Late stabilization surgery in flail chest and pulmonary contusion

Abstract

Background: Traumatic thoracic injury is currently the second leading cause trauma-related death after head injury, and rib fracture are the most common of thoracic injury. Flail chest, as defined by the presence of three or more consecutive rib fractures in 2 or more places characterized by paradoxical motion of flailing chest wall. An associated injury directly related to flail chest is pulmonary contusion. Pulmonary contusion in turn is the most common injury in blunt thoracic trauma, occurring in 30% to 75% of all cases.Case Description: a 69-year-old woman was referred from the rural hospital to the Dr. Zainoel Abidin General Hospital emergency room with chief complains of unconsciousness since 3 days ago after collision. Patients had a motorcycle crush accident and loss of consciousness after the event. Clear airway, but there is a paradoxical motion at left chest wall. Crepitation found from palpation at left hemithorax. From the chest X-ray shown haemothorax, pulmonary contusion, multiple ribs fracture at 3,4,5,6,7,8 at the left hemithorax. From head CT Scan found cerebral oedema. Also closed fracture at left 1/3 medial radius ulna and tibia fibula medial. The patients were performed surgery for open reduction and internal fixation of the flail chest. Hospitalized in ICU afterwards, Unfortunately, the patients were died few days later due to intracerebral worsening.Conclusion: Flail chest which related with pulmonary contusion must be treated immediately. If it is accompanied by severe head injury, it will make the patient's prognosis worse, if we delay the diagnosis and treatment.Â