ABSTRACT
OBJECTIVES: Conservative management of patients with flail chest is the treatment of choice. Rib fracture repair is technically challenging; however, with the advent of specially designed molding titanium clips, surgical management has been simplified. Surgical stabilization has been used with good outcomes. We are reporting on our institutional matched-case-control study. METHODS: Between April 2010 and April 2011, ten polytraumatized patients undergoing rib stabilization for flail chest were matched 1 : 1 to 10 control patients by age ±10 years, sex, neurological or vertebral trauma, abdominal injury, and arm and leg fractures. Surgery was realized in the first 48 hours. RESULTS: There were no significant differences between groups for matched data and prognostic scores: injury severity score, revised trauma score, and trauma injury severity score. Ventilator time (142 ± 224 versus 74 ± 125 hours, P = 0.026) and overall hospital stay (142 ± 224 versus 74 ± 125 hours, P = 0.026) were significantly lower for the surgical group after adjustment on prognostic scores. There was a trend towards shorter ICU stay for operative patients (12.3 ± 8.5 versus 9.0 ± 4.3 days, P = 0.076). CONCLUSIONS: Rib fixation with Stracos is feasible and decreases the length of ventilation and hospital stay. A multicenter randomized study is warranted so as to confirm these results and to evaluate impact on pulmonary function status, pain, and quality of life.
Subject(s)
Bone Plates/statistics & numerical data , Flail Chest/surgery , Length of Stay/statistics & numerical data , Ventilators, Mechanical/statistics & numerical data , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Multiple Trauma/therapy , Treatment OutcomeSubject(s)
Cardiac Surgical Procedures/methods , Heart Neoplasms/diagnosis , Lipoma/diagnosis , Pericardium , Aged, 80 and over , Diagnosis, Differential , Echocardiography, Transesophageal , Follow-Up Studies , Heart Neoplasms/surgery , Humans , Lipoma/surgery , Male , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
Traumatic aortic valve rupture is an extremely rare complication of non-penetrating cardiac injury, and may be caused by a tear or avulsion of the cusp or commissure. Transesophageal echocardiography represents the most important tool for evaluating the nature and extent of such traumatic lesions. The case is reported of a 74-year-old male who had sustained a non-penetrating chest injury in a motor vehicle accident, and suffered from aortic regurgitation as a result of rupture of the normal aortic valve. A primary valve repair was performed using an autologous pericardium patch.