thoracic trauma

Thoracic Trauma
Following both penetrating and blunt trauma, chest injuries are also common in multiply
injured patients.



Rib fractures
Most common injury associated with blunt chest trauma

– 4-10 % of all trauma admission

– the true incidence in probably higher since up to 50% of rib fractures may be missed on
initial CXR

Causes:

– motor vehicle crashes

– falls

– blows to the chest with blunt objects



• fractures of ribs 3 trought 8 – maximum frequency directly – at the site of force

•laterally – significant antero-posterior compression of the chest



The first rib is protected by the shoulder girdle and clavicle

– Fractures of the first rib indicate a significant amount of energy transferred to the torso

– have been associated with aortic injuries

• Posterior rib fractures are also associated with significant energy transfer to the thorax.




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, • Associated injuries:
– 20% incidence of splenic injury is associated with fractures of ribs 9, 10, and 11 on the
left side

– similar for hepatic injuries

– 50% of patients with blunt cardiac injury have rib fractures.



Rib fractures - diagnosis
• The diagnosis of rib fractures is primarily clinical

• Pain

– Directly

– Antero-posterior compression,

• Crepitus over the possible area of fracture

• Decreased breath sounds on the side of injury

• Pain:

– Subsequent atelectasis

– Underlying pulmonary contusion

– Restriction of ventilation.

PS: radiologic confirmation of the diagnosis is not essential



Children

– pulmonary contusion is more common

– rib fractures = a sign of significant energy transfer.

Elderly

– Patients older than 65 years with 3 or more rib fractures had a 5-fold increased
mortality rate and an almost 4-fold increased incidence of pneumonia compared with
younger patients


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