Search

Delayed hemothorax is a potentially life-threatening complication of thoracic trauma that should be carefully considered in all patients presenting with thoracic injury. We report a case of delayed hemothorax in a 77-year-old male presenting eleven days’ status post multiple right mid- to high-rib fractures. His case was complicated by retained hemothorax after CT-guided chest-tube with subsequent video-assisted tube thoracostomy (VATS) revealing fibrothorax necessitating conversion to open thoracotomy. Known risk factors for development of delayed hemothorax include older patient age, three or more rib fractures, and presence of mid- to high-rib fractures, and should be used in risk stratification of thoracic trauma. Tube thoracostomy is often sufficient in management of delayed hemothorax. In rare cases, hemothoraces can be complicated by retained hemothorax or fibrothorax, which require more invasive therapy and carry greater morbidity and mortality.

Thoracic injury secondary to rib fractures following motor vehicle collisions (MVCs) significantly contribute to morbidity and mortality. While obesity has reached epidemic proportions, little is known regarding how BMI impacts outcomes in MVCs. The aim of this study was to examine how BMI impacts outcomes in MVC patients with rib fractures.The ACS-TQIP Database was utilized to evaluate adult MVC patients with ≥3 rib fractures. Patients with a non-thoracic AIS ≥3 were excluded, to focus on chest injuries. Patients were sorted according to the presence or absence of flail chest injuries and BMI into groups with a low (15), intermediate (15-24), or severe (≥25) ISS.Overweight and obese patients in the non-flail cohort had decreased odds of pneumothorax in all ISS groups (P0.05). Overweight (P = 0.049) and obese (P = 0.011) patients in the low ISS non-flail cohort had decreased odds of splenic laceration. In the non-flail cohort, obese patients with a low and intermediate ISS had decreased odds of pulmonary contusion (P0.01). Obese patients in the low and intermediate ISS non-flail cohorts had increased odds of PE (P0.05). In both the flail and non-flail cohorts, obese patients with an intermediate ISS had decreased odds of liver laceration (P0.05), as well as a longer HLOS, ICU-LOS, and mechanical ventilation time (P0.01).Obesity affects associated injuries, complications, and hospital outcomes in a complex way after MVC related chest wall trauma. Thus, the effect of BMI should be taken into consideration when assessing and treating obese MVC trauma patients.

Background. Motor vehicle accident (MVA) is a global health hazard that results in spinal, thoracic, and abdominal injuries. Detailed studies on the association between MVA-related traumatic spinal injury (TSI) and thoracoabdominal injuries are lacking. This study aims to elucidate the prevalence, pattern of association between these injuries, and related outcomes in terms of in-hospital mortality. Methods. This is a retrospective single-center study of MVA-related TSI with thoracoabdominal associated injuries. Descriptive analysis was performed for gender, age, spinal injury level, thoracoabdominal injury region, admission day, hospital stay duration, and discharge category. The association between TSI and thoracoabdominal injury was analyzed, and the chi-square test was used to test the significance of differences. A statistically significant difference was considered at P values less than 0.05. Results. The cohort had a mean age of 33.6 ± 17.7 years with predominantly more males (85.1%). Thoracoabdominal injuries were present in 10.5% of MVA-related TSIs, and 9.2% of victims died during their hospital stay. There is a significant ( P = 0.045 ) association between the level of the spinal and the region of thoracoabdominal injuries. The presence of TSI-associated thoracic injury significantly ( P = 0.041 ) correlated with increased in-hospital mortality more than abdominal injury. Conclusion. Thoracoabdominal injuries concomitant with MVA-related TSI cause considerable mortality. A pattern of association exists between the level of spinal and region of thoracoabdominal injury. Knowledge of this pattern is helpful in the routine practice of trauma health partitioners.

Despite a lack of consensus recommendations for surgical stabilization of rib fractures (SSRF), SSRF has increased over the past decade. Outcomes of patients with isolated thoracic injuries undergoing SSRF are unknown. We hypothesized adult trauma patients with isolated thoracic injuries and rib fractures undergoing SSRF would have a decreased risk of mortality and in-hospital respiratory complications compared with those not undergoing SSRF.The Trauma Quality Improvement Program (2010-2016) was queried for patients presenting with a rib fracture. Patients who died in the emergency department or within 24-h, as well as those with a grade1 for abbreviated injury scale of the head, face, neck, spine, abdomen, and extremities, were excluded. A multivariable logistic regression analysis was performed.From 60,000 patients with isolated thoracic injuries and rib fractures, 688 (1.1%) underwent SSRF. Compared with patients without SSRF, those undergoing SSRF had a similar median age (P = 0.83) and higher injury severity score (P 0.001). Patients undergoing SSRF had a longer length of stay (P 0.001), higher rate of acute respiratory distress syndrome (P 0.001), unplanned intubation (P 0.001), and pneumonia (P 0.001) but lower rate of mortality (0.9% versus 1.7%, P = 0.084). After adjusting for confounding variables, patients undergoing SSRF had a decreased associated risk of mortality (OR 0.40, P = 0.036) compared with those not undergoing SSRF.The risk of mortality in trauma patients with isolated thoracic injuries and rib fractures is lower when undergoing SSRF despite being associated with a higher rate of respiratory complications during their increased length of stay.

The objective of this study was to evaluate the effects of sex, loading rate, and age on the compressive and tensile material properties of human costal cartilage over a wide range of subject ages and sexes. Cylindrical compression samples and dog-bone shaped tension samples were tested to failure on a material testing system using target strain rates of 0.005 strain/s and 0.5 strain/s. Compression data were obtained from forty (n = 40) subjects (M = 26, F = 14) ranging in age from 11 – 69 years (Avg. = 39.1 ± 18.2 yrs.), and matched loading rate data were obtained for thirty-four (n = 34) samples. Tension data were obtained from forty-one (n = 41) subjects (M = 30, F = 11) ranging in age from 10 – 59 years (Avg. = 32.9 ± 14.9 yrs.), and matched loading rate data were obtained for seventeen (n = 17) samples. For both compression and tension, load and sample deflection data were collected and used to calculate stress and strain. For the compression data, the toe region was fit using a second-order polynomial, and the toe transition stress, toe transition strain, second-order polynomial coefficient A, and second-order polynomial coefficient B were calculated. In addition, the elastic modulus, ultimate stress, ultimate strain, and strain energy density (SED) were also calculated for each test. For the tension data, only the elastic modulus, ultimate stress, ultimate strain, and SED were calculated for each test. There were no effects of sex on the material properties for either method of loading or strain rate. Therefore, male and female data were combined for the age and loading rate analyses. For compression, toe transition stress, toe transition strain, A, elastic modulus, ultimate stress, and SED were all found to be significantly higher at 0.5 strain/s compared to 0.005 strain/s. For tension, no material properties were found to differ with respect to loading rate. Regarding the effects of age, toe transition stress, toe transition strain, A, B, ultimate stress, ultimate strain and SED were found to significantly decrease with advancing age for the 0.005 strain/s compression data. At 0.5 strain/s, toe transition stress, toe transition strain, elastic modulus, ultimate stress, ultimate strain, and SED all significantly decreased with advancing age. For tension, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age at 0.005 strain/s and 0.5 strain/s. Comparing the two loading modes, the ultimate stress, elastic modulus, and SED were significantly higher in compression than in tension. For the compression samples, sample density and percent calcification were also obtained for each sample using physical measurements and micro-CT scans, respectively. However, since there were only a few samples with large calcifications, no meaningful trends were found. This is the first study of its kind to analyze the effects of sex, loading rate, and age on both the compressive and tensile material properties on human costal cartilage from such a wide range of subject ages. The results from this study can be used to develop more accurate finite element models of the human body, which will allow researchers to better evaluate human occupant response and injury risk in motor vehicle collisions for both young and old individuals. Master of Science Serious thorax injuries are often observed in motor vehicle collisions. Although a considerable amount of research has investigated the material and structural properties of rib cortical bone and whole rib sections, only a limited number of studies have focused on characterizing the material properties of costal cartilage, which comprises a substantial portion of the anterior region of the thorax. The studies that do exist include small subject pools and/or are limited to sub-failure indentation tests. Indentation tests are limited to low deflections and focal loading and are unable to obtain the failure material properties of costal cartilage. Therefore, the purpose of this study was to quantify the compressive and tensile material properties of human costal cartilage at two loading rates for a wide range of subject demographics. These properties were then evaluated with respect to sex, loading rate, and age. Cylindrical compression samples and dog-bone shaped tension samples were tested to failure on a material testing system at target strain rates of 0.005 strain/s and 0.5 strain/s. Compression data were obtained from forty (n = 40) subjects ranging in age from 11 – 69 years, and tension data were obtained from twenty-eight (n = 28) subjects ranging in age from 10 – 59 years. For both compression and tension, load and sample deflection data were collected and used to calculate stress and strain. For the compression data, the magnitude and shape of the initial loading region (i.e., the toe region), elastic modulus, ultimate stress, ultimate strain, and strain energy density (SED) were quantified for each test. For the tension data, the elastic modulus, ultimate stress, ultimate strain, and SED were calculated for each test. There were no significant effects of sex on the material properties for either method of loading or strain rate. Therefore, male and female data were combined for the age and loading rate analyses. For compression, the toe region transition point (i.e., stress and strain), toe region shape coefficient A, elastic modulus, ultimate stress, and SED were all found to be significantly higher at 0.5 strain/s compared to 0.005 strain/s. For tension, no material properties were found to differ with respect to loading rate. Regarding the effects of age, toe region transition point (i.e., stress and strain), toe region shape coefficients A and B, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age for the 0.005 strain/s compression data. For the 0.5 strain/s compression data, toe transition stress, toe transition strain, elastic modulus, ultimate stress, ultimate strain, and SED all significantly decreased with age. For tension, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age at 0.005 strain/s and 0.5 strain/s. The ultimate stress, elastic modulus, and SED were higher in compression than in tension. Overall, this is the first study to evaluate the effects of sex, loading rate and age on the compressive and tensile material properties of human costal cartilage from a wide range of ages. These data can be used to assess differences in the response and tolerance of the human rib cage for occupants of various age in motor vehicle collisions.

AIMS: The aim of this study was to explore hospital discharge processes and the self-management of recovery in the early post-discharge period after blunt thoracic injury from a patient perspective.DESIGN: Qualitative interview study.METHODS: Interviews were conducted with participants recruited from 8 sites across England and Wales between November 2019-May 2020. Semi-structured interviews were conducted between 5-8 weeks after hospital discharge, and in total, 14 interviews were undertaken. These interviews were recorded, transcribed and analysed using thematic coding.RESULTS: Three main themes were identified from the analysis: (a) challenges in the discharge process, (b) coping at home after discharge and (c) managing medications at home. Pain was a dominant thread running throughout all themes which represented an important quality and safety concern for all participants. Associated concerns included insufficient preparation and education for hospital discharge, ineffective communication and subsequent unsafe use of opioids at home highlighting unmet patient care needs.

Modern vehicles generally use steel fabricated or alloy blended rims. The manufacturing process and atomic structure of the rim both yield different responses under destructive loading. The aim of this research was to investigate to what extend the type of vehicle rim may influence occupant injury risk.A matched cohort study of frontal German In-Depth Accident Study collisions was devised. The risk of injury to various body regions was compared between vehicles with steel and alloy rims.Occupants in vehicles with alloy rims were at a greater risk of thoracic injury (relative risk [RR] = 1.57; 95% confidence interval [CI], 1.01-2.42) and thoracic abdomen injury (RR = 1.62; 95% CI, 1.10-2.39) at the Maximum Abbreviations Injury Scale (MAIS) 2+ severity. Risk of thoracic injury was greatest for the cluster of occupants seated on the nonimpacted side in frontal collisions (RR = 2.21; 95% CI, 1.01-4.86). MAIS 2+ injury to the head/face/neck yielded no association (RR = 0.98; 95% CI, 0.66-1.47).Alloy rims are more brittle and, as a result, destructive loading is realized with less severe impact. The critical failure increases the amount of loading that needs to be distributed by the restraint system and results in injury.

INTRODUCTION: We aimed to analyze the data of patients who were admitted to our emergency department (ED) because of terrorism-related injuries. MATERIAL AND METHODS: We have retrospectively analyzed the patients who were admitted to a state hospital’s ED with terrorism-related injuries between 01.01.2016 and 01.01.2018. The data about mechanism of injury, injured body part, Abbreviated Injury Scale scores, management, and outcomes: discharge from the ED, hospitalization to the ward, transfer to the operation room and/or intensive care unit, transfer to a tertiary hospital, the length of stay in the hospital, exitus, and re-admission were analyzed. RESULTS: Of the 296 patients admitted, 93.9% were male and 6.1% were female, and 14.2% of the cases were children. Gunshot wounds represented 66.2% of the cases, whereas 33.8% of them had explosion injuries. Overall ED mortality rate was 15.5%. The mortality rate was higher in gunshot wounds. The most affected regions were the extremities, pelvis and external organs. Thorax injuries had the highest rate of mortality. Of the patients, 42.2% were discharged from the ED. The highest rate of ED discharge was with extremities, pelvis and external organ injuries. The ED mortality rate in the pediatric group was 21.4%. Gunshot wounded group had a higher mortality rate. Similar to adults the highest mortality rate was in the thoracic injury group. CONCLUSIONS: Because of the variety of injuries, the management of terrorism victims requires a broad perspective. We think that the ED mortality rate can be used to assess the quality of the critical care provided.

Purpose: The purpose of the study is to analyze the diagnosis and treatment of patients with traumatic chest injuries and traumatic hemopneumothorax in UMHATEM "N. I. Pirogov ". Material and Methods: Data on 113 patients with thoracic trauma were processed within a retrospective clinical analysis for the period of 1.1. 2016 to 1.1. 2018 in the General, Visceral and Emergency Surgery Section of the UMHATEM "Pirogov. Of the hospitalized women are 38 (33.63%), men 75 (66.37%). The age in this retrospective analysis varied from 18 to 83 years (average 57.4 years). Results: In our study, among 113 patients, 43 patients had a pneumothorax, 29 patients were with hemothorax, 18 patients with hemopneumothorax, 2 patients had tension pneumothorax and others 21 had only rib fractures. Associated injuries were confirmed in 43 patients (38.05%). From all patients group, 21 patients were managed conservatively, 89 patients with chest tube insertion and only 3 with thoracotomy. Conclusions: The majority of the patients with a thoracic injury can be performed in emergency surgery by conservative management or by mini-intervention- thoracic chest tube. Tube thoracostomy was evaluated to be important for pleural collections from blunt or penetrating trauma. Therefore it was recommended as a first-line therapeutic approach.

Thoracic endovascular aortic repair (TEVAR) is a life-saving treatment for blunt thoracic aortic injury. We report long-term outcomes of two young patients who underwent TEVAR for blunt thoracic aortic injury with first-generation thoracic stent grafts. The off-label use of the endograft affected the outcomes: one case of open surgery conversion due to an aortoesophageal fistula and one case of endovascular relining for a voluminous pseudoaneurysm associated with a type III endoleak. Long-term follow-up is crucial in TEVAR, especially in case of a first-generation device used in an urgent setting.

Background: The need to evacuate the chest after a penetrating wound was first recognized in the 18th century. Most thoracic injuries are treated with tube thoracostomy (TT) which refers to the insertion of a TT into the pleural cavity to drain air, blood, pus, or other fluids. However, TT has been challenged in the trauma care due to insertional, positional, or infective complications. Methods: A retrospective study of all trauma patients who had TT insertion from 2008 to 2014 was conducted based on the trauma registry data to describe patient characteristics, injury characteristics, management, and outcomes. The complication incidences per TT before (2008) and after (2009–2014) the implementation of standard protocol were compared. Results: During the study period, 804 patients were managed with 1004 TT procedures. The mean age was 34 years, and majority (91%) was males. Motor vehicle crash (43%) was the main mechanism of injury. Mean injury severity score was 22. The rib fractures (68%) were more frequent followed by pneumothorax (49%). Nearly 72% of patients received antibiotic coverage before insertion. The complications developed per TT reduced over the years from 2008 to 2014 (12.6% to 4.4%). The average complication per TT after the protocol implementation (2009–2014) reduced by 7% when compared to the duration before implementation (2008). Conclusions: The present study shows that standardized management of trauma patients who undergo TT results in a reduction in complications, helps improve patient flow, and ensures the proper management of resources in our high-volume trauma center.

Trauma is a common phenomenon in South Africa, with a large proportion of patients suffering from penetrating chest injuries. Occasionally atypical penetrating thoracic injuries require surgical intervention with special considerations. We describe the management of a 15-year-old boy who presented to our trauma unit with a large diameter branch penetrating his left chest above the left clavicle and with the tip lodged in the mediastinum between the great vessels. Pulsatile movement of the foreign body was clearly visible and required careful consideration for the optimal approach and possible complications that may arise. The tract and location of the foreign body made the approach and management of this patient unique and a valuable learning opportunity. A high lateral thoracotomy was done, and the object removed under direct vision. It yielded excellent exposure and proved to be a good alternative approach for certain atypical cases. The boy made a full recovery with no long-term complications.

Zusammenfassung Hintergrund und Fragestellung Im Hinblick auf den Ressourcen- und Ausbildungsbedarf eines Schweizer Traumazentrums wollten wir wissen, wie häufig in der Schwerverletztenversorgung relevante Thoraxverletzungen auftreten und wie oft eine thoraxchirurgische Spezialversorgung notwendig ist. Material und Methoden Retrospektive Analyse aller von 2010 bis 2017 notfallmäßig mit einem Mindesttrauma-NISS (New Injury Severity Score) ≥8 betreuten Patienten bez. relevanter Thoraxverletzung (Abbreviated Injury Scale [AIS] Thorax [ohne Brustwirbelverletzungen] ≥2). Ergebnisse In der 7‑jährigen Beobachtungsperiode wurden 2839 Verletzte mit einem NISS ≥8 notfallmäßig behandelt. Davon erlitten 791 Patienten (27,9 %) eine relevante Thoraxverletzung. Von diesen bedurften 27,1 % (n = 215) eines Thoraxeingriffes, der in 86,5 % (n = 186) allein einer Thoraxdrainage und in 13,5 % (n = 29) einem weitergehenden Eingriff entsprach. Bei 19 der Thoraxverletzten musste darüber hinaus ein Thoraxchirurg gerufen werden, davon 4‑mal sofort und 4‑mal innerhalb von 24 h. Die in unserem Haus im Mittel 30 notfallmäßigen Thoraxdrainageneinlagen pro Jahr ermöglichten 1 bis 2 Eingriffe pro in Ausbildung stehendem Chirurg. Diskussion Im Beobachtungszeitraum benötigten nur 1 % aller relevant Thoraxverletzten eine über eine Pleuradrainage hinausgehende, notfallmäßige thoraxchirurgische Versorgung. Aufgrund dieser geringen Rate erscheint aus Effizienz- wie Kostengründen ein thoraxchirurgischer Präsenzdienst an einem derartigen Traumazentrum nicht angezeigt. Die Fähigkeit der Thoraxdrainageneinlage muss allerdings in der chirurgischen Ausbildung entsprechend vermittelt werden. Die gemäß Facharztausbildungskatalogen notwendigen Mindesteingriffszahlen sollten angesichts der erhobenen Fallzahlen gut erfüllbar sein.

Objective. To study peculiarities of course and diagnosis of traumatic and spontaneous injuries of ductus thoracicus. Маterials and methods. Ten patients, suffering chylothorax, were observed and examined, using thoracoscopy, аnd exudate - using test with sudan ІІІ. Results. In 6 patients the injuries of ductus thoracicus were revealed: in 1 patient - direct, in 1 - iatrogenic, and in 4 - spontaneous. In 4 patients chylothorax presented a symptom of other diseases. Conclusion. Diagnostic-treatment tactics, if the ductus thoracic injury and presence of chylothorax are suspected, ought to be following: analysis of anamnesis - pleural puncture - exudate aspiration - investigation, directed on identification of the malignant tumor cells and mycobacteria of tuberculosis - test with sudan ІІІ - thoracoscopy - pleurobiopsy - histological investigation - final diagnosis - specialized treatment (оperative-conservative).

Previous studies indicate that seatbelts may require supplementary restraints to increase their effectiveness in far-side impacts. This study aimed to evaluate the effectiveness of a novel, far-side-specific airbag in restraining and preventing injuries in far-side impacts, and to evaluate the WorldSID’s response to the presence of a far-side airbag. A series of tests with three Post-Mortem Human Subjects and the WorldSID was conducted in a vehicle-based sled environment equipped with a far-side airbag. Results of these tests were evaluated and compared to a previous test series conducted without the airbag. All of the PMHS retained the shoulder belt on the shoulder. The airbag significantly reduced PMHS injury severity and maximum lateral head excursion. While the WorldSID exhibited a similar decrease in lateral excursion, it was unable to represent PMHS thoracic deflection or injury probability, and it consistently slipped out of the shoulder belt. This indicates that the WorldSID is limited both in its ability to evaluate the effect of changes in the seatbelt system and in its ability to predict thoracic injury risk and assess airbag-related injury mitigation countermeasures.

Background: There is a worldwide increase in the prevalence of assaulted penetrating thoracic and abdominal trauma which may lead to disabilities and death. Aim: To describe the pattern and predictors of outcome in assaulted penetrating thoracic and abdominal trauma. Methods: A two years prospective study was conducted on 123 patients with assaulted penetrating thoracic and abdominal trauma who were admitted to Menoufia University Hospital during the period from the 1st January 2017 to the 31th December 2018. For each case, demographic data, circumstances of trauma were taken. Also, general and local examination of injury was performed and findings in penetrating wounds were reported after investigation and surgical explorations. Outcome of cases either death or survived was determined. Results: Abdominal injuries constituted 58.5% while thoracic injury was presented (31.7%) of cases. The most frequent subjects aged from 20

Trauma in the elderly (>65 years) is an increasingly common presentation to the ED. A fall from standing height is the most common mechanism after which such patients present, and rib fracture is the most common non-spinal fracture. Thoracic injury in patients aged over 65 is associated with significant morbidity and mortality. There are currently no universally applied guidelines for assessment, investigation and management of such patients. In this expert practice review, we discuss the evidence base and options for clinical management in this vulnerable patient group.

Pneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstrated a large right sided pneumothorax with associated punctured right breast implant, a ‘pneumocapsule’ and extensive subcutaneous emphysema of the breast. This case highlights that the fibrous tissue capsule around a breast implant can function as an anatomical space in continuity with the thoracic cavity, masking the diagnosis of pneumothorax in penetrating trauma.

IntroductionFalls cause 75% of trauma in patients above 65 years of age and thoracic trauma is the second commonest injury;rib fractures are the commonest thoracic injury. There is wide variation in care. Older trauma patients are less likely to have trauma assessments. Rib fractures carry up to 12% mortality with up to 31% developing pneumonia.1 The number of fractures correlates with morbidity. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anaesthetists for rib fracture management on a respiratory support unit.MethodsWith Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between Aug 20-Apr 21 were analysed. Descriptive statistical methodology was applied.Results119 patients were identified. Mean age was 71.1 years (range 23–97). 53 were male, 66 female. Mechanism of injury were falls from standing (65), falls down stairs/bed or in the bath (18), ladders (4), cycling (12), assault (3), road accidents (8) and 9 others (for example off horses). LOS was 7.3 days (range 1–54). 85 patients had more than 1 co-morbidity. 26 had a full trauma assessment and 75 had pan CTs. Mean number of rib fractures was 3.6. 31 (26%) had a pneumothorax and/or haemothorax. 18 chest drains were inserted (all small bore) and 1 needle aspiration done. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All had pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. 20 (17%) developed pneumonias.16 (14%) deaths occurred within 30 days (1 heart failure and cancer progression, 2 Covid and 14 pneumonias)- all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality.ConclusionsHigh level care for thoracic trauma can be performed by the respiratory team with analgesia managed by the pain team. 42% of pneumothoraces/haemothoraces were observed. Falls from standing are associated with significant mortality and morbidity. The service is now complemented by a frailty assessment service.Referencehttps://academic.oup.com/ageing/article/49/2/161/5673134

Introduction and importance For many years, thoracotomy has been considered as the standard approach for thoracic injuries. The aim of the current paper is to report a successful use of video assisted thoracoscopic surgery (VATS) as the first line approach for the removal of a bullet retained deep in the lung parenchymal tissue. Case presentation A 46-year-old male presented with a vague pain in the chest at the site of a penetrating bullet injury 26 years prior. Chest and native chest Computed Tomography scan (CT scan) showed a 22 mm foreign body inside the substance of the left lower lobe in the anterior segment. Decision was made to remove the foreign body using VATS. The surgery was performed through an uni-port. The left lower lobe was explored and the foreign body was found within the anterior segment. It was removed and the defect was sutured using Vicryl 2/0. Clinical discussion Although VATS has been established to be an accurate evaluating technique for direct evaluation of the chest wall, lung parenchyma, mediastinum and diaphragm, along with its effectiveness in successfully treating a variety of conditions, its use in thoracic trauma is still not well defined. Conclusion This report supports the use of VATS as an effective and minimally invasive approach in the removal of foreign bodies in lung parenchyma., Highlights • Video-assisted thoracoscopic surgery (VATS) has been suggested as a lessor invasive procedure. • It's use in thoracic trauma remains controversial. • Loss of tactile sensation is a major obstacle. • In this report, removal of a retained bullet in the lung parenchyma using VATS has been discussed.

Severe thoracic injury secondary to penetrating trauma requires prompt resources and rapid decision-making by trauma centers and teams. Implementing trauma systems has significantly impacted medical and critical care quality and outcomes, including managing rare trauma injuries. We describe a report of a rare case of a 21-year-old man with a gunshot wound to the chest with injuries to the right pulmonary hilum requiring pneumonectomy and to the left atrium with bullet embolism to the right common iliac artery. In addition, the systematic approach where each phase of the individual's treatment -- prehospital, emergency room, running room, and intensive care -- was positively affected by the implementation, development, and progressive maturation of a trauma system is also explained.

Bu çalışmada amacımız akciğer yaralanmasının eşlik ettiği ortopedi travma hastalarının; travma etiyolojilerini, demografik özelliklerini, tedavi yaklaşımlarını, morbitide ve mortalite özellikleri analiz etmektir. 2019-2021 tarihleri arasında Mardin Devlet Hastanesi ortopedi ve travmatoloji ile göğüs cerrahisi kliniğinin birlikte takip edip, tedavisini sürdürdüğü politravma hastalarının kayıtları retrospektif olarak tarandı. Hastaların tamamı çoklu kemik kırığı ile birlikte toraks travmasına sahip olup vital fonksiyonları için yoğun bakım ünitesinde takip edilen hastalardan oluşmaktaydı. Beyin cerrahisi veya genel cerrahisi invaziv müdehalesi ihtiyacı olan hastalar çalışma dışında bırakıldı. Hastaların demografik özellikleri, travma etiyolojileri, etkilenen vücut bölümü, hastanın toraks etkilenme biçimi, kırık özellikleri, uygulanan tedavi ve zamanı, yatış süresi, komplikasyonlar, mortalite özellikleri ve radyolojik verileri hastane bilgi işlem veri tabanından kayıt edildi. Elde edilen verilerin istatistiksel analizi yapıldı. Çalışmaya 40 hasta dahil edildi. Hastaların %72.5’i (n=29) erkek, yaş ortancası 36.5(14-85) yıl idi. Hastaların ortanca yoğun bakım yatış süresi 11.5(2-70) gün idi. Hastalar %57.5 (n=23)’i trafik kazası, %40 (n=16)’ı yüksekten düşme ve %2.5’i (n=1) ise ateşli silah-patlayıcı yaralanmasından oluşmaktaydı. Hastaların %27.5 (n=11)’i beyin cerrahisi, %10 (n=4)’u genel cerrahi patolojileri içermekte idi. En sık skapula kırığı eşlik etmekte idi. Hastaların %30 (n=12)’unda pnömotoraks, %30 (n=12) hastada hemotoraks ve %55 (n=22) hastada da en az bir kot kırığı bulunmaktaydı. Pnömotoraks eşlik etmesi hastaların mortalitesini 1.8 kat (%95 GA: 1.717-1997) artırmaktayken, hemotoraks eşlik etmesinin mortaliteyi 1.9 kat (%95 GA:1.797-2.061) arttırdığı saptandı. Hastaların %67.5 (n=27)’i hasar koruyucu cerrahi ve %32.5 (n=13)’i konservatif tedavi ile takibi yapıldı. İki grup arasında mortalite açısından istatistiksel fark bulunmadı. Toraks yaralanmasının eşlik ettiği kırık hastalarının mortalitesi yüksektir. Cerrahi planlanan hastalara hasar koruyucu cerrahi ilkelerin ışığında tedavi sürdürülmesi sağ kalımı artırabilmektedir., In this study, our aim is to analyze the etiologies, demographic characteristics, treatment approaches, morbidity and mortality characteristics of orthopedic trauma patients accompanied by lung injury. The records of polytrauma patients who were followed up and treated in Mardin State Hospital by orthopedics and traumatology and thoracic surgery clinic between 2019-2021 were retrospectively reviewed. All of the patients had thoracic trauma with multiple bone fractures and were followed in the intensive care unit for their vital functions. Patients who needed neurosurgery or general surgery invasive intervention were excluded from the study. Demographic characteristics of the patients, trauma etiology, affected body part, the way they are affected by the patient's thorax, fractured features, treatment, and time, duration of hospitalization, complications, and Radiological characteristics of the transaction information from the data base hospital mortality data were recorded. Statistical analysis of the obtained data was performed. 40 patients were included in the study. The median age was 36.5 (14-85) years and 72.5% (n=29) of the patients were male. The median hospitalization time of the patients was 11.5(2-70) days. Patients consisted of 57.5% (n=23) from a traffic accident, 40% (n=16) from a high fall, and 2.5% (n=1) from a firearm-explosive injury. 27.5% (n=11) of the patients included neurosurgery, 10% (n=4) included general surgery pathologies. The most common fracture of the scapula was found in the entire group of patients. 30% (n=12) of the patients had pneumothorax, 30% (n=12) had hemothorax, and 55% (n=22) had at least one denim fracture. Concomitant pneumothorax increased the mortality of patients by 1.8 times (%95 CI: 1.717-1997), while concomitant hemothorax increased mortality by 1.9 times (%95 CI:1.797-2.061). 67.5% (n=27) of the patients were followed up with damage-preserving surgery and 32.5% (n=13) with conservative treatment. There was no statistical difference in mortality between the two groups. The mortality of fracture patients accompanied by thoracic injury is high. Maintaining treatment in the light of surgical principles that protect against damage to patients scheduled for surgery can improve survival.

Background and Aims Evaluate the referral of rib fracture patients to anaesthetics/acute pain team/physiotherapy & Critical Care Outreach Team (CCOT) Pain management and use of regional techniques for these patients Offered PCA within first 24 hours Early physiotherapy – as soon as pain is controlled Early regional analgesia CCOT referral if mortality risk is high or NEWS >7 Methods Retrospective audit over the year 2019 at the QEHKL 80 patients coded as having a primary diagnosis of rib fractures – given Pressley Risk & Easter severity score. 29 patients scored moderate/moderate and above, 25 patients’ paper notes were available – first 72 hours of admission was audited Results Not achieving standard of care at 3 days Specialty input: Within 72 hours 80% had anaesthetics + physio reviews 5 patients weren’t reviewed by any external teams All high risk of mortality patients are not getting a CCOT referral Pain management: 40% received PCA within 24 hours At 72 hours 64% of patients had a regional technique/PCA Regional techniques used were serratus anterior/erector spinae or thoracic epidural catheters. They were left in for an average of 4.4 days. Conclusions Presented audit at information governance and teaching sessions for medical/surgical and A+E juniors Guideline revised with focus on regional anaesthesia TIPTOP Implementation: 1) Refer high risk thoracic injury patients to anaesthetic/acute pain team. 2) Book patient onto emergency theatre booking system 3) TIPTOP proforma to be completed by acute pain team/anaesthetist to ensure follow up & standardised care Re–audit in 6 months time

Introduction: Trauma is one of the most common causes of death in low- and middle-income countries, with thoracic injury accounting for 20–25% of these deaths worldwide. The current management of a life-threatening pre-hospital pneumothorax is with a needle chest decompression, however, definitive care for a pneumothorax and/or haemothorax is still the insertion of an intercostal chest drain. The aim of this study was to seek expert opinion and consensus on the placement of ICDs in the pre-hospital emergency care setting in South Africa. Methods: A three-round modified Delphi study was undertaken with an expert panel drawn from local emergency care experts consisting of physicians and emergency medical service practitioners. Participants supplied opinion statements in round 1 under headings derived from common emerging themes found in the literature. During round 2 participants used a 9-point Likert scale to rate their consensus on each statement and in round 3 they were able to change their position based on the earlier panel distributions. A consensus percentage of 60% was set within a narrow margin of ‘strongly agree’ or ‘strongly disagree’. Results: A total of 22 experts took part as panel members. There were 123 opinion statements produced from round 1, of which 21 (17%) reached consensus in round 2. At the end of round 3 another four statements reached consensus, bringing the total up to 25 (20%). Conclusion: Definitive care of a life-threating pneumothorax and/or haemothorax must be sought emergently. The insertion of an ICD, under select conditions, may be required in the pre-hospital setting in South Africa. Keywords: Pre-hospital, Intercostal chest drain, Pneumothorax, Haemothorax

Background Aged people all over the world are prone to fall down accidentally and be injured with fracture, such as the rib fracture. To protect the elderly, the safety vest has been developed to protect them from being injured when falling down. To effectively protect the elderly, more analysis on the protective capacity of a safety vest under different situation are needed. Results Herein, a finite element model based on the computed tomography CT scanning data of a Chinese old female was built, and then used to simulate the process of falling down at different velocities. Analysis and comparison were done on the maximum shear stress, kinetic energy curves and internal energy curves with and without safety vest. The maximum shear stress indicated that the Abbreviated Injury Scale (AIS) 2+ injury risks of rib were 8%, 100% and 100% at the velocities of 1.5 m/s, 2.0 m/s and 2.5 m/s, respectively. The corresponding risks were lowered to 0%, 0% and 60% by the vest, respectively. Furthermore, the vest could absorb the internal energy resulted by the deformation of the thoracic osseous tissue by about 20%, thus decreasing the shear stress and the injury risk. Conclusion It is concluded that the safety vest decreases the injury risk when the elderly fall down, thus protects them from being injured.

Background Traumatic spinal cord injury (TSCI) is one of the most devastating injuries that has a physical impact on patients. The CHORDATA® method involves suspension and pendulous exercises and has been clinically used to treat patients with TSCI. Although empirically used to treat neurological patients, there is no scientific evidence of the efficacy of this method. Purpose To evaluate the chronic effects of CHORDATA® method on torque, muscle activation, muscle thickness, and functionality in patients with traumatic spinal cord injury. Methods Twenty-six male patients with medullar thoracic injury were randomly categorised into two groups: intervention group (n = 14) and control group (n = 12). Rehabilitation program comprised of 16 sessions of body suspension and pendulum exercises (twice/week). The maximal voluntary isometric trunk flexion and extension torques, muscle activation and thickness (external and internal oblique, rectus and transversus abdominis, longissimus, and multifidus muscles), and functionality (adapted reach test) were evaluated before and after of rehabilitation program. Findings A significant increase was observed in maximal voluntary isometric torque (flexion, 58%; extension, 76%), muscle activation of the rectus abdominis muscle, and muscle thickness of all intervention group muscles, without changes in the control group. Compared to the pre-intervention period, the intervention group also showed improvement in functionality at post-intervention, but no such differences were noted in the control group. Interpretation The corporal suspension and pendulum exercises training improved rectus abdominis muscle activation, trunk muscles structure and strength, and reaching capacity in medullar thoracic injury patients.

Rib fractures are the most common form of blunt thoracic injury. Multiple rib fractures are an important indicator of trauma severity, with increased morbidity and mortality occurring with increasing numbers of rib fractures, especially in the elderly. Thoracic cage injuries may be associated with concomitant and potentially life-threating injuries. In the acute setting, correct recognition of the pattern, extent and severity of thoracic cage injuries, may aid in more accurate delineation of concomitant injuries.

Impalement injuries are rare and among the most spectacular and dramatic traumatic injuries especially of the chest. The survival of a patient with a thoracic impalement injury can be extremely rare. Herein we present and discuss our successes of the management of 7 rare cases of thoracic impalement injuries over a 5-year period from January 2014 to June 2019 at the Komfo Anokye Teaching Hospital, Kumasi in Ghana. We discuss the presentation, diagnosis, treatment and outcomes of the seven cases encountered.

Context: Minor thoracic injury causes non-negligible pain that could reduce the cough capacity and can cause infectious problems and atelectasis. Objectives: To describe the association between atelectasis and cough capacity, and to assess the concordance of cough capacity perceptions between health professionals and the patient. Design:The data were collected from 2006 to 2012 in 4 Canadian emergency departments (ED). Participants: Patients with a chief complaint of minor thoracic injury, ≥ 16 years old, discharged home from the ED after an evaluation by the attending physician, were included. They have three visits, at the ED, 7-day and 14-day follow-up. The initial ED visit included medical evaluation, data collection and mandatory chest and rib radiography. Main outcome measures: The presence of atelectasis was noted at the initial ED and subsequent visits.Participants cough capacity was noted by a physician, a nurse and the patients himself at subsequentvisits and classified as good, diminished, weak /absent.Results: Among the 1474 patients, 8.89% (95% CI: 7.55 - 10.47), 7.33% (95% CI: 6.04 – 8.89) and 4.63% (95% CI: 3.51 – 6.09) had atelectasis at the initial visit, 7-day and 14-day follow-up visit respectively. Except for patients with weak or absent cough capacity at the 7-day visit, which had a 2.89 (95%CI: 2.05 – 4.05) folds atelectasis proportion relative to those with a good cough capacity, they were no associations between cough capacity and atelectasis. The weighted kappa coefficient suggests a moderate to substantial agreement between the cough capacity measured by patients and nurses (0.52 to 0.65).Conclusion: There was not strong evidence of an association between atelectasis and cough capacity and the best agreement between cough capacity perception was between nurses and patients.

A method to evaluate the effectiveness of wearable airbag protectors for motorcyclists is proposed in this work. The mitigation of thoracic injury severity in relevant accident conditions was inves...

Background: The most common thoracic injury in children, resulting in trauma, is pulmonary contusion (PC). Bone marrow–derived mesenchymal stem cells (BM-MSCs) are used in wound healing and many other diseases. This study aims to examine the effects of BM-MSCs on PC healing in rats. Materials and methods: A total of 45 male Wistar albino rats were used. Four groups were formed. BM-MSCs were labeled with the green fluorescent protein. PC was observed in the control group. In group II, PC occured and left to spontaneous healing. In group III, PC formed and BM-MSCs were given. In group IV, BM-MSCs were given without PC formation. Subjects were sacrificed 1 week later. Whether there was any difference in terms of BM-MSC involvement and lung injury score was investigated. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 17.0, software (SPSS Inc., Chicago, IL), and p value of

OBJECTIVE To investigate the relationship between the prevalence of cardiopulmonary resuscitation (CPR) related thoracic injury and patients' thoracic volume and dimensions. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey, from August 2015 to August 2019. METHODOLOGY Patients, who were in hospital due to a non-traumatic cause, had experienced cardiac arrest and subsequently had a post-CPR thorax tomography, were included in the study. Thorax dimensions were measured on sagittal, transverse, and longitudinal axes, while thorax volumes were calculated using a 3D computer programme. This data was later compared to trauma findings. RESULTS A total of 246 patients were included in the study. The sagittal measurements ranged from 130 - 302 mm, with an average of 228.42 ± 25.61 mm; the transverse measurements ranged from 160-293 mm, average 238.60 ± 22.25 mm, and longitudinal measurements ranged from 99-259 mm, average 187.94 ± 29.76 mm; while thorax volumes were between 4670 - 21512 cc, with an average of 10118.19 ± 2438.01 cc. Trauma was present in 34.1% of patients. Sagittal, longitudinal dimensions, and thorax volume were lower for the group positive for trauma compared to the non-trauma group (p=0.019, p=0.023 and p=0.002). Thorax volume and longitudinal dimensions were found to be lower in patients who experienced rib fractures (p=0.021, p

ObjectivesIn the UK, 20% of patients with severe traumatic brain injury (TBI) receive prehospital emergency anaesthesia (PHEA). Current guidance recommends an end-tidal carbon dioxide (ETCO2) of 4.0–4.5 kPa (30.0–33.8 mm Hg) to achieve a low-normal arterial partial pressure of CO2 (PaCO2), and reduce secondary brain injury. This recommendation assumes a 0.5 kPa (3.8 mm Hg) ETCO2–PaCO2 gradient. However, the gradient in the acute phase of TBI is unknown. The primary aim was to report the ETCO2–PaCO2 gradient of TBI patients at hospital arrival.MethodsA retrospective cohort study of adult patients with serious TBI, who received a PHEA by a prehospital critical care team in the East of England between 1 April 2015 and 31 December 2017. Linear regression was performed to test for correlation and reported as R-squared (R2). A Bland-Altman plot was used to test for paired ETCO2 and PaCO2 agreement and reported with 95% CI. ETCO2–PaCO2 gradient data were compared with a two-tailed, unpaired, t-test.Results107 patients were eligible for inclusion. Sixty-seven patients did not receive a PaCO2 sample within 30 min of hospital arrival and were therefore excluded. Forty patients had complete data and were included in the final analysis; per protocol. The mean ETCO2–PaCO2 gradient was 1.7 (±1.0) kPa (12.8 mm Hg), with moderate correlation (R2=0.23, p=0.002). The Bland-Altman bias was 1.7 (95% CI 1.4 to 2.0) kPa with upper and lower limits of agreement of 3.6 (95% CI 3.0 to 4.1) kPa and −0.2 (95% CI −0.8 to 0.3) kPa, respectively. There was no evidence of a larger gradient in more severe TBI (p=0.29). There was no significant gradient correlation in patients with a coexisting serious thoracic injury (R2=0.13, p=0.10), and this cohort had a larger ETCO2–PaCO2 gradient, 2.0 (±1.1) kPa (15.1 mm Hg), p=0.01. Patients who underwent prehospital arterial blood sampling had an arrival PaCO2 of 4.7 (±0.2) kPa (35.1 mm Hg).ConclusionThere is only moderate correlation of ETCO2 and PaCO2 at hospital arrival in patients with serious TBI. The mean ETCO2–PaCO2 gradient was 1.7 (±1.0) kPa (12.8 mm Hg). Lower ETCO2 targets than previously recommended may be safe and appropriate, and there may be a role for prehospital PaCO2 measurement.

This study evaluates the effect of combined epidural electrical stimulation (EES) applied above (C5) and below (L2) the spinal cord injury (SCI) at T8&ndash, 9 combined with motor training on the restoration of sensorimotor function in mini pigs. The motor evoked potentials (MEP) induced by EES applied at C5 and L2 levels were recorded in soleus muscles before and two weeks after SCI. EES treatment started two weeks after SCI and continued for 6 weeks led to improvement in multiple metrics, including behavioral, electrophysiological, and joint kinematics outcomes. In control animals after SCI a multiphasic M-response was observed during M/H-response testing, while animals received EES-enable training demonstrated the restoration of the M-response and H-reflex, although at a lower amplitude. The joint kinematic and assessment with Porcine Thoracic Injury Behavior scale (PTIBS) motor recovery scale demonstrated improvement in animals that received EES-enable training compared to animals with no treatment. The positive effect of two-level (cervical and lumbar) epidural electrical stimulation on functional restoration in mini pigs following spinal cord contusion injury in mini pigs could be related with facilitation of spinal circuitry at both levels and activation of multisegmental coordination. This approach can be taken as a basis for the future development of neuromodulation and neurorehabilitation therapy for patients with spinal cord injury.

With respect to the resource and training requirements of a Swiss trauma center, we wanted to know how frequently relevant thoracic injuries occur and how often specialized thoracic surgery is needed.Retrospective analysis of all severely injured patients with a new injury severity score (NISS) ≥8 from 2010-2017 with respect to relevant thoracic injuries (abbreviated injury scale, AIS thorax without thoracic vertebral injuries ≥2).In the 7‑year observational period 2839 patients with NISS ≥8 were treated as an emergency. Of these 791 (27.9%) suffered a relevant injury in the thoracic region and 27.1% (n = 215) of them required a thoracic intervention, which in 86.5% (n = 186) corresponded to a thoracic drainage only and in 13.5% (n = 29) to an extended intervention. In 19 cases following relevant thoracic injury, a thoracic surgeon was also required, 4 times immediately and 4 times within 24 h of hospital arrival. On average, 30 emergency thoracic drainage insertions per year corresponded to 1-2 interventions per surgeon in training.In the observational period only 1% of all relevant thoracic injuries required emergency thoracic surgical care beyond a pleural drainage. Given this low rate, for efficiency and cost reasons a thoracic surgery on-call service appears to be appropriate and compulsory attendance is not needed; however, the capability to insert a thoracic drainage must be appropriately assured by surgical training. In view of the number of cases observed per trainee, the minimum number of interventions required according to specialty training regulations should be well achievable.HINTERGRUND UND FRAGESTELLUNG: Im Hinblick auf den Ressourcen- und Ausbildungsbedarf eines Schweizer Traumazentrums wollten wir wissen, wie häufig in der Schwerverletztenversorgung relevante Thoraxverletzungen auftreten und wie oft eine thoraxchirurgische Spezialversorgung notwendig ist.Retrospektive Analyse aller von 2010 bis 2017 notfallmäßig mit einem Mindesttrauma-NISS (New Injury Severity Score) ≥8 betreuten Patienten bez. relevanter Thoraxverletzung (Abbreviated Injury Scale [AIS] Thorax [ohne Brustwirbelverletzungen] ≥2).In der 7‑jährigen Beobachtungsperiode wurden 2839 Verletzte mit einem NISS ≥8 notfallmäßig behandelt. Davon erlitten 791 Patienten (27,9 %) eine relevante Thoraxverletzung. Von diesen bedurften 27,1 % (n = 215) eines Thoraxeingriffes, der in 86,5 % (n = 186) allein einer Thoraxdrainage und in 13,5 % (n = 29) einem weitergehenden Eingriff entsprach. Bei 19 der Thoraxverletzten musste darüber hinaus ein Thoraxchirurg gerufen werden, davon 4‑mal sofort und 4‑mal innerhalb von 24 h. Die in unserem Haus im Mittel 30 notfallmäßigen Thoraxdrainageneinlagen pro Jahr ermöglichten 1 bis 2 Eingriffe pro in Ausbildung stehendem Chirurg.Im Beobachtungszeitraum benötigten nur 1 % aller relevant Thoraxverletzten eine über eine Pleuradrainage hinausgehende, notfallmäßige thoraxchirurgische Versorgung. Aufgrund dieser geringen Rate erscheint aus Effizienz- wie Kostengründen ein thoraxchirurgischer Präsenzdienst an einem derartigen Traumazentrum nicht angezeigt. Die Fähigkeit der Thoraxdrainageneinlage muss allerdings in der chirurgischen Ausbildung entsprechend vermittelt werden. Die gemäß Facharztausbildungskatalogen notwendigen Mindesteingriffszahlen sollten angesichts der erhobenen Fallzahlen gut erfüllbar sein.

Purpose Pediatric thoracic trauma differs from those of adult in terms of the small anatomy and rapid tissue recovery. Therefore, it is important to know the characteristics of the pediatric thoracic trauma to improve treatment results. In addition, this study examined the changes in pediatric thoracic trauma features and results from the establishment of a level 1 regional trauma center. Methods Data of 168 patients’ ≤ 15 years old diagnosed with thoracic trauma between 2008 and 2019 were retrospectively analyzed. Results Pedestrian traffic accidents were the most common cause of chest injury. The average injury severity score was 17.1 ± 12.4 and the average pediatric trauma score was 5.6 ± 4.1. Lung contusion was the most common in 134 cases. There were 48 cases of closed thoracostomy. There was one thoracotomy for cardiac laceration, one case for extracorporeal membranous oxygenation, and six cases for embolization. Of all, 25 patients died, providing a mortality rate of 14.9%. In addition, independent risk factors of in-hospital mortality were hemopneumothorax and cardiac contusion. Since 2014, when the level 1 regional trauma center was established, more severely injured thoracic trauma patients came. However, the mortality was similar in the two periods. Conclusions Understanding the clinical features of pediatric thoracic trauma patients can help in efficient treatment. In addition, as the severity of pediatric thoracic trauma patients has increased due to the establishment of the regional trauma center, so pediatric trauma center should be organized in regional trauma center to improve the outcomes of pediatric thoracic trauma.

Rib fracture is closely related to thoracic injury with high morbidity and mortality. This study aimed to investigate the clinical effect of Zhang ZhiFei (ZZF) zoning method on the selection of incision and approach in minimally invasive surgery for rib fracture. A total of 110 patients with rib fractures from July 2017 to July 2019 were enrolled in the study. Preoperative computed tomography and three-dimensional reconstruction of ribs was performed. Then, the rib fractures to be surgically fixed were divided into costal cartilage zone, chest zone, lateral costal zone, high posterior costal zone, low posterior costal subscapular zone, and low posterior costal paraspinal zone, which was called ZZF zoning method. Rib fractures in each zone had unique minimally invasive incision approach, and the open reduction and internal fixation of rib fracture was performed under minimally invasive surgery of corresponding small incision. The average incision length and number of incisions of the 110 patients were 6.2 cm and 1.3, respectively. The average number of internal fixation was 5.3 and the average operation time was 82 min. The postoperative fracture end was well aligned. After 3 months of follow-up, no internal fixation was displaced or detached. Based on the anatomical characteristics of different zones of the chest wall, ZZF zoning method provides a new idea and reference for the selection of incision and approach in minimally invasive internal fixation for rib fracture.

Background: In polytrauma (PT) patients, osseous thoracic injuries are commonly observed. One of the most severe injuries is the flail chest where the rib cage is broken in such a way that leads to a partial functional detachment of the thoracic wall. Especially in PT patients, the integrity of the respiratory system and especially, of the respiratory muscles is essential to prevent respiratory failure. Besides conservative treatment options, flail chest injuries may be surgically stabilized. However, this treatment option is rarely carried out and evidence on the outcome of surgically treated flail chest patients is rare. Objective: This study intends to investigate the clinical outcome of PT patients with the diagnosis of a flail chest who received an osteosynthetic stabilization for that compared to the same group of patients without an operative treatment. The between-groups outcome was compared regarding the duration of the total hospital and the intensive care unit (ICU) stay, the total of the invasive ventilation days, the incidence of pneumonia, and the dosage of the pain medication at the hospital discharge. Methods: A retrospective analysis was conducted including all PT patients who received an osteosynthetic stabilization of a flail chest. Furthermore, another cohort of PT patients and the diagnosis of a flail chest but without operative treatment was determined. Both groups were case-control matched for the Injury Severity Score (ISS) and age. Further statistical analysis was performed using the Wilcoxon signed-rank test and the McNemar&rsquo, s test. Results: Out of eleven operatively and 59 conservatively treated patients, eleven patients per group were matched. Further analysis revealed no significant differences in the normal ward treatment duration (5.64 &plusmn, 6.62 and 6.20 &plusmn, 5.85 days), the invasive ventilation duration (was 6.25 &plusmn, 7.17 and 7.10 &plusmn, 6.14 days), the morphine equivalent dosage of the oral analgesia (61.36 &plusmn, 67.23 mg and 39.67 &plusmn, 65.65 mg), and the pneumonia incidence (36.4 and 54.5%) when conservatively and operatively treated patients were compared, respectively. However, surgically treated patients had a longer ICU (25.18 &plusmn, 14.48 and 15.27 &plusmn, 12.10 days, Z = &minus, 2.308, p = 0.021) and a longer total hospital treatment duration (30.10 &plusmn, 13.01 and 20.91 &plusmn, 10.34 days, Z = &minus, 2.807, p = 0.005) when compared to conservatively treated patients. Conclusion: In the present study cohort, there was no outcome difference between conservatively and operatively treated patients with the diagnosis of a flail chest regarding the normal ward treatment duration, the invasive ventilation duration, the morphine equivalent dosage of the oral analgesia, and the pneumonia incidence while ICU treatment duration and hospital treatment duration was longer in operatively treated patients.

Road Traffic Accidents (RTA) constitute a significant health problem. They constitute the 8th leading cause of death. The aim of this study was to analyse road traffic accidents in Tirupati city and find out the pattern of injuries in drivers who were victims of fatal road traffic accidents. This retrospective study was conducted at the Department of Forensic medicine, S.V Medical College, Tirupati during period 2016 to 2018. Specific findings regarding the injuries sustained to the drivers were noted. A total of 904 people were killed in RTA and were brought to the morgue for postmortem examination. Out of all victims 170 (18.80%) were drivers. Most common age group involved was 30 – 39 yrs. Most of the drivers were males. Polytrauma with lower limb injuries accounted for most common injury in drivers (40.35%) followed by head injury (19.29%) and thoracic injury (12.28%). This study has shown the vulnerability of the vehicle drivers to fatal injuries during RTA. Hence, there is a need for road safety awareness, usage of seat belts, strict enforcement of laws, maintaining vehicle fitness etc. to protect the vulnerable group of people, to decrease the associated morbidity, mortality and reduce the economic burden to the society/ country at large.

Background: In polytrauma (PT) patients, osseous thoracic injuries are commonly observed. One of the most severe injuries is the flail chest where the rib cage is broken in such a way that leads to a partial functional detachment of the thoracic wall. Especially in PT patients, the integrity of the respiratory system and especially, of the respiratory muscles is essential to prevent respiratory failure. Besides conservative treatment options, flail chest injuries may be surgically stabilized. However, this treatment option is rarely carried out and evidence on the outcome of surgically treated flail chest patients is rare. Objective: This study intends to investigate the clinical outcome of PT patients with the diagnosis of a flail chest who received an osteosynthetic stabilization for that compared to the same group of patients without an operative treatment. The between-groups outcome was compared regarding the duration of the total hospital and the intensive care unit (ICU) stay, the total of the invasive ventilation days, the incidence of pneumonia, and the dosage of the pain medication at the hospital discharge. Methods: A retrospective analysis was conducted including all PT patients who received an osteosynthetic stabilization of a flail chest. Furthermore, another cohort of PT patients and the diagnosis of a flail chest but without operative treatment was determined. Both groups were case-control matched for the Injury Severity Score (ISS) and age. Further statistical analysis was performed using the Wilcoxon signed-rank test and the McNemar’s test. Results: Out of eleven operatively and 59 conservatively treated patients, eleven patients per group were matched. Further analysis revealed no significant differences in the normal ward treatment duration (5.64 ± 6.62 and 6.20 ± 5.85 days), the invasive ventilation duration (was 6.25 ± 7.17 and 7.10 ± 6.14 days), the morphine equivalent dosage of the oral analgesia (61.36 ± 67.23 mg and 39.67 ± 65.65 mg), and the pneumonia incidence (36.4 and 54.5%) when conservatively and operatively treated patients were compared, respectively. However, surgically treated patients had a longer ICU (25.18 ± 14.48 and 15.27 ± 12.10 days, Z = −2.308, p = 0.021) and a longer total hospital treatment duration (30.10 ± 13.01 and 20.91 ± 10.34 days, Z = −2.807, p = 0.005) when compared to conservatively treated patients. Conclusion: In the present study cohort, there was no outcome difference between conservatively and operatively treated patients with the diagnosis of a flail chest regarding the normal ward treatment duration, the invasive ventilation duration, the morphine equivalent dosage of the oral analgesia, and the pneumonia incidence while ICU treatment duration and hospital treatment duration was longer in operatively treated patients.

Background Penetrating thoracic injuries are uncommon in childhood. Massive penetrating injury due to impalement is even more rare and has scarcely been reported. It has a dramatic clinical presentation and is often fatal, depending on the organs injured. Case presentation Two boys presented with an unusual mechanism of injury. They fell from a height to be impaled by a large stick. Appropriate emergency medical service was not available and surgery was delayed by more than 24 h after the accident. Both children were labelled “lucky” as they survived the injury without any significant sequelae. Conclusion We discuss two new cases of pediatric thoracic impalement and perform the first literature review on the subject. Emphasis should be given to the initial care which comprises avoiding premature removal, rapid transport, resuscitation, anti-tetanus and antibiotics. All reported cases had a favorable outcome, even those managed within the constraints of low-income countries.

Introduction Penetrating thoracic injuries are a common presentation in Emergency Departments in South Africa with pneumothorax, haemothorax and haemopneumothorax (PTX/HTX/HPTX) a cause of morbidity and mortality. Serial chest X-rays (CXRs) are used to assess patients with penetrating thoracic injury without PTX/HTX/HPTX on initial CXR in order to increase sensitivity and thus detection of PTX/HTX/HPTX. This study aimed to assess the utility of serial CXRs to detect a delayed presentation of PTX/HTX/HPTX following penetrating thoracic injury. Methods This retrospective observational study analysed data from Helen Joseph Hospital Emergency Department, Johannesburg, South Africa for patients presenting with penetrating thoracic injury over a 2-year period for whom the initial CXR was negative for a PTX/HTX/HPTX to determine the utility of serial CXRs for detection of a delayed presentation of PTX/HTX/HPTX. Results 118 patients, the majority of which had penetrating trauma secondary to a stab wound, were included in the study. Eight (7%) had a PTX/HTX/HPTX detected on subsequent investigation. Three (3%) patients with normal initial CXRs and three (3%) patients with abnormal initial CXRs had a PTX/HPX/HPTX detected on serial CXRs. Two (2%) delayed presentations of PTX/HTX/HPTX were noted on computerised tomography (CT) scan only. Six patients had an intercostal drain (ICD) inserted and were admitted; 2 patients (those with PTX/HTX/HPTX noted on CT only) were managed conservatively. Three patients (3%) had an ICD inserted to manage a delayed presentation of PTX/HTX/HPTX with a normal initial CXR. Discussion Only 3% of patients with normal initial CXRs required intervention. Conclusions It is recommended that patients for whom the presentation CXR shows an abnormality undergo serial CXRs. Given the low incidence of PTX/HTX/HPTX in patients with a normal presentation CXR, along with the resource implications of serial CXRs, it may be prudent to discharge patients with thorough counselling and advice to return for review if warranted.

Several studies, available in the literature, were conducted to establish the most relevant criterion for predicting the thoracic injury risk on the THOR dummy. The criteria, such as the maximum deflection or a combination of parameters including the difference between the chest right and left deflections, were all developed based on given samples of Post Mortem Human Subject (PMHS). However, they were not validated against independent data and they are not always consistent with the observations from field data analysis. For this reason, 8 additional PMHS and matching THOR tests were carried out to assess the ability of the criteria to predict risks. Accident investigations showed that a reduction of the belt loads reduces the risk of rib fractures. Two configurations with different levels of force limitation were therefore chosen. A configuration representing an average European vehicle was chosen as a reference. It consists of a 3-point belt with a 3.5 kN and then 2 kN digressive limiter, combined with a 54-liter airbag. For better reproducibility and durability, the tests were performed with a pre-inflated bag and a semi-rigid seat. In this first configuration, the THOR dummy had a maximum resulting deflection of 43 mm. To differentiate the criteria, the second configuration was chosen such that it resulted in about the same deflection on the THOR dummy, but with a 5 kN belt force limitation combined with a lower pressure airbag. To reach this target of 43 mm, the pulse severity was lowered. Some criteria were higher in this second configuration, which allows them to be distinguished from the maximum deflection criterion. Four tests on four PMHS were performed in each configuration. The injury assessments showed that the total number of fractures was almost the same in both configurations, but that the number of separated fractures was greater in the 5 kN configuration. 25% of the subjects sustained AIS >3 injuries related to the number of displaced fractures in the 3.5/2 kN load limitation configuration. The result increased to 75% in the 5kN configuration. In total, 8 PMHS and the matching THOR tests were performed and used to assess the ability of the thoracic criteria to predict rib fractures in 2 types of chest loading configurations. The test results did not allow to conclude on the relevance of the criteria measured on the THOR dummy for the total number of rib fractures identified at autopsy (NFR). However, clearly different assessments for separated rib fractures (NSFR), make it possible to differentiate the criteria. The maximum resultant deflection failed to properly predict separated rib fractures while other criteria that include the left-to-right rib deflection difference did.

Bean bag guns were developed as a nonlethal means for law enforcement personnel to subdue individuals. The large surface area and lower velocities of the bean bag round theoretically result in transfer of most of the energy to the skin/subcutaneous tissue and minimize the likelihood of dermal penetration, thereby ‘stunning’ intended victims without causing injury to deeper structures. However, this technology has been associated with significant intra-abdominal and intrathoracic injuries, skin penetration and death. We present a 59-year-old man who sustained a penetrating thoracic injury from a bean bag gun. Although the bean bag was successfully removed, the patient developed a postoperative empyema requiring operative management. We discuss the unique aspects of thoracic trauma from bean bag ballistics as well as considerations in management of patients with this uncommon mechanism of injury.