Nonunion of a dominant side first rib stress fracture in a baseball pitcher.
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Adolescent↗
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[Gastric wall necrosis owing to its incarceration through a rupture of the diaphragm into the left thoracic cavity].
A 73 year-old female patient was admitted to the 3rd Medical Department of Semmelweis University with a painful haematoma in the left loin and respiratory disorders. Her general condition was getting progressively worse. Chest X-ray demonstrated a left sided hemopneumothorax caused by a fractured rib. Thoracic drainage was planned, but the tube introduced on the usual place into the left thoracic cavity perforated the stomach which was incarcerated in the chest. After this an urgent operation was carried out. We found an incarcerated, twisted stomach prolapsing through a rupture of the diaphragm. It was partially necrotic. Excision of the stomach wall with suturing the diaphragm, lavage and drainage of the thoracic and abdominal cavity was carried out. Despite the operation multi-organ failure developed as a result of sepsis, and the patient'died. We discuss the literature in connection with the presentation of this rare and interesting case. In the past 15 years we could not find similar case in the Hungarian surgical literature.
Aged↗
[Pneumothorax revealed by postoperative computed tomography].
We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.
Accidents, Traffic↗
Prognostic factors in blunt chest trauma. Analysis of 652 cases.
All records of 652 patients treated for blunt chest trauma at Ullevål Hospital, Surgical Department 3, during the period 1973-1981 were analyzed for factors predictive of prognosis. Mortality for the whole group was 7.7%. Age, blood pressure on admission, the number of fractured ribs, the need for blood transfusions and the need for artificial ventilation were the most important predictors of prognosis. Mortality increased significantly when at least two extrathoracic injuries were present (22.6%). Intrathoracic injuries did not increase mortality in cases of isolated thoracic injuries. Combined thoraco-abdominal injuries carried a high mortality (25%), especially when the injury had resulted in rupture of the diaphragm (57.1%). There were no sex-related differences. The majority of the patients could be handled adequately with oxygen support, chest drainage, physiotherapy and pain relief. The incidence of bronchial infection, septicaemia and hypercoagulability was significantly higher for patients on ventilators than for patients breathing spontaneously. Mortality increased when septicaemia or bronchial infection was present (30.8 and 21.9%, respectively). The injury severity score (ISS) for the 50 patients who died in the hospital was similar to that of some other reports.
Abdominal Injuries↗
Old familiar faces: some aspects of the asylum era in Britain. Part 1.
Conditions which had an historical association with Asylums in the years 1850-1950, but which are no longer commonly seen in psychiatric practice, are reviewed. These include: Asylum pellagra, Erysipelas, Insane Ear and Fractured Ribs. The history of each condition and its manifestation is reviewed in the context of its relationship with mental illness and its treatment as seen by authorities writing when these conditions were prevalent. It is not clear why these conditions became common, why they had a particular association with Asylums, or why they have largely disappeared.
Ear Diseases↗
Failure of naloxone to reverse peripheral transcutaneous electro-analgesia in patients suffering from acute trauma.
Transcutaneous electrical stimulation of the intercostal nerves innervating the site of fractured ribs in 6 patients produced subjective and clinical evidence of decrease in the pain experienced by the patients. This analgesia was not significantly modified by naloxone, a pure narcotic antagonist. The possible role of endogenous morphine-like substances in peripheral electro-analgesia in man is discussed.
Acute Disease↗
Management of traumatic pneumothorax.
In road accident trauma, pneumothorax can be 'open' (associated with a penetrating chest wound) or 'closed'; either can be associated with fractured ribs or development of intrapleural tension. Tension and open pneumothorax are recognised easily and their correction at the scene of the accident can be lifesaving. Any accompanying major intrathoracic and subcostal organ damage should be assessed.
Accidents, Traffic↗
[Epidural morphine analgesia (author's transl)].
We report our experience with epidural morphine analgesia. Morphine 2-3 mg in 10-15 ml 0.9% saline was given to patients after abdominal surgery, patients with terminal carcinoma and patients with multiple fractured ribs. Mean duration of analgesia was 14 hours and was not accompanied by severe complications.
Aged↗
Diving injuries: a preventable catastrophe.
During a 5-year period from January 1987 through January 1992, 58 patients were admitted to the Allegheny General Hospital trauma center for non-scuba, non-suicidal diving injuries. There were 46 men and 12 women (mean age, 23 years). Forty-five patients were injured in swimming pools. Twenty-two patients had blood alcohol levels > 100 mg/dL. Cervical spine injury was the most common pathologic entity encountered in this group of patients. Closed head injury, pelvic fracture, thoracic vertebral fracture, and rib fractures were other injuries identified. Some patients had multiple organ failure syndrome. Aquatic recreational activities carry a risk for injury that is preventable. The mechanism, clinical data, and complications of 58 patients are presented and the importance of prevention is discussed.
Adolescent↗
Chest injuries in childhood.
Differences in anatomy and mechanisms of injury are believed to contribute to the unique response of children to thoracic trauma. To characterize the scope and consequences of childhood chest injury, we reviewed the records of 105 children (ages 1 month to 17 years, mean 7.6 years) with chest injuries admitted to a level I pediatric trauma center from 1981 to 1988. Nearly all injuries (97.1%) were due to blunt trauma, and more than 50% were traffic related. Rib fractures, commonly multiple, and pulmonary contusions occurred with nearly equal frequency (49.5% and 53.3%, respectively), followed by pneumothorax (37.1%) and hemothorax (13.3%). One fourth of all pneumothoraces were under tension. Significant intrathoracic injuries occurred without rib fractures in 52% of cases with blunt trauma. Associated head, abdominal, and orthopedic injuries were present in 68.6% of children reviewed. One in five received endotracheal intubation and ventilatory support for 1 to 109 days. Presence or absence of head injury neither increased the need for respiratory support (29.4% vs. 17.2%, respectively; p = 0.24) nor affected the duration of support for those who were ventilated (6.8 +/- 8.9 days vs. 3.3 +/- 2.6 days, excluding one ventilator-dependent head-injured patient and five early deaths). The presence of associated injuries, intubation, and pneumothorax or hemothorax all resulted in significantly longer hospitalizations and more severe injury as measured by Injury Severity Score (ISS). Age, rib fracture, and contusion had no effect. Rarely encountered were ruptured diaphragm (2 cases), transection of the aorta (1), major tracheobronchial tears (3), flail chest (1), and cardiac contusion (2). Only two of the three children with penetrating injuries and three of the 83 (3.6%) with blunt injuries underwent chest operations. Six children (7%) died, one from a penetrating injury and five from blunt mechanisms. Chest Abbreviated Injury Scale (AIS) and ISS correlated significantly with mortality; age and head AIS did not. Rib fractures, lung contusions, and associated head, abdominal, and skeletal injuries are common because of the predominance of blunt-injury mechanisms. Nearly one half of chest injuries occurred without rib fractures. The need for ventilatory support is uncommon; when required, its duration is generally brief. Aortic transection, flail chest, and penetrating injuries more frequently encountered in adults and are uncommon in children. Thoracotomy generally is not required.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Serious complications from active compression-decompression cardiopulmonary resuscitation.
Complications arising from techniques of cardiopulmonary resuscitation (CPR) were reviewed by analysing the autopsy protocols of 25 patients who died after standard (Std) CPR and 31 who died after active compression-decompression (ACD) CPR, 15 of them preceded by Std CPR. The results can be summarised as follows: After Std CPR (n = 25) rib fractures were detected in 28%, sternal fractures in 16%, and no injuries in 68%. After ACD-CPR (n = 16) rib fractures occurred in 68%, sternal fractures in 68% and no injuries in 25%. After ACD-CPR following Std CPR(n = 15) rib fractures were detected in 93%, sternal fractures in 93%, and no patients were without thoracic fracture. In two patients severe cardiac injuries occurred clearly attributable to CPR. In conclusion cardiopulmonary resuscitation by the ACD-technique caused rib and sternal fractures more often than Std CPR and has a higher risk for iatrogenic cardiac and possible fatal injury.
Adolescent↗
Severe chest trauma. Morbidity implication.
Patients who sustain fracture of either the first or second rib have severe injuries usually involving multiple systems. In comparing 71 patients with first rib fractures and 49 patients with second rib fractures, we found morbidity and mortality to be similar. A multidisciplinary approach to management of these patients is described and vigorous diagnostic and therapeutic measures are warranted to promptly determine the extent of injury and minimize the frequency of missed diagnosis.
Abdominal Injuries↗
Jumpers and fallers: a comparison of the distribution of skeletal injury.
AIM: The aim of this study was to compare the distribution of injuries between patients who have fallen and those who have jumped from a height, and to relate the mechanism of injury to the fractures sustained. MATERIALS AND METHODS: Three hundred and ninety-nine patients, admitted via Helicopter Emergency Medical Service (HEMS), classified as either having fallen or jumped from a height were included in the study. The radiographs from the primary survey, together with radiographs of specific injury sites were analysed. The distribution of injury was compared in the two groups. RESULTS: Of the 399 patients, 342 were fallers and 57 were jumpers. Jumpers had a higher Injury Severity Score (ISS), death rate and number of fractures per person. Jumpers sustained more rib fractures (particularly on the right), pelvic and lower limb fractures but fewer skull fractures. CONCLUSION: Jumpers tend to sustain different injuries to fallers. It is proposed that jumpers have a tendency to land feet-first and then try to break their falls on their dominant side, sustaining more right-sided rib fractures in the process. The patterns of injury that have emerged from this study have important implications for evaluating skeletal injuries in those who jump or fall from a height.
Accidental Falls↗
Post-mortem diagnosis and age estimation of infants' fractures.
Detection and dating of infants' fractures plays an important role in the diagnosis of the battered child syndrome. Under this aspect three cases of infants with multiple fractures of different ages due to child abuse were evaluated post-mortem. Radiological findings were compared with the autopsy results, followed by contact radiography and histopathological assessment. Out of a total of 44 osseous lesions, 27 fractures were diagnosed by post-mortem skeletal survey, additionally 5 recent rib fractures were suspected, 4 of which were confirmed histologically and all were located paravertebrally. The fractures not detected radiologically were mostly recent rib fractures diagnosed or suspected at autopsy or by contact radiography and confirmed histologically. The histological investigation allowed a more precise dating of the fractures, particularly with reference to the early stages of fracture healing. Microscopic signs of fracture healing processes, such as periosteal thickening, osteoid production and calcification of soft callus tissue, can be detected earlier and quantified more accurately. In advanced stages of healing the osseous apposition rate can be measured semiquantitatively up to a certain extent. A scheme involving a careful external investigation, skeletal survey, autopsy, contact radiography and histology has been proven useful for diagnosing and dating infants' fractures.
Autopsy↗
[Lumbar rib and fracture of transverse process; their significance as centers of irritation].
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Fractures, Bone↗
[On the treatment of rib serial fractures. Anesthesiologic report].
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Accidents, Traffic↗
Iatrogenic fractures of ribs and vertebrae during delivery in perinatally dying calves: 235 cases (1978-1988).
To determine the pathogenesis of vertebral fractures in calves during the perinatal period, a retrospective study was done to determine the relationships between clinical factors at dystocia and the findings during necropsy of 235 perinatally dying calves. It was concluded that excessive traction is the most important cause of rib and vertebral fractures in the calf during dystocia. Vertebral fractures in perinatally dying calves may not be simply judged as a sign of asphyxia. The occurrence of vertebral fractures is highly correlated with the type of delivery and the force of traction. The veterinarian as well as the type of calf also are influencing factors. More perinatally dying calves were delivered after hips were locked, when extraction had been forced, or through induction of trauma when the head of the calf had the pelvic canal during the first obstetric examination. Consequently, fetal position at delivery may predispose calves to risky extractions and to the risk of perinatal death secondary to trauma. In light calves, significantly more vertebral fractures occurred during extractions than in other calves. Therefore, the veterinarian should accurately estimate the birth weight of the calf and the force of traction that should be applied.
Animals↗
Inhibitory effects of tumor necrosis factor alpha on fracture healing in rats.
Fracture healing, which involves a cascade of biological tissue responses, may be affected by various biochemical substances. One of these substances is tumor necrosis factor alpha (TNF). Studies were made on the effects of TNF on healing of fractured ribs of rats. Fracture healing was inhibited by daily administration of recombinant human TNF (400 micrograms/kg body weight per day, intraperitoneally) after fracture. The rate of union on day 20 was significantly lower in the TNF-treated group (4/18, 22.2%) than in the control group (14/18, 77.8%) (p less than 0.001 by Chi-square test). Histological examination showed that TNF inhibited cartilagenous callus formation. On day 10, cartilage was seen in the gap zone and under the periosteum in the control group, but no cartilage formation was observed in the gap zone in 9 of 12 specimens from the TNF-treated group. On day 20, the fracture ends were united by newly formed bone in the control group, but mature fibrous tissue was seen in the gap zone, and bony or cartilagenous union was not achieved in the TNF-treated group. These results show that TNF inhibits cartilage formation in the early phase of bone induction in fracture healing and suggest that this effect of TNF is due to its inhibition of differentiation of mesenchymal cells into chondroblasts.
Animals↗