VFDs) in the first 28 days after injury. Secondary outcomes included mortality, length of hospital stay, intensive care unit stay, and rates of complications (pneumonia, ventilator-associated pneumonia, sepsis, tracheostomy).
RESULTS
A total of 207 patients were included in the analysis (operative group: 108 patients [52.2%]; mean [SD] age, 52.9 [13.5] years; 81 male [75%]; nonoperative group: 99 patients [47.8%]; mean [SD] age, 53.2 [14.3] years; 75 male [76%]). Mean (SD) VFDs were 22.7 (7.5) days for the operative group and 20.6 (9.7) days for the nonoperative group (mean difference, 2.1 days; 95% CI, -0.3 to 4.5 days; P = .09). Mortality was significantly higher in the nonoperative group (6 [6%]) than in the operative group (0%; P = .01). Rates of complications and length of stay were similar between groups. Subgroup analysis of patients who were mechanically ventilated at the time of randomization demonstrated a mean difference of 2.8 (95% CI, 0.1-5.5) VFDs in favor of operative treatment.
CONCLUSIONS AND RELEVANCE
The findings of this randomized clinical trial suggest that operative treatment of patients with unstable chest wall injuries has modest benefit compared with nonoperative treatment. However, the potential advantage was primarily noted in the subgroup of patients who were ventilated at the time of randomization. No benefit to operative treatment was found in patients who were not ventilated.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01367951.
Topics: Humans; Male; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Rib Fractures; Prospective Studies; Thoracic Wall; Treatment Outcome; Thoracic Injuries; Length of Stay; Respiration, Artificial
PubMed: 36129720
DOI: 10.1001/jamasurg.2022.4299 -
Trials Dec 2019An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery. This study explored its effect on lung function and pulmonary complication rates in patients with rib fractures.
METHODS
Between June 2014 and May 2017, 50 adult patients with traumatic rib fractures were prospectively investigated. Patients who were unconscious, had a history of chronic obstructive pulmonary disease or asthma, or an Injury Severity Score (ISS) ≥ 16 were excluded. Patients were randomly divided into a study group (n = 24), who underwent IS therapy, and a control group (n = 26). All patients received the same analgesic protocol. Chest X-rays and pulmonary function tests (PFTs) were performed on the 5th and 7th days after trauma.
RESULTS
The groups were considered demographically homogeneous. The mean age was 55.2 years and 68% were male. Mean pretreatment ISSs and mean number of ribs fractured were not significantly different (8.23 vs. 8.08 and 4 vs. 4, respectively). Of 50 patients, 28 (56%) developed pulmonary complications, which were more prevalent in the control group (80.7% vs. 29.2%; p = 0.001). Altogether, 25 patients had delayed hemothorax, which was more prevalent in the control group (69.2% vs. 29.2%; p = 0.005). Two patients in the control group developed atelectasis, one patient developed pneumothorax, and five patients required thoracostomy. PFT results showed decreased forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV) in the control group. Comparing pre- and posttreatment FVC and FEV, the study group had significantly greater improvements (p < 0.001).
CONCLUSIONS
In conclusion, the use of an IS reduced pulmonary complications and improved PFT results in patients with rib fractures. The IS is a cost-effective device for patients with rib fractures and its use has clinical benefits without harmful effects.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT04006587. Registered on 3 July 2019.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Forced Expiratory Volume; Hemothorax; Humans; Length of Stay; Lung; Male; Middle Aged; Pneumothorax; Prospective Studies; Pulmonary Atelectasis; Rib Fractures; Spirometry; Thoracotomy; Treatment Outcome; Vital Capacity; Young Adult
PubMed: 31888765
DOI: 10.1186/s13063-019-3943-x -
Journal of Thoracic Disease May 2019As a means of treating rib fractures, surgical stabilization of rib fractures (SSRF) has been carried out sporadically for nearly 100 years. However, with the recent... (Review)
Review
As a means of treating rib fractures, surgical stabilization of rib fractures (SSRF) has been carried out sporadically for nearly 100 years. However, with the recent advent of new materials and technologies suitable for SSRF, the developmental rate and data concerning SSRF have increased greatly. The main manifestations of these advancements include the improvement of the preoperative localization method by combining CT scanning with three-dimensional reconstruction technology and ultrasound application to accurately locate fractures. The bone fracture plate is specifically used for rib fixation, and the intramedullary fixation devices and special SSRF tools make SSRF relatively simple. The application of 3D printing technology can accurately reproduce the anatomical shape of the fracture site under conditions before operation and combine with the internal fixation of chest wall, especially the thoracoscopy-assisted internal fixation of the chest wall, to achieve the minimally invasive internal fixation of the rib fracture. Absorbable internal fixation materials and thoracoscopic SSRF are considered the primary future research directions.
PubMed: 31205764
DOI: 10.21037/jtd.2019.04.99 -
Cureus Jul 2023Chronic alcohol use has been associated with impaired pulmonary function, increased risk of pneumonia and poor outcomes after trauma. With a high incidence of rib... (Review)
Review
Chronic alcohol use has been associated with impaired pulmonary function, increased risk of pneumonia and poor outcomes after trauma. With a high incidence of rib fractures in this population, the clinical and physiological factors associated with alcohol dependence may influence how these patients recover from thoracic injuries. Therefore, the aim of the systematic review was to examine the effect of alcohol dependence on rib fracture outcomes. The Embase, PubMed and Web of Science databases were searched for studies examining adult patients with rib fractures, with and without a history of alcohol dependency. The outcomes of interest were mortality, pulmonary complications, intensive care length of stay, ventilator days and hospital length of stay. A meta-analysis was performed to combine the data and compare results. Three studies met the criteria for inclusion in the review and all studies were observational in design. Alcohol dependency was associated with increased mortality (OR 1.44 (95% CI: 1.33-1.56)), pneumonia (OR 2.14 (2.02-2.27)) and ARDS (OR 1.71(1.48-1.98)) as well as longer stays in hospital and intensive care (p<0.05). No difference was found in ventilator days between the two groups. Early intensive care review should be considered to reduce complications in this population alongside prompt management of withdrawal symptoms. However, limited primary research exists on this topic and the quality of current evidence is low. Additional primary research is needed to further understand this correlation and draw meaningful conclusions.
PubMed: 37644941
DOI: 10.7759/cureus.42639 -
European Journal of Trauma and... Dec 2021Rib fractures (RF) occur in 10% of trauma patients; associated with significant morbidity and mortality. Despite advancing technology of surgical stabilization of rib...
PURPOSE
Rib fractures (RF) occur in 10% of trauma patients; associated with significant morbidity and mortality. Despite advancing technology of surgical stabilization of rib fractures (SSRF), treatment and indications remain controversial. Lack of displacement is often cited as a reason for non-operative management. The purpose was to examine RF patterns hypothesizing RF become more displaced over time.
METHODS
Retrospective review of all RF patients from 2016-2017 at our institution. Patients with initial chest CT (CT1) followed by repeat CT (CT2) within 84 days were included. Basic demographics were obtained. Primary outcomes included RF displacement in millimeters (mm) between CT1 and CT2 in three planes (AP = anterior/posterior, O = overlap/gap, and SI = superior/inferior). Displacement was calculated by subtracting CT1 fracture displacement from CT2 displacement for each rib. Given anatomic and clinical characteristics, ribs were grouped (1-2, 3-6, 7-10, 11-12), averaged, and analyzed for displacement. Secondary outcome included number of missed RF on CT1. Non-parametric sign test and paired t test were used for analysis. Significance was set at p < 0.002.
RESULTS
78 of 477 patients with RF on CT1 had CT2 during the study period: primarily male (76%) and age 55.8 ± 20.1 with blunt mechanism of injury (99%). Median Injury Severity Score was 21 (IQR, 13-27) with Chest Abbreviated Injury Score of 3 (IQR, 3-4). Median time between CT1 and CT2 was 6 days (IQR, 3-12). Missed RF rate for CT1 was 10.1% (p = 0.11). Average fracture displacement was significantly increased for all rib groupings except 11-12 in all planes (p < 0.002).
CONCLUSION
RF become more displaced over time. Pain regimens and SSRF considerations should be adjusted accordingly.
Topics: Adult; Aged; Humans; Injury Severity Score; Male; Middle Aged; Retrospective Studies; Rib Fractures; Ribs; Thoracic Injuries
PubMed: 32219487
DOI: 10.1007/s00068-020-01353-w -
Computational and Mathematical Methods... 2022Rib fractures are common injuries caused by chest trauma, which may cause serious consequences. It is essential to diagnose rib fractures accurately. Low-dose thoracic...
Rib fractures are common injuries caused by chest trauma, which may cause serious consequences. It is essential to diagnose rib fractures accurately. Low-dose thoracic computed tomography (CT) is commonly used for rib fracture diagnosis, and convolutional neural network- (CNN-) based methods have assisted doctors in rib fracture diagnosis in recent years. However, due to the lack of rib fracture data and the irregular, various shape of rib fractures, it is difficult for CNN-based methods to extract rib fracture features. As a result, they cannot achieve satisfying results in terms of accuracy and sensitivity in detecting rib fractures. Inspired by the attention mechanism, we proposed the CFSG U-Net for rib fracture detection. The CSFG U-Net uses the U-Net architecture and is enhanced by a dual-attention module, including a channel-wise fusion attention module (CFAM) and a spatial-wise group attention module (SGAM). CFAM uses the channel attention mechanism to reweight the feature map along the channel dimension and refine the U-Net's skip connections. SGAM uses the group technique to generate spatial attention to adjust feature maps in the spatial dimension, which allows the spatial attention module to capture more fine-grained semantic information. To evaluate the effectiveness of our proposed methods, we established a rib fracture dataset in our research. The experimental results on our dataset show that the maximum sensitivity of our proposed method is 89.58%, and the average FROC score is 81.28%, which outperforms the existing rib fracture detection methods and attention modules.
Topics: Humans; Image Processing, Computer-Assisted; Neural Networks, Computer; Rib Fractures; Tomography, X-Ray Computed
PubMed: 36035283
DOI: 10.1155/2022/8945423