Fracture of the first rib; its occurrence and clinical diagnosis.
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BACKGROUND: To gain a wider operation field, ribs often are fractured as the intercostal retractor is expanded. Thoracotomy through the periosteal bed and other procedures have been performed to prevent rib fractures, and rib resections occasionally have been required. METHODS: We designed a poly-L-lactide costal coaptation pin. We used this pin in 184 thoracotomies and carried out long-term observation after insertion to evaluate its clinical efficacy and safety. Postoperative observation periods ranged from 1 to 58 months (mean +/-standard error, 21.6+/-1.2 months). We evaluated the costal pin according to its degree of fixation, categorizing it as "good," "fair," or "poor" in this respect. We also judged its lateral shift. RESULTS: We judged fixation as "good" in 130 cases (70.7%), and found no lateral shift in 103 cases (56%). Our overall evaluation indicated satisfactory results in 172 cases (93.5%). CONCLUSIONS: Rib fixation was secured in nearly all cases, and no side effects were encountered. We can confirm that the poly-L-lactide costal coaptation pin is a highly effective and safe device.
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OBJECTIVE: To analyze the epidemiological conditions and characteristics of inpatients with traffic trauma in order to provide objective data for basic research and clinical application of traffic trauma. METHODS: The data of 2213 inpatients with traffic trauma admitted to Lihuili Hospital, Ningbo Medical Centre, Ningbo, China, from January 2003 to September 2005 were studied retrospectively. According to the transportation ways, the patients were divided into four groups: pedestrians, bicyclists, motorcyclists, and automobilists. And the data of injured regions, combined injuries and causes of death were analyzed statistically. RESULTS: Among the 2213 patients, there were 550 pedestrians (23.5%), 521 bicyclists (24.9%), 738 motorcyclists (33.3%), and 404 automobilists (18.3%). Male patients were more than female ones, with the ratio of male to female of 2.8:1. Single region injury was found in 1663 patients (75.15%) and multiple injuries in 550 patients (24.85%). In total, 2849 regions were injured. Fracture of extremities (53.3%) occurred most often, craniocerebral trauma (19.4%) next, then followed in turn by thoraco-abdominal visceral injury (6.56%), spine fracture (5.37%), fracture of ribs (4.88%), and pelvic fracture (4.18%). The percentage of multiple injuries (33.2%) was highest and the percentage of thoraco-abdominal injury (18.0%) was higher in motorcyclists. The percentages of craniocerebral trauma in pedestrians and bicyclists were 27.8% and 28.2%, respectively. The incidence of fracture of extremities in motorcyclists reached 73.8%, but with the lowest case-fatality ratio of 1.4%. The incidence of traffic accidents caused by motorcyclists themselves (32.8%) was highest. A total of 56 patients died, with the case-fatality ratio of 2.53%. Among the deaths, 47 died from craniocerebral injury, 6 from multiple fractures combined with hemorrhagic shock, 2 from combined injury in the thoraco-abdominal region, and 1 from cervical cord injury. CONCLUSIONS: Nowadays, the patients with traffic trauma are mainly pedestrians, bicyclists and motorcyclists, and they suffer generally from fracture of extremities and craniocerebral injury. The main cause of death is craniocerebral injury. Another characteristic of traffic trauma is that the ratio of multiple injuries is higher.
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A case of acute intercostal pulmonary herniation due to vigorous coughing secondary to chronic bronchitis is reported in a 70-year-old male. Protruding pleura-covered lung tissue was found bulging through an intercostal space defect between the left midaxillary line and the infrasternal costochondral arch. A hernial sac consisting of parietal pleura and atrophic intercostal muscle confined a "sliding pouch" for two pulmonary segments of which one presented a demarcation zone of temporary incarceration interpreted as an entrapment of lung tissue between two ribs. A fracture gap was discovered affecting the anterior synostosis between ribs 7 and 8. Treatment was accomplished by anterior fixation of the ribs and by the basic principles of hernia repair between adjacent ribs. A case report and a brief survey of aetiological and anatomical classification is presented.
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