1/75. Injury to the first rib synchondrosis in a rugby footballer.Injuries to the first rib synchondrosis are uncommon in sport. The potential for serious complications following posterior displacement is similar to that seen with posterior sternoclavicular joint dislocation. Clinical examination and plain radiography may not provide a definitive diagnosis. Computerised tomography is the most appropriate imaging modality if this injury is suspected. Posterior dislocation of the first rib costal cartilage with an associated fracture of the posterior sternal aspect of the synchondrosis has not been previously reported.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/75. Incarcerated postraumatic intercostal lung hernia. Case report and review of the literature.Traumatic lung hernia is a rare diagnosis. A 52-year-old female motorvehicle passenger was admitted as a trauma patient after a motorvehicle accident. She was found to have an incarcerated lung hernia. Size of the hernia, incarceration and respiratory insufficiency mandated immediate surgical intervention with reposition, drainage and stabilisation of the chest wall. The postoperative course was uneventful. The management of the patient is discussed and the available literature reviewed.- - - - - - - - - - ranking = 0.21094145137988keywords = lung (Clic here for more details about this article) |
3/75. rib fractures in infants: red alert! The clinical features, investigations and child protection outcomes.OBJECTIVE: To examine clinical features, investigation methods and outcomes of infants with rib fractures. METHODOLOGY: All infants aged 2 years or younger who presented over a 5-year period with documented rib fractures were identified from the medical records database of a tertiary referral paediatric hospital and data collected by retrospective chart review. Additional data regarding notifications and placements were obtained from the Department of Families Youth and Community Care, queensland. RESULTS: rib fractures were attributed to child abuse in 15 of 18 infants identified. The initial presentation in the abused infants was most often as a result of intracranial pathology and limb fractures. In four cases the rib fractures were incidental findings when abuse had not been suspected. Bone scintigraphy revealed eight previously undetected rib injuries in four cases. In three cases of abuse, the rib fractures were an isolated finding. Three of the infants with inflicted rib injuries were discharged home. In one such infant a significant re-injury occurred. Three returned home with implicated adults no longer in residence, and nine spent a mean period of 12 months in foster care. CONCLUSIONS: rib fractures in infancy are usually caused by severe physical abuse. Accidental rib fractures are rare in infants and result from massive trauma. rib fractures, multiple or single, may occur in isolation in abused infants. The implications of such injuries must be recognized to ensure appropriate, safe and consistent child protection outcomes. Bone scintigraphy is more sensitive than radiographs in the detection of acute rib fractures and should be performed in all cases of suspected infant abuse.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
4/75. Lung isolation for the prevention of air embolism in penetrating lung trauma. A case report.PURPOSE: To illustrate a new airway and ventilatory management strategy for patients with unilateral penetrating lung injury. Emphasis is placed on avoiding positive pressure ventilation (PPV)-induced systemic air/gas embolism (SAE) through traumatic bronchiole-pulmonary venous fistulas. CLINICAL FEATURES: A 14-yr-old male, stabbed in the left chest, presented with hypovolemia, left hemopneumothorax, an equivocal acute abdomen, and no cardiac or neurological injury. In view of the risk of SAE, we did not ventilate the left lung until any fistulas, if present, had been excised. After pre-oxygenation, general anesthesia was induced and a left-sided double-lumen tube (DLT) was placed to allow right-lung ventilation. bronchoscopy was performed. The surgeons performed a thorascopic wedge resection of the lacerated lingula. Upon completion of the repair, two-lung ventilation was instituted while the ECG, pulse oximetry, PETCO2, and blood pressure were monitored. Peak inflation pressure was increased slowly and was well tolerated up to 50 cm H2O. The patient's intravascular status was maintained normal. CONCLUSION: patients with lung trauma are at risk of developing SAE when their lungs are ventilated with PPV. In a unilateral case, expectant non-ventilation of the injured lung until after repair is recommended.- - - - - - - - - - ranking = 12.117675705698keywords = lung injury, injury, lung (Clic here for more details about this article) |
5/75. Thoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma.BACKGROUND AND OBJECTIVES: The need for continual neurological assessment in patients with lumbar spinal injury poses a challenge for effective management of pain associated with multiple fractured ribs. Two cases are presented to illustrate the benefits of using thoracic paravertebral block to control the pain of multiple fractured ribs without compromising the ongoing neurological assessment. CASE REPORT: Thoracic paravertebral block was used in 2 patients with concomitant multiple fractured ribs and lumbar spinal injury. Case 2 also had a head injury and there was moderate coagulopathy. The thoracic paravertebral catheter was placed in the upper thoracic region and radiological imaging was used to delineate spread before the injection of relatively small volumes (10 to 15 mL) of local anesthetic. In case 1, the thoracic paravertebral block produced ipsilateral segmental thoracic anesthesia, providing excellent pain relief for the fractured ribs. It also spared the lumbar and sacral nerve roots, preserving neurological function in the lower extremities and bladder sensation. In case 2, effective analgesia without systemic sedation and opioids resulted in the patient regaining consciousness, which allowed continuous assessment of central and peripheral neurological function. CONCLUSION: Thoracic paravertebral block is an option for managing pain associated with multiple fractured ribs in the presence of concomitant lumbar spinal injury requiring continual neurological assessment.- - - - - - - - - - ranking = 4keywords = injury (Clic here for more details about this article) |
6/75. Horizontal gradient in ventilation distribution due to a localized chest wall abnormality.Horizontal gradients in the distribution of ventilation and of regional vital capacities, as well as a reversed vertical, esophageal pressure gradient, were observed in a patient with a unilateral painful chest wall lesion. The distribution abnormalities disappeared after surgical treatment. These findings suggest that the interdependency between chest wall and lungs, and within the latter, between lobes, is an important factor determining the regional distribution of ventilation and the pleural pressure gradient in man.- - - - - - - - - - ranking = 0.035156908563313keywords = lung (Clic here for more details about this article) |
7/75. mitral valve plasty for mitral regurgitation after blunt chest trauma.A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.- - - - - - - - - - ranking = 0.035156908563313keywords = lung (Clic here for more details about this article) |
8/75. Operative stabilization of a flail chest six years after injury.We report a case of operative stabilization of an incompetent upper chest wall 6 years following flail chest. The indications for stabilization were chronic pain and dyspnea associated with rib malunion and loss of hemithorax volume. At operation, multiple pseudoarthroses were encountered and partial resection of ribs three and four was required. Malleable plates were used to bridge the gaps created by the resection and were secured in place with sternal wire. The patient reported a dramatic relief of symptoms and, at 18 months postoperatively, continues to work full-time on his cattle ranch essentially pain-free.- - - - - - - - - - ranking = 4keywords = injury (Clic here for more details about this article) |
9/75. Suicidal nonfatal impalement injury of the thorax.We treated an impalement injury of the thorax resulting from a suicide attempt in the form of a road traffic accident. The patient survived and was discharged 5 weeks after his injury. The surgical management of thoracic impalement injuries and the rationale behind a multidisciplinary approach are discussed.- - - - - - - - - - ranking = 6keywords = injury (Clic here for more details about this article) |
10/75. Reactivation of pulmonary tuberculosis due to trauma.A 53-year-old man developed pulmonary tuberculosis, presumably reactivation, with ten days of sustaining multiple fractured ribs. Tuberculous bronchopneumonia developed in the right lung adjacent to the site of injury and spread to the contralateral lung. sputum smears were positive for acid-fast bacilli three weeks after trauma. Theories for the reactivation of pulmonary tuberculosis secondary to trauma are reviewed.- - - - - - - - - - ranking = 1.0703138171266keywords = injury, lung (Clic here for more details about this article) |
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