14 results on '"Thoracic Wall injuries"'
Search Results
2. Flail Chest.
- Author
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Hu Z and Wang B
- Subjects
- Humans, Tomography, X-Ray Computed, Accidents, Traffic, Open Fracture Reduction, Fracture Fixation, Internal, Thoracic Wall diagnostic imaging, Thoracic Wall injuries, Intubation, Intratracheal, Flail Chest diagnosis, Flail Chest etiology, Flail Chest therapy, Rib Fractures complications, Rib Fractures diagnosis, Rib Fractures surgery, Sternum diagnostic imaging, Sternum injuries, Sternum surgery
- Published
- 2024
- Full Text
- View/download PDF
3. Large Penetrating Wounds to the Chest Managed With Immediate Chest Wall Reconstruction Using Biologic Mesh, Titanium Plates, and Rotational Tissue Flaps.
- Author
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Shillinglaw JP, Nonnemacher CJ, and Christie DB 3rd
- Subjects
- Humans, Male, Adult, Wounds, Penetrating surgery, Middle Aged, Female, Surgical Mesh, Titanium, Bone Plates, Thoracic Wall surgery, Thoracic Wall injuries, Surgical Flaps, Plastic Surgery Procedures methods, Thoracic Injuries surgery
- Abstract
Large open chest wall wounds can be difficult to manage due to full-thickness tissue loss with underlying rib fractures and exposed lung parenchyma. Historically, the use of synthetic material has been discouraged in the traumatic setting with the concern that it may be associated with an increased risk of infection. We present 4 patients with large open injuries to the thorax-one from blunt and three from penetrating trauma. We describe our initial management followed by prompt surgical repair using biologic mesh, titanium rib spanning plates, and rotational tissue flaps with Z-plasty of the skin for definite closure. All patients did well post-operatively without complications or wound infections. With the appropriate management, we suspect there may be an advantage in performing immediate reconstruction and closure in large open thoracic injuries utilizing biologic mesh and titanium rib spanning plates with a lower risk of infection than previously believed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
- Full Text
- View/download PDF
4. Pectoralis Muscle Index as Predictor of Outcomes in Patients With Severe Blunt Chest Wall Injury.
- Author
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Wakefield CJ, Baucom M, Sisak S, Seder CW, and Janowak CF
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Adult, Sarcopenia diagnosis, Sarcopenia etiology, Length of Stay statistics & numerical data, Tomography, X-Ray Computed, Rib Fractures diagnosis, Rib Fractures complications, Aged, Intensive Care Units statistics & numerical data, Pectoralis Muscles injuries, Pectoralis Muscles diagnostic imaging, Wounds, Nonpenetrating complications, Wounds, Nonpenetrating therapy, Wounds, Nonpenetrating diagnosis, Thoracic Injuries complications, Thoracic Injuries diagnosis, Thoracic Injuries therapy, Thoracic Wall diagnostic imaging, Thoracic Wall injuries, Respiration, Artificial statistics & numerical data
- Abstract
Introduction: Sarcopenia has been shown to portend worse outcomes in injured patients; however, little is known about the impact of thoracic muscle wasting on outcomes of patients with chest wall injury. We hypothesized that reduced pectoralis muscle mass is associated with poor outcomes in patients with severe blunt chest wall injury., Methods: All patients admitted to the intensive care unit between 2014 and 2019 with blunt chest wall injury requiring mechanical ventilation were retrospectively identified. Blunt chest wall injury was defined as the presence of one or more rib fractures as a result of blunt injury mechanism. Exclusion criteria included lack of admission computed tomography imaging, penetrating trauma, <18 y of age, and primary neurologic injury. Thoracic musculature was assessed by measuring pectoralis muscle cross-sectional area (cm
2 ) that was obtained at the fourth thoracic vertebral level using Slice-O-Matic software. The area was then divided by the patient height in meters2 to calculate pectoralis muscle index (PMI) (cm2 /m2 ). Patients were divided into two groups, 1) the lowest gender-specific quartile of PMI and 2) second-fourth gender-specific PMI quartiles for comparative analysis., Results: One hundred fifty-three patients met the inclusion criteria with a median (interquartile range) age 48 y (34-60), body mass index of 30.1 kg/m2 (24.9-34.6), and rib score of 3.0 (2.0-4.0). Seventy-five percent of patients (116/153) were male. Fourteen patients (8%) had prior history of chronic lung disease. Median (IQR) intensive care unit length-of-stay and duration of mechanical ventilation (MV) was 18.0 d (13.0-25.0) and 15.0 d (10.0-21.0), respectively. Seventy-three patients (48%) underwent tracheostomy and nine patients (6%) expired during hospitalization. On multivariate linear regression, reduced pectoralis muscle mass was associated with increased MV duration when adjusting for rib score and injury severity score (β 5.98, 95% confidence interval 1.28-10.68, P = 0.013)., Conclusions: Reduced pectoralis muscle mass is associated with increased duration of MV in patients with severe blunt chest wall injury. Knowledge of this can help guide future research and risk stratification of critically ill chest wall injury patients., (Published by Elsevier Inc.)- Published
- 2024
- Full Text
- View/download PDF
5. Favourable outcome in survivors of CPR-related chest wall injuries.
- Author
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Al Nouh M, Caragounis EC, Rossi Norrlund R, and Fagevik Olsén M
- Subjects
- Humans, Male, Female, Cross-Sectional Studies, Middle Aged, Aged, Survivors, Adult, Thoracic Injuries physiopathology, Thoracic Injuries complications, Fracture Healing physiology, Flail Chest etiology, Flail Chest physiopathology, Sternum injuries, Sternum diagnostic imaging, Cardiopulmonary Resuscitation adverse effects, Thoracic Wall injuries, Thoracic Wall physiopathology, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest physiopathology, Rib Fractures physiopathology, Rib Fractures etiology, Quality of Life, Tomography, X-Ray Computed
- Abstract
Background: There is a lack of studies focusing on long-term chest function after chest wall injury due to cardiopulmonary resuscitation (CPR). The purpose of this cross-sectional study was to investigate long-term pain, lung function, physical function, and fracture healing after manual or mechanical CPR and in patients with and without flail chest., Methods: Patients experiencing out-of-hospital cardiac arrest between 2013 and 2020 and transported to Sahlgrenska University Hospital were identified. Survivors who had undergone a computed tomography (CT) showing chest wall injury were contacted. Thirty-five patients answered a questionnaire regarding pain, physical function, and quality of life and 25 also attended a clinical examination to measure the respiratory and physical functions 3.9 (SD 1.7, min 2-max 8) years after the CPR. In addition, 22 patients underwent an additional CT scan to evaluate fracture healing., Results: The initial CT showed bilateral rib fractures in all but one patient and sternum fracture in 69 %. At the time of the follow-up none of the patients had persistent pain, however, two patients were experiencing local discomfort in the chest wall. Lung function and thoracic expansion were significantly lower compared to reference values (FVC 14 %, FEV1 18 %, PEF 10 % and thoracic expansion 63 %) (p < 0.05). Three of the patients had remaining unhealed injuries. Patients who had received mechanical CPR in additional to manual CPR had a lower peak expiratory flow (80 vs 98 % of predicted values) (p=0.030) =0.030) and those having flail chest had less range of motion in the thoracic spine (84 vs 127 % of predicted) (p = 0.019) otherwise the results were similar between the groups., Conclusion: None of the survivors had long-term pain after CPR-related chest wall injuries. Despite decreased lower lung function and thoracic expansion, most patients had no limitations in physical mobility. Only minor differences were seen after manual vs. mechanical CPR or with and without flail chest., Competing Interests: Declaration of competing interest The authors declare no competing interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
- Full Text
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6. Post-traumatic cholecystocutaneous fistula of the thoracic wall.
- Author
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Gómez-Gago AM, de Las Heras-Marqués B, Hernández-Escobar F, and Quero-Valenzuela F
- Subjects
- Humans, Male, Gallbladder Diseases complications, Gallbladder Diseases etiology, Gallbladder Diseases diagnostic imaging, Thoracic Injuries complications, Adult, Cutaneous Fistula etiology, Thoracic Wall injuries, Biliary Fistula etiology, Biliary Fistula surgery, Biliary Fistula diagnostic imaging
- Published
- 2024
- Full Text
- View/download PDF
7. Blunt mechanism chest wall injury: initial patient assessment and acute care priorities.
- Author
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Baker E, Battle C, and Lee G
- Subjects
- Humans, Thoracic Wall injuries, Emergency Nursing, United Kingdom, Emergency Service, Hospital, Nursing Assessment, Wounds, Nonpenetrating nursing, Thoracic Injuries nursing, Thoracic Injuries therapy
- Abstract
Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)
- Published
- 2024
- Full Text
- View/download PDF
8. Incidence of surgical rib fixation at chest wall injury society collaborative centers and a guide for expected number of cases (CWIS-CC1).
- Author
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Eriksson EA, Wijffels MME, Kaye A, Forrester JD, Moutinho M, Majerick S, Bauman ZM, Janowak CF, Patel B, Wullschleger M, Clevenger L, Van Lieshout EMM, Tung J, Woodfall M, Hill TR, White TW, and Doben AR
- Subjects
- Humans, Male, Female, Middle Aged, Retrospective Studies, Adult, Incidence, Aged, Thoracic Wall injuries, Thoracic Wall surgery, Adolescent, Thoracic Injuries surgery, Thoracic Injuries epidemiology, Length of Stay statistics & numerical data, Societies, Medical, Young Adult, Fracture Fixation methods, Fracture Fixation statistics & numerical data, Rib Fractures surgery, Rib Fractures epidemiology, Trauma Centers, Injury Severity Score, Registries
- Abstract
Purpose: Surgical stabilization of rib fractures (SSRF) improves outcomes in certain patient populations. The Chest Wall Injury Society (CWIS) began a new initiative to recognize centers who epitomize their mission as CWIS Collaborative Centers (CWIS-CC). We sought to describe incidence and epidemiology of SSRF at our institutions., Methods: A retrospective registry evaluation of all patients (age > 15 years) treated at international trauma centers from 1/1/20 to 7/30/2021 was performed. Variables included: age, gender, mechanism of injury, injury severity score, abbreviated injury severity score (AIS), emergency department disposition, length of stay, presence of rib/sternal fractures, and surgical stabilization of rib/sternal fractures. Classification and regression tree analysis (CART) was used for analysis., Results: Data were collected from 9 centers, 26,084 patient encounters. Rib fractures were present in 24% (n = 6294). Overall, 2% of all patients underwent SSRF and 8% of patients with rib fractures underwent SSRF. CART analysis of SSRF by AIS-Chest demonstrated a difference in management by age group. AIS-Chest 3 had an SSRF rate of 3.7, 7.3, and 12.9% based on the age ranges (16-19; 80-110), (20-49; 70-79), and (50-69), respectively (p = 0.003). AIS-Chest > 3 demonstrated an SSRF rate of 9.6, 23.3, and 39.3% for age ranges (16-39; 90-99), (40-49; 80-89), and (50-79), respectively (p = 0.001)., Conclusion: Anticipated rate of SSRF can be calculated based on number of rib fractures, AIS-Chest, and age. The disproportionate rate of SSRF in patients age 50-69 with AIS-Chest 3 and age 50-79 with AIS-Chest > 3 should be further investigated, as lower frequency of SSRF in the other age ranges may lead to care inequalities., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
- Published
- 2024
- Full Text
- View/download PDF
9. Additional Outcomes and Limitations in the Treatment of Acute Unstable Chest Wall Injuries.
- Author
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Slowey C, Divito A, and Goeddel L
- Subjects
- Humans, Thoracic Wall surgery, Thoracic Wall injuries, Thoracic Injuries surgery, Rib Fractures
- Published
- 2023
- Full Text
- View/download PDF
10. Additional Outcomes and Limitations in the Treatment of Acute Unstable Chest Wall Injuries.
- Author
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Forrester JD, Eriksson EA, and Pieracci FM
- Subjects
- Humans, Thoracic Wall surgery, Thoracic Wall injuries, Thoracic Injuries surgery, Rib Fractures
- Published
- 2023
- Full Text
- View/download PDF
11. Primary Lung Hernia After Blunt Chest Trauma: Chest Wall Repair Strategies.
- Author
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Belyayev LA, Parker WJ, Madha ES, Jessie EM, and Bradley MJ
- Subjects
- Humans, Lung Diseases etiology, Lung Diseases surgery, Thoracic Wall injuries, Thoracic Wall surgery, Tomography, X-Ray Computed, Hernia etiology, Herniorrhaphy methods, Thoracic Injuries complications, Thoracic Injuries surgery, Wounds, Nonpenetrating complications, Wounds, Nonpenetrating surgery
- Abstract
Lung herniation is a rare pathology seen after trauma. A case of acquired lung hernia is presented after blunt thoracic trauma that was repaired primarily. Surgical management and decision-making for this process are discussed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2023
- Full Text
- View/download PDF
12. Blunt chest wall trauma: Rib fractures and associated injuries.
- Author
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Beloy V and Dull M
- Subjects
- Humans, Pain Management, Retrospective Studies, Rib Fractures therapy, Rib Fractures surgery, Thoracic Wall injuries, Thoracic Wall surgery, Thoracic Injuries surgery, Wounds, Nonpenetrating complications
- Abstract
Abstract: Blunt injuries to the chest wall, specifically those related to rib fractures, need to be promptly identified and effectively managed to reduce patient morbidity and mortality. Furthermore, judicious use of multimodal pain management and early identification of patients who will benefit from the surgical stabilization of rib fractures are paramount to optimal outcomes., (Copyright © 2022 American Academy of Physician Associates.)
- Published
- 2022
- Full Text
- View/download PDF
13. Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor.
- Author
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Elgar G, Smiley A, and Latifi R
- Subjects
- Adult, Aged, Female, Hospital Mortality, Hospitals, Humans, Injury Severity Score, Length of Stay, Male, Middle Aged, Retrospective Studies, Risk Factors, Thoracic Injuries epidemiology, Thoracic Wall injuries, Wounds, Nonpenetrating
- Abstract
Background: Blunt thoracic trauma is responsible for 35% of trauma-related deaths in the United States and significantly contributes to morbidity and healthcare-related financial strain. The goal of this study was to evaluate factors influencing mortality in patients emergently admitted with the primary diagnosis of blunt chest wall trauma. Methods: Adults emergently admitted for blunt chest trauma were assessed using the National Inpatient Sample Database, 2004-2014. Data regarding demographics, comorbidities, and outcomes were collected. Relationships were determined using univariable and multivariable logistic regression models. Results: In total, 1120 adult and 1038 elderly patients emergently admitted with blunt chest trauma were assessed; 46.3% were female, and 53.6% were male. The average ages of adult and elderly patients were 46.6 and 78.9 years, respectively. Elderly and adult patients both displayed mortality rates of 1%. The regression model showed HLOS and several comorbidities as the main risk factors of mortality Every additional day of hospitalization increased the odds of mortality by 9% (OR = 1.09, 95% CI = 1.01-1.18, p = 0.033). Mortality and liver disease were significantly associated (OR = 8.36, 95% CI = 2.23-31.37, p = 0.002). Respiratory disease and mortality rates demonstrated robust correlations (OR = 7.46, 95% CI = 1.63-34.11, p = 0.010). Trauma, burns, and poisons were associated with increased mortality (OR = 3.72, 95% CI = 1.18-11.71, p = 0.025). The presence of platelet/white blood cell disease correlated to higher mortality. (OR = 4.42, 95% CI = 1.09-17.91, p = 0.038).
- Published
- 2022
- Full Text
- View/download PDF
14. Improving Blunt Chest Wall Injury Outcomes: Introducing the PIC Score.
- Author
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Terry SM, Shoff KA, and Sharrah ML
- Subjects
- Humans, Injury Severity Score, Length of Stay, Retrospective Studies, Rib Fractures diagnosis, Rib Fractures therapy, Thoracic Injuries diagnosis, Thoracic Injuries therapy, Thoracic Wall injuries, Wounds, Nonpenetrating diagnosis, Wounds, Nonpenetrating therapy
- Abstract
Background: To improve care for nonintubated blunt chest wall injury patients, our Level I trauma center developed a treatment protocol and a pulmonary evaluation tool named "PIC Protocol" and "PIC Score," emphasizing continual assessment of pain, incentive spirometry, and cough ability., Objective: The primary objective was to reduce unplanned intensive care unit admissions for blunt chest wall injury patients using the PIC Protocol and the PIC Score. Additional outcomes included intensive care unit length of stay, ventilator days, length of hospital stay, inhospital mortality, and discharge destination., Methods: This was a retrospective cohort study comparing outcomes of rib fracture patients treated at our facility 2 years prior to (control group) and 2 years following PIC Protocol use (PIC group). The protocol included admission screening, a power plan order set, the PIC Score patient assessment tool, in-room communication board, and patient education brochure. Outcomes were compared using independent-samples t tests for continuous variables and Pearson's χ2 for categorical variables with α set to p < .05., Results: There were 1,036 patients in the study (control = 501; PIC = 535). Demographics and injury severity were similar between groups. Unanticipated escalations of care for acute pulmonary distress were reduced from 3% (15/501) in the control group to 0.37% (2/535) in the PIC group and were predicted by a preceding fall in the PIC Score of 3 points over the previous 8-hr shift, marking pulmonary decline by an acutely falling PIC Score., Conclusions: The PIC Protocol and the PIC Score are easy-to-use, cost-effective tools for guiding care of blunt chest wall injury patients., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Society of Trauma Nurses.)
- Published
- 2021
- Full Text
- View/download PDF
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