Missed Injuries in Trauma Patients; The Value of a Diagnostic Thoracotomy or Thoracoscopy During Surgical Stabilisation of Rib Fractures.

Wemeijer, Tess M; Hogeboom, Wim; Steenvoorde, Pascal; Withaar, Dominique S.; Groot, Reinier de

doi:10.21203/rs.3.rs-268188/v1

Cited by 2 publications

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“…Benefits of surgical stabilization in traumatic flail chest has been proven [18] and the popularity of SSRF in patients with severe chest wall injuries increased [19]. Wemeijer et al [20] favored the use of an inspection through thoracotomy or thoracoscopy during SSRF to diagnose missed intrathoracic injuries. The authors investigated 51 patients with thoracotomy or thoracoscopy while SSRF, and 11 patients was found to have TDI (22%).…”

Section: Discussionmentioning

confidence: 99%

Benefits of routine uniportal thoracoscopy during rib fixation in the diagnosis and repair of diaphragmatic injury

Derdiyok,

Temel

2024

Curr Thorac Surg

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Background:The incidence of missed diagnosis of traumatic diaphragmatic injury (TDI) is about 30%.Lower rib fractures may cause TDI. We aimed to present our clinical results of uniportal video-assisted thoracoscopic surgery (VATS) in terms of detecting and repairing TDI, in patients undergoing rib fixation. Materials and Methods:In this retrospective study, routine uniportal VATS was performed in patients planned to undergo rib fixation due to flail chest and severely displaced rib fractures between January 2021 and January 2023. The results of 11 patients with TDI were investigated.Results: All patients were male. Eighty-two percent of the patients had blunt type of injury. Most TDIs were detected during VATS (55%). There were 7 left and 4 right TDIs with diaphragmatic defects varying from 2 to 5 cm in size. Two patients had minor omental herniation. Mean number of fractured ribs was 4.Mean duration of operation was 139 minutes. Mean hospital stay was 7 days. Morbidity developed in 1 patient (9%, wound infection).Conclusions: Routine VATS in patients undergoing SSRF helps detecting and repair TDIs. Its diagnostic benefit in the diagnosis of acute TDI is greatest in patients with multiple rib fractures involving the lower chest wall, although there are no radiographic evidences of TDI.

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Section: Discussionmentioning

confidence: 99%

Benefits of routine uniportal thoracoscopy during rib fixation in the diagnosis and repair of diaphragmatic injury

Derdiyok,

Temel

2024

Curr Thorac Surg

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Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States

Brewer,

Karsmarski,

Fridling

et al. 2024

J Trauma Inj

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Purpose: Research on rib fracture management has exponentially increased. Predicting fracture patterns based on the mechanism of injury (MOI) and other possible correlations may improve resource allocation and injury prevention strategies. The Chest Injury International Database (CIID) is the largest prospective repository of the operative and nonoperative management of patients with severe chest wall trauma. The purpose of this study was to determine whether the MOI is associated with the resulting rib fracture patterns. We hypothesized that specific MOIs would be associated with distinct rib fracture patterns.Methods: The CIID was queried to analyze fracture patterns based on the MOI. Patients were stratified by MOI: falls, motor vehicle collisions (MVCs), motorcycle collisions (MCCs), automobile-pedestrian collisions, and bicycle collisions. Fracture locations, associated injuries, and patient-specific variables were recorded. Heat maps were created to display the fracture incidence by rib location. Results: The study cohort consisted of 1,121 patients with a median RibScore of 2 (0–3) and 9,353 fractures. The average age was 57±20 years, and 64% of patients were male. By MOI, the number of patients and fractures were as follows: falls (474 patients, 3,360 fractures), MVCs (353 patients, 3,268 fractures), MCCs (165 patients, 1,505 fractures), automobile-pedestrian collisions (70 patients, 713 fractures), and bicycle collisions (59 patients, 507 fractures). The most commonly injured rib was the sixth rib, and the most common fracture location was lateral. Statistically significant differences in the location and patterns of fractures were identified comparing each MOI, except for MCCs versus bicycle collisions.Conclusions: Different mechanisms of injury result in distinct rib fracture patterns. These different patterns should be considered in the workup and management of patients with thoracic injuries. Given these significant differences, future studies should account for both fracture location and the MOI to better define what populations benefit from surgical versus nonoperative management.

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Missed Injuries in Trauma Patients; The Value of a Diagnostic Thoracotomy or Thoracoscopy During Surgical Stabilisation of Rib Fractures.

Cited by 2 publications

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Benefits of routine uniportal thoracoscopy during rib fixation in the diagnosis and repair of diaphragmatic injury

Benefits of routine uniportal thoracoscopy during rib fixation in the diagnosis and repair of diaphragmatic injury

Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States

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