1/69. Isolated fracture of the ventricular septum after blunt chest trauma.Isolated rupture of of the ventricular septum after blunt chest trauma is a very rare traumatic affection. A 21-year-old man was admitted to our hospital because of blunt chest trauma and a forearm fracture. Initial echocardiography did not show any intracardiac or extracardiac pathologic lesions, but 12 hours later this examination was repeated because of the onset of a holosystolic murmur. An unusual traumatic rupture of the ventricular septum was demonstrated. The hemodynamically stable condition of the patient allowed surgical repair to be performed 3 months later.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/69. Fourteen shots for a suicide.A 56-year-old man is discovered unconscious in a pool of blood in the kitchen of his house. According to findings, the man used a 22 long Rifle to fire 14 shots at his thorax with trajectories going from front to back, from right to left and on a nearly horizontal level. All the projectiles got into the left front side of his thorax and came out just under the back of his left armpit. One of them then got through his left arm and fractured his left humerus. According to the findings made on the premises and the position of the bloodstains, we think that man put his rifle against the wall, resting on a pipe. He fired, unloading two clips into his thorax. He had to handle the bolt of the rifle before each shot. To reload, he took the bullets which were on the nearby table on which blood marks can be seen. When reloading at a certain moment, he sat down in his armchair and when he wanted to stand up, he leaned on the armrests, on which blood marks can be seen. The last bullet was probably the one which went through his left arm, preventing him from keeping on shooting. His death, caused by a hypovolemical shock, was obviously very slow.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
3/69. Blunt trauma with flail chest and penetrating aortic injury.Blunt chest trauma with flail chest is common. The mortality attributes initially to the associated pulmonary contusion, massive hemothorax and later to the occurrence of adult respiratory distress syndrome. We report a case of flail chest with segmental fractures near the costovertebral junction and delayed hemothorax attacked 14 h later. The final diagnosis of the penetrating aortic injury by detached rib fragment was appreciated by aortogram. Unfortunately, active aortic hemorrhage made prompt thoracotomy in vain for life salvage.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
4/69. Characteristics of child abuse by anteroposterior manual compression versus cardiopulmonary resuscitation: case reports.Lethal and sublethal injuries to infants caused by anteroposterior manual compression can be accompanied by lateral rib fractures, hemorrhage into the viscera, and when severe, rupture of large vessels and solid organs. Abusers may claim that these injuries were sustained in an attempt to perform cardiopulmonary resuscitation (CPR). The difference between injuries caused by CPR and injuries caused by inflicted anteroposterior compression is examined in one sublethal and two lethal cases.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
5/69. Delayed presentation of traumatic left-sided diaphragmatic avulsion. A case report.We describe the case of a 35-year-old man who had suffered a severe multitrauma with blunt thoracic injury, left scapula and humerus fractures 5 years earlier. At the time of the trauma, a diaphragmatic lesion went unnoticed. Five years later, the patient had a 24-h history of increasingly severe abdominal pain with repeated vomiting. Helical CT showed a portion of the left hemidiaphragm avulsed from its insertions on the ribs with large-bowel loop obstruction herniated in the left hemithorax. The preoperative CT diagnosis was confirmed by surgery: reduction of the hernia and reinsertion of the hemidiaphragm to the lumbocostal arch were performed.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
6/69. Bronchial repair with pulmonary preservation for severe blunt trauma.After a motorcycle accident, a 22-year-old male was diagnosed with multiple rib fractures, left-sided tension pneumothorax, hemothorax and left upper lobe bronchus rupture at its origin. An emergency left thoracotomy revealed an almost complete avulsion of the upper lobe bronchus from the main stem bronchus, a severely damaged pulmonary artery, and a concurrent deep intraparenchymal lower lobe laceration. Since the patient was hemodynamically stable, a decision was made to preserve as much lung as possible. In the event of complex pulmonary trauma, pulmonary preservation is desirable since emergency pneumonectomy is usually associated with high mortality. Early bronchoscopic assessment, careful anesthetic management, and meticulous surgical technique with liberal use of fibrin glue were crucial to successful outcome.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
7/69. Extrapericardial cardiac tamponade caused by traumatic retrosternal hematoma.cardiac tamponade is an uncommon complication of blunt chest trauma, resulting typically from hemorrhage into the pericardial space. We report a case of hemodynamic compromise secondary to an extrapericardial compression caused by the acute formation of a retrosternal hematoma associated with a sternal fracture. The patient was involved in a violent deceleration accident. Initially, he only complained of an anterior thoracic pain, but subsequently became restless, pale, and dyspneic. A severe hypotension associated with sinus bradycardia (45 bpm) rapidly occurred. Both jugular veins became markedly turgescent, but no significant pulsus paradoxus was noted. echocardiography disclosed a large hematoma, compressing anteriorly both the right ventricular cavity and outflow tract. Surgical evacuation of the retrosternal hematoma related to a bifocal fracture of the manubrium was followed by instantaneous hemodynamic improvement. Regional extrapericardial tamponade secondary to the acute formation of compressive retrosternal hematoma is an unusual cause of circulatory failure after severe blunt chest trauma. Since conventional clinical signs associated with typical tamponade physiology may be lacking in this setting, echocardiography is ideally suited for early recognition of this unusual condition.- - - - - - - - - - ranking = 0.4keywords = fracture (Clic here for more details about this article) |
8/69. Unusual cardiac injury following blunt chest trauma.Cardiac injury following blunt chest trauma is known to occur, but traumatic rupture of ventricular septum is a rare injury, especially following blunt chest trauma. A case of a 20-year-old male is presented who fell on his back from a 9th-floor window and was resuscitated for 3 hours to no avail. Post-mortem examination confirmed a fracture of the pelvis, pulmonary contusion and rupture of ventricular septum of the heart.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
9/69. Subclavian arterial injury associated with blunt trauma.Blunt subclavian artery trauma is an uncommon but challenging surgical problem. The purpose of this study was to retrospectively review the management of blunt subclavian artery injuries treated by the Trauma and Vascular Surgery Services at the East tennessee State University-affiliated hospitals between 1992 and 1998. Six patients with seven blunt subclavian artery injuries were identified. Physical signs indicating blunt subclavian artery injury were pain or contusion around the shoulder joint; fractures of the clavicle, scapula, or ribs; periclavicular hematomas; and ipsilateral pulse or neurologic deficits. Seven subclavian artery injuries were treated-two arterial transections, two pseudoaneurysms, and three intimal dissections. Associated injuries included four clavicle fractures, one humerus fracture, one combined rib and scapular fractures, and two pneumothoraxes. Vascular surgical treatment included three primary arterial repairs, two saphenous vein interposition grafts, and one polytetrafluoroethylene (PTFE) graft. One patient was treated nonoperatively with anticoagulation. No deaths occurred. morbidity occurred in two patients with chronic upper extremity neuropathy producing prolonged disability from pain and weakness; one patient had reflex sympathetic dystrophy, and the other had a brachial plexus injury. In conclusion, blunt subclavian artery trauma can be successfully managed with early use of arteriography and prompt surgical correction by a variety of vascular techniques. Vascular morbidity is usually low, but long-term disability because of chronic neuropathy may result from associated brachial plexus nerve injury despite a successful arterial repair.- - - - - - - - - - ranking = 0.8keywords = fracture (Clic here for more details about this article) |
10/69. Facial fractures and related injuries: a ten-year retrospective analysis.A retrospective analysis of 828 patients with significant midface or mandibular fractures was undertaken to illustrate the multisystem nature of traumatic injuries associated with fracture of the facial skeleton, covering the period from 1985 to 1994. Special emphasis was placed on determining associated injuries sustained as well as epidemiological information. The experience presented differs from other large series in the literature in that the predominant mechanism of injury is motor vehicle accidents (67%) rather than assaults. Of the patients reviewed, 89% sustained significant associated injuries. Closed head trauma with documented loss of consciousness was noted most frequently (40%), followed by extremity fractures (33%), thoracic trauma (29%), and traumatic brain injuries (25%). Only 11% of patients sustained facial fractures without concomitant injury.- - - - - - - - - - ranking = 1.6keywords = fracture (Clic here for more details about this article) |
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