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Journal of Trauma and Injury 2013;26(3):170-174.
Comparison of Rib Fracture Location for Morbidity and Mortality in Flail Chest
Chun Sung Byun, Il Hwan Park, Geum Suk Bae, Pil Yeong Jeong, Joong Hwan Oh
1Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital, Korea. nicecs@yonsei.ac.kr
2Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital, Korea.
3Department of General Surgery, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital, Korea.
늑골 골절의 위치가 동요흉의 이환율 및 사망률에 미치는 요인
변천성1,2, 박일환1,2, 배금석1,3, 정필영1,3, 오중환1,2
연세대학교 원주의과대학 원주세브란스기독병원 1중증외상센터, 2흉부외과학교실, 3일반외과학교실
Received: 8 July 2013   • Revised: 8 August 2013   • Accepted: 2 September 2013
Abstract
PURPOSE
A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality.
METHODS
Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups.
RESULTS
Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was 19.08+/-10.57. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related morbidity (p=0.369) or mortality (p=0.189).
CONCLUSION
An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.
Key Words: Trauma; Rib fracture; Flail chest
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