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[Delayed epipleural hematoma as a fatal complication following blunt chest injury].

Delayed epipleural haematoma was found on autopsy of a 92-year-old woman after a fall at her home. X-ray performed 3 hours after the blunt thoracic trauma showed fractures of 5 ribs on the right side without any indication of intrathoracic bleeding or masses. Dressing and moving the patient about one day later caused multiple injuries of intercostal arteries and subsequently led to epipleural haematoma and unexpected death. Origin and morphology of epipleural haematoma are discussed with reference to a pertinent report in the literature. Hospitalization, with utmost care in nursing attention, is recommended in the treatment of patients presenting with thoracic trauma.

Aged↗

[Traumatic ruptures of the diaphragma. Diagnostic and therapeutic problems (author's transl)].

Between 1970 and 1976, 34 cases of traumatic ruptures of the diaphragma were observed and treated at the Surgical Clinic of the University of Würzburg: 23 acute ruptures and 11 delayed diagnostic ruptures. The etiology and mechanism of the rupture are discussed. A predominency of left over right ruptures occured in 90% of cases. In only one case there was an open rupture of the right side. Among associated abdominal lesions, ruptures of the spleen are the most frequent. Among skeletal associated lesions, one observes most frequently, fractures of the ribs. In 4 acute cases, there were no herniated organs. In the 11 patients were diagnosis was delayed we always found herniated viscera. Symptoms and diagnostic means are discussed. Traumatic rupture of the diaphragm is an absolute surgical indication. In acute cases we attempt the repair through a laparotomy; delayed cases should be treated by thoracotomy. Among 23 cases operated in emergency, 3 died because of associated lesions. Operative mortality was zero in the 11 patients with delayed diagnosis.

Abdominal Injuries↗

[Dorsal peridural analgesia in thoracic traumatisms (author's transl)].

Prolonged dorsal peridural analgesia is technically easy to achieve: after puncture in the middle of the metameric segment to be anaesthetized, an extradural catheter is inserted and graded doses of bupivacaine are injected. The method provides a valuable contribution to the management of thoracic traumas and is indicated for multiple fractures of the ribs, intolerable pains and flaioe chest. It reduces the incidence of bronchopulmonary complications due to accumulated secretions and of hypoxia from impaired gas exchanges or enlarged physiological dead space. It helps to overcome the acute stage of chest injury, prevents or limits its pernicious effects and shortens the patients' stay in hospital.

Analgesia↗

[Injuries of the wall of the thorax].

The mortality rate of chest injuries sustained in road accidents stands now at 15-20 per cent. The considerable force of the impact in road accident is, in 60-80 per cent of the cases responsible for chest injuries which involve other organs. Fractures of a single rib needs only analgetica or intercostal blockade. If a rib is broken in several places or if several rib are fractured instability of the chest wall is act to develop in 15-20 per cent of the cases. It manifest itself in paradoxical breathing and ensuing increase in dead space. In these cases required "internal pneumatic splitting" in form of positive pressure surgical stabilisation of the chest wall has regained favour. Wire or plate osteosynthesis screw-less rib plates and steel splints are being used. Primary stabilisation of the thoracis wall is indicated in the cases: with paradoxical breathing, with respiratory insufficiency or in the cases there are other reasons for thoracotomy. In these circumstances surgical intervention ensure that prolonged artificial ventilation and its attendant risks and complications and the demands made on the nursing staff are reduced to a minimum.

Fracture Fixation↗

[Chest injuries (author's transl)].

The mortality rate of chest injuries sustained during work or in road accidents stands now at 15-20%. The considerable force of the impact in road accidents is, in 60-80% of the cases, responsible for chest injuries which involve not only the chest wall but also the lungs. The extent and course of the lung damage must be assessed by repeated X-ray examinations, blood gas analyses and clinical observations. The decision to intubate and apply artificial ventilation should be made at an early stage. Fracture of a single rib needs only pain killers. If a rib is broken in several places or if several ribs are fractured instability of the chest wall is apt to develop in 15-20% of the cases. It manifests itself in paradoxical breathing and ensuing increase in the dead space. These cases require prompt "internal pneumatic splinting" in the form of positive pressure respiration and intubation. In recent years surgical stabilization of the chest wall has regained favour. Plate osteosynthesis, screw-less rib plates, self-gripping steel plates and steel splints are being used (Brunner, Hofmeister, Koncz). Primary osteosynthetic stabilization of the chest wall is indicated only if artificial ventilation has proved inadequate and there are other reasons for performing a thoracotomy. In these circumstances surgical intervention ensures that prolonged artificial ventilation and its attendent risks and complications and the demands made on the nursing staff are reduced to a minimum.

Accidents, Traffic↗

Stress fracture of the ipsilateral first rib in a pitcher.

This stress fracture of the left first rib in a 17-year-old, left-handed high school baseball pitcher represents the first of its type reported in the literature. Two similar cases have been reported in pitchers, but the fracture was on the nondominant side in both cases. In contrast to most cases of this rare lesion, the stress fracture we report occurred acutely and was documented roentgenographically from onset to complete healing 9 months later.

Adolescent↗

The role of autogenous primary rib grafts in treating fractures of the atrophic edentulous mandible.

Fractures of the atrophic edentulous mandible are relatively uncommon representing less than 1% of all facial bone fractures seen at The Queen Victoria Hospital, East Grinstead. Only 35 patients have been treated for fractures of the atrophic edentulous mandible at this unit from a total of over 4000 facial bone fractures seen here between 1975 and 1994. All traditional treatment modalities have been utilised with varying degrees of success. A technique is presented whereby all displaced fractures of the atrophic edentulous mandible with a measured bony vertical dimension of less than 10 mm at the fracture site are managed with primary autogenous rib grafting. This reduces the risk for formation of pseudarthrosis and facilitates subsequent prosthetic rehabilitation.

Aged↗

Application of fracture mechanics to failure in manatee rib bone.

BACKGROUND: The Florida manatee (Trichechus manatus latirostris) is listed as endangered by the U.S. Department of the Interior. Manatee ribs have different microstructure from the compact bone of other mammals. Biomechanical properties of the manatee ribs need to be better understood. Fracture toughness (K(C)) has been shown to be a good index to assess the mechanical performance of bone. Quantitative fractography can be used in concert with fracture mechanics equations to identify fracture initiating defects/cracks and to calculate the fracture toughness of bone materials. METHOD OF APPROACH: Fractography is a standard technique for analyzing fracture behavior of brittle and quasi-brittle materials. Manatee ribs are highly mineralized and fracture in a manner similar to quasi-brittle materials. Therefore, quantitative fractography was applied to determine the fracture toughness of manatee ribs. RESULTS: Average fracture toughness values of small flexure specimens from six different sizes of manatees ranged from 1.3 to 2.6 MPa(m)(12). Scanning electron microscope (SEM) images show most of the fracture origins were at openings for blood vessels and interlayer spaces. CONCLUSIONS: Quantitative fractography and fracture mechanics can be combined to estimate the fracture toughness of the material in manatee rib bone. Fracture toughness of subadult and calf manatees appears to increase as the size of the manatee increases. Average fracture toughness of the manatee rib bone materials is less than the transverse fracture toughness of human and bovine tibia and femur.

Animals↗