Blunt Chest Wall Trauma Research Articles

Use of SternaLock Plating System in Acute Treatment of Unstable Traumatic Sternal Fractures

Optimal surgical treatment of unstable sternal fractures is controversial. Wiring provides suboptimal fixation and adaptations of existing non-sternum specific plating systems may be dangerous when rapid sternal reentry is required. We present our experience with the sternal specific fixation system, SternaLock (Biomet Microfixation Inc, Jacksonville, FL), in the acute treatment of transverse sternal body fractures in 2 patients who sustained significant blunt anterior chest wall trauma. SternaLock provides the rigid sternal fixation necessary for reliable fracture healing while offering advantages over other systems with regards to ease of use and safety.

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

Evaluation of the safety of high-frequency chest wall oscillation (HFCWO) therapy in blunt thoracic trauma patients

BackgroundAirway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO) has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vest™ Airway Clearance System (Hill-Rom, Saint Paul, MN), was safe and well tolerated by these patients.MethodsTwenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest® Airway Clearance System (Hill-Rom, Inc., St Paul, MN). The Vest® system was set to a frequency of 10–12 Hz and a pressure of 2–3 (arbitrary unit). Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason.ResultsNo chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions.ConclusionThis study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment.

Acute myocardial infarction after blunt chest trauma

Coronary artery injury rarely occurs after blunt chest wall trauma. It can, however, lead to extensive myocardial infarction. We report a rare case of acute anterolateral myocardial infarction in a young man after blunt chest trauma.

Pain Management Guidelines for Blunt Thoracic Trauma

Pain Management Guidelines for Blunt Thoracic Trauma Bruce Simon;James Cushman;Robert Barraco;Vivian Lane;Fred Luchette;Maurizio Miglietta;David Roccaforte;Ruth Spector; The Journal of Trauma: Injury, Infection, and Critical Care

Operative Chest Wall Fixation with Osteosynthesis Plates

Blunt chest wall trauma is a major cause of morbidity and mortality, especially in the presence of a flail chest where paradoxical inward movement of the flail segment in inspiration is found. Patients with a flail chest require aggressive pain control, pulmonary toilet, and often intubation and mechanical ventilation to establish an internal pneumatic stabilization of the flail segment. This may result in a prolonged ICU stay and pulmonary complications including pneumonia, septicemia and barotrauma. The high mortality rate of up to 10 –36% –12 is partly due to the high prevalence of associated life-threatening extra-thoracic injuries. However, one principle cause of death consists of pneumonia and sepsis with prolonged intubation. Several potential advantages of operative chest wall stabilizations have been reported. These include reduced duration of mechanical ventilation, shortened ICU stay and hospitalization, and decreased likelihood of clinically significant long-term respiratory dysfunction and skeletal deformity. Despite the advantages of operative chest wall fixation, little consensus on the fixation technique exists. This report describes three cases of flail chest injury managed by operative stabilization with plates and screws. The criteria for surgical intervention in this trauma center are traumatic loss of 30% of pleural cavity volume, inability to wean an awake patient from the ventilator, inability to control chest wall pain despite epidural catheter, major air leak or major bleeding, or unstable sternal fracture with overlap. In all three cases a standard posterolateral thoracotomy was performed. The serratus anterior was retracted anteriorly and the latissimus dorsi was divided. To reach more cranially a small portion of the trapezius and the rhomboids were transected in cases 2 and 3. The chest was always entered and hematoma was removed. Pelvic, mandibular and customized reconstruction plates were used, with bending stiffness ranging from 1,936 over 414 to 56 kN mm, respectively. In addition to documentation of the technique, this report describes the results obtained with three distinct osteosynthesis plates and provides a historic overview of alternative fixation means.

Rupture of the coronary artery after blunt nonpenetrating chest wall trauma detected by color Doppler echocardiography: A case report

We report a rare case of a ruptured papillary muscle of the anterior leaflet of the tricuspid valve and the rupture of the septal branch of the left anterior descending coronary artery with drainage into the right ventricle after blunt nonpenetrating chest wall trauma. Both abnormalities were detected by transthoracic 2-dimensional and color Doppler echocardiography, and the septal branch rupture was confirmed by coronary angiography. The leading echocardiographic sign of the rupture of the coronary artery was intramyocardial mosaic-colored flow, representing the turbulent high-velocity flow in the ruptured coronary artery. Hypokinesis of the anteroseptal myocardial segments and the presence of Q waves in leads V1 through 4 on the electro-cardiogram were suggestive of anteroseptal myocardial infarction. We conclude that the history of chest trauma, the electrocardiographic changes, and wall motion abnormalities should be stimuli for a careful color Doppler flow “mapping” of the myocardium for possible identification of a coronary artery rupture. (J Am Soc Echocardiogr 2000;13:1043-6.)

Utility of Cardiac Troponins in Patients with Suspected Cardiac Trauma or After Cardiac Surgery

Detection of cardiac injury after blunt chest wall trauma or cardiac surgery is problematic. Previously available biomarkers have been hindered largely by limitations of specifity for myocardial damage. Both cardiac troponin I and T have been evaluated in these patient subgroups. While many questions remain unanswered, it appears that measurement of troponin proteins will facilitate patient care in these difficult situations.

Silicone thorax: a complication of tube thoracostomy in the presence of mammary implants

Rupture of silicone breast implants is usually either iatrogenic or due to trauma. We present a case of blunt chest wall trauma in a patient with bilateral breast implants. Emergency chest tube thoracostomy resulted in rupture of one of the prostheses and caused subsequent migration of silicone into the chest cavity, where it led to empyema. The patient ultimately required a thoracotomy to evacuate the silicone and decorticate the lung. Review of the literature and methods to avoid this complication are described.

Delayed hemopericardium and cardiac tamponade after unrecognized chest trauma

Delayed hemopericardium after blunt chest wall trauma in children is rare and difficult to recognize before overt signs of cardiac tamponade. We present a 21-month-old girl who developed a late hemopericardium with cardiac tamponade after initially unrecognized blunt chest wall injury.

セラミック肋骨ピンにより胸壁固定を行い良好に経過したｆｌａｉｌ ｃｈｅｓｔの１例

A 74-year-old man was admitted with multiple rib fractures and hemopneumothorax in the left thorax caused by blunt chest wall trauma. Paradoxical movement of the left anterolateral chest wall was observed. Following 9 days of conservative therapy, multiple rib fractures were surgically repaired using polycrystal alumina ceramic pins. In his post-operative course, paradoxical movement of the chest wall and severe chest pain subsided completely in the early postoperative period. No complication was observed and the result was satisfactory. Treatment for flail chest is still controversial. This report describes the operative stabilization of traumatic flail chest using polycystal alumina ceramic pins.