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PubMed1979

[Radiology in chest trauma (author's transl)].

In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20--30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology.

Adolescent↗
PubMed2006

[Surgical fixation of the ribs for flail chest injuries].

The record of 20 patients presenting with flail chest injury from 1998 to 2005 was reviewed to determine surgical indication and timing. There were 4 groups with each indication as followed: 1) 8 patients with surgical indication for injury regions other than fractured ribs, 2) 5 without improvement of flail chest after internal pneumatic stabilization for more than 10 days, 3) 4 performed surgical fixation positively for flail chest with respiratory failure, 4) 3 with strong deformation of the thorax without respiratory failure. Eight patients (40%) required artificial respiration for more than 6 days after surgical stabilization. The reasons of prolonged artificial respiration included unconsciousness in 4 patients, pneumonia in 2, and others in 2. In the group consisting of 8 patients taking more than 6 days to be extubated after surgical fixation, the injury severity score (ISS) was significantly higher (p = 0.006) than that of the other group. In patients with no improvement of flail chest after internal pneumatic stabilization for more than 10 days, surgical fixation reduces the period of internal pneumatic stabilization and the risk of pneumonia. For the elderly who can develop complications easily, early indication of surgical fixation should be considered. In patients with unconsciousness or ISS > or = 25, the extubation delays frequently after surgical fixations.

Adult↗
PubMed1987

Complications of cardiac resuscitation.

In a prospective study of the complications of cardiac resuscitation, 705 cases were autopsied to identify the cause of death and the pathologic findings attributable to cardiac resuscitation. Thoracic complications were observed in 42.7 percent of the cases. A total of 31.6 percent had rib fractures, 21.1 percent had sternal fractures, and 18.3 percent were reported as having anterior mediastinal hemorrhage; 20.4 percent of the cases had an upper airway complication. Abdominal visceral complications were noted in 30.8 percent of the cases, and pulmonary complications occurred in 13 percent of the resuscitation population. Life-threatening complications, such as heart and great vessel injuries, occurred in less than .5 percent of the cases.

Abdominal Injuries↗
PubMed1986

Rib radiographs for trauma: useful or wasteful?

In trauma to the chest, the clinical impression and the physical findings of rib fractures are nonspecific. Fractures often are not seen on initial films. The principal diagnostic goal should be the detection of significant complications (pneumothorax, hemothorax, major vascular injury, or pulmonary contusion) requiring admission. The therapeutic effort should be to provide pain relief and prevent the delayed development of atelectasis or pneumonia in patients with painful chest wall injuries, whether or not a fracture is detected initially. An upright posteroanterior chest radiograph has the greatest yield in detecting fractures and complications resulting from them. Tomograms and expiratory, oblique, and "coned-down" views should not be done routinely. The use of these more specific examinations may be indicated, however, in such cases as trauma to ribs 1 to 3 or 9 to 12. Their selective use in isolated cases (trauma to ribs 1 to 3 or 9 to 12) and suspected child abuse may indicate the need for these more specific examinations. Because detection of pulmonary complications of chest trauma is most important, a delayed or repeat upright posteroanterior chest radiograph may be the most cost-effective second radiograph. Significant medical care cost savings may be appreciated by limiting the use of specific rib views to instances in which it might influence the patient's therapy.

Adolescent↗
PubMedDate not supplied

[Portable device for ribs traction].

Described in the paper is a portable device designed by the author for the traction of ribs in the complex treatment of multiple rib fractures. It is autonomous and easy in use. The devise does not damage the skin and tissues.

Equipment Design↗
PubMed1989

Fatal intraoperative hemorrhage during spinal fusion surgery for osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is an uncommon inherited systemic disorder of the connective tissues characterized primarily by varying degrees of bony fragility. Consequently, individuals affected by this condition frequently suffer severe skeletal injuries from otherwise innocuous traumatic events. This syndrome has other associated abnormalities, including hydrocephalus and brain stem compression on the basis of cranial developmental defects (platybasia), cardiac and vascular problems, respiratory disease from spinal deformities, vascular fragility, a bleeding disorder caused by an apparent platelet function abnormality, and anesthesia-related hyperpyrexia. A case is presented here of a young girl with advanced OI in whom intraoperative death occurred as a consequence of inadvertent rib fractures, with subsequent uncontrollable hemorrhage. OI may also potentially be mistaken for child abuse by an inexperienced examiner.

Child↗
PubMed1999

Hedgehog signaling molecules in bone marrow cells at the initial stage of fracture repair.

Ihh is a secreted protein expressed in chondrocytes in cartilaginous soft callus and thought to be involved in regulation of chondrogenic differentiation in fracture repair processes. However, gene expression and function of Ihh and its signaling molecules, Ptc and Smo, at the initial stage of fracture repair remain unknown. In the present study, we showed by RT-PCR of mouse rib fractures that the upregulation of Ihh mRNA occurred within hours after fracture, immediately followed by that of Ptc mRNA, and that both Ihh and Ptc mRNAs exhibited the time course similar to those of OP and OC mRNAs at the initial stage of fracture repair. The transcript level of Smo mRNA gradually increased within hours after fracture and was continuously maintained throughout the subsequent fracture repair processes. By in situ hybridization analysis, the transcripts of Ptc and Smo genes localized in bone marrow of unfractured ribs, and those of Ihh, Ptc, and Smo were expressed in the vicinity of the fracture site at 8 h after fracture. Furthermore, in adherent bone marrow cells in culture, mrIhh-N upregulated the gene expression of TGF-beta(1) as well as OPGL, a potent stimulator of osteoclastogenesis and osteoclast activity. These observations suggest that Ihh may play roles in the initial stage of fracture repair via TGF-beta(1) and OPGL.

Animals↗
PubMed1996

Significance of chest trauma in children.

Chest trauma in children is a marker of injury severity and is associated with a high mortality rate. This retrospective study of 1,356 trauma patients from a private pediatric hospital over a 2.5-year period identified 82 patients with chest injuries and a mortality rate of 22%. Results of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score all indicated that children with chest injuries sustained more severe injuries. The presence of any extrathoracic injury was associated with a higher mortality (29%) than chest injury alone (4.3%). The type of extrathoracic injury was important, with head and neck injuries resulting in the highest mortality. Specific chest injuries, such as rib fractures and pulmonary contusions, were not related to increased mortality unless there was an associated extrathoracic injury. Many reports have shown a high mortality associated with chest trauma. This study suggests that it is the associated extrathoracic injury, rather than the chest injury itself, that is the real cause of the high mortality.

Abdominal Injuries↗
PubMed1997

Non-life-threatening blunt chest trauma: appropriate investigation and treatment.

Non-life-threatening blunt chest trauma is a commonly occurring phenomenon. No clear guidelines exist in the literature regarding the appropriate investigation and treatment, and most clinicians' practice patterns are based on anecdote, individual experience, and the theoretical risk of complications. A prospective study was undertaken of all patients with non-life-threatening blunt chest trauma presenting to a high-volume, community-based teaching hospital emergency department. No clinical features were found to have a high enough positive predictive value for rib fracture or any other injury to warrant their use as a screening tool for further investigations. No significant lung injury was detected in the study cohort of patients, on either an immediate or delayed basis. In the absence of compelling evidence of an underlying lung injury, the performance of chest or rib radiography is of no benefit, and considerable cost savings can potentially be realized.

Adolescent↗
PubMed1995

Fractures of the first rib in child abuse.

PURPOSE: To evaluate the incidence and specificity of fracture of the first rib as an indicator of child abuse and to determine a mechanism of fracture. MATERIALS AND METHODS: All infants and young children with rib fractures who were seen at the radiology department of an academic medical center over a 2-year period were identified from the radiology data base. RESULTS: Rib fractures were attributed to child abuse in 12 of 35 children identified. Apart from a neonate with congenital osteogenesis imperfecta, only three children, all abused, had first-rib fracture, one bilaterally. Two additional children with first-rib fracture were identified from years prior to the study period. In four children, first-rib fractures were "isolated," without fractures of adjacent bones. CONCLUSION: Child abuse should be considered in cases of pediatric rib fracture, particularly fracture of the first rib. Possible mechanisms for first-rib fracture include impact force, compressive force, and shaking or acute axial load (slamming), which cause an indirect fracture.

Academic Medical Centers↗
PubMed1993

Case report: child abuse--necklace calcification--a sign of strangulation.

Strangulation has been postulated as one cause of cerebral hypoxia in child abuse. This report describes the finding of necklace calcification in an infant with rib fractures and a metaphyseal fracture and an admission of a shaking injury. The calcification is likely to represent fat necrosis as the result of strangulation.

Calcinosis↗
PubMed1992

[Delayed hemothorax after chest injuries. Report of 31 cases].

Thirty-one patients with delayed hemothorax were treated. The time from trauma to hemothorax formation ranged from 2 to 30 days. The patients with chest injuries accompanied by multiple rib fracture, potential vascular injuries and foreign body retention the thoracic cavity were observed closely. The diagnosis, pathogenesis and treatment were discussed.

Adult↗
PubMed2002

Direct medical costs attributable to osteoporotic fractures.

Osteoporotic fractures are a major cause of morbidity in the elderly, the most rapidly growing segment of our population. We characterized the incremental direct medical costs following such fractures in a population-based cohort of men and women in Olmsted County, Minnesota. Cases included all County residents 50 years of age and older with an incident fracture due to minimal or moderate trauma between January 1, 1989 and January 1, 1992. For each case, a control of the same age (+/- 1 year) and sex who was attended in the local medical system in the same year was identified. Total incremental costs (cases - controls) in the year after fracture were estimated. Unit costs for each health service/procedure were obtained through the Mayo Cost Data Warehouse, which provides a standardized, inflation-adjusted estimate reflecting the national average cost of providing the service. Regression analysis was used to identify factors associated with incremental costs. There were 1263 case/control pairs; their average age was 73.8 years and 78% were female. Median total direct medical costs were $761 and $625, respectively, for cases and nonfracture controls in the year prior to fracture, and $3884 and $712, respectively, in the year following fracture. The highest median incremental costs were for distal femur ($11756) and hip fractures ($11241), whereas the lowest were for rib fractures ($213). Although hip fractures resulted in more incremental cost than any other fracture type, this amounted to only 37% of the total incremental cost of all moderate-trauma fractures combined. Regression analyses revealed that age, prior year costs and type of fracture were significant predictors of incremental costs (p<0.03 for all comparisons). The incremental costs of osteoporotic fractures are therefore substantial. Whereas hip fractures contributed disproportionately, they accounted for only one-third of the total incremental cost of fractures in our cohort. The use of incremental costs in economic analyses will provide a more accurate reflection of the true cost-effectiveness of osteoporosis prevention.

Age Factors↗
PubMed2004

Severity and pattern of injury in survivors of alpine fall accidents.

Few data are available on the medical aspects of fall accidents in mountainous terrain. Therefore, we report the severity and pattern of injury in 97 survivors of a major fall in Alpine terrain. Twenty-eight of 97 victims (29%) had severe or critical multisystem trauma, with an injury severity score >/=14, the incidence increasing to 23 out of 28 (82%) in individuals with falls exceeding 50 m. Fractures of the extremities and the sacropelvic region (n = 55) were the most common injuries. Seventeen of 21 spine fractures (81%) occurred in the thoracolumbar region. Rib fractures were found in 17 victims, in eight of them (47%) with an accompanying pneumothorax. Critical head trauma with a Glasgow Come Scale below 9 was rather uncommon (n = 6); abdominal visceral injuries were rare (n = 2). The pattern of injury observed in our study suggests a feet- or side-first body position at impact in the majority of individuals surviving Alpine fall accidents. Furthermore, it indicates a direct impact, rather than deceleration type mechanism of injury. Because of the high incidence of severe multisystem trauma, major fall in Alpine terrain should be used as triage criterion for the dispatch of an advanced trauma life support unit and direct transfer of the victim to a trauma center. Considering the high incidence of fractures, measures for adequate immobilization and analgesia will generally be necessary before the difficult evacuation from the site of the accident can be started.

Accidental Falls↗
PubMed1980

Fractures of the scapula.

One hundred thirty-seven fractures of the scapula in 121 patients were reviewed. The average age at the time of injury was 35 years, with fractures predominant in males (64%). The majority of cases (43%) involved fractures of the body of the scapula, with fractures of the scapular neck being second most common (26%). Automobile accidents produced the most injuries (52%), followed by auto-pedestrian (18%), falls (12%), and motorcycle accidents (11%). Associated bony or major soft-tissue trauma was present in all but 15 of the 121 patients, the most common being fractured ribs in 44%. Other associated injuries included fractures of the clavicle (26%), fractured skull (24%), cerebral contusion (20%), neurologic deficit (13%), and pulmonary contusion or hemo-pneumothorax (16%). Patients with injuries involving the acromion process or acromioclavicular joint had a significantly higher incidence of associated peripheral nerve injuries than those with other fractures of the scapula, indicating that special attention should be given to the neurologic examination of patients with these fractures. Careful neurovascular examination is mandatory. Treatment was usually conservative, independent of the location of the fracture, with satisfactory long-term results. We recommend simple immobilization followed by early active range of motion exercise.

Adolescent↗