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Discoveries (Craiova) 2021 Mar 4;9(1):e123. Epub 2021 Mar 4.

4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.

Transdiaphragmatic intercostal hernia, in which the abdominal contents of the hernia protrude through the diaphragm and the thoracic wall defect. is a very rare type of hernia with only a few cases having been reported in the literature. That type of hernia is usually manifested in male patients after trauma, penetrating or blunt. Read More

Injury 2021 May 19. Epub 2021 May 19.

Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, United States.

Background: The aim of this study is to define the cost of rib fracture hospitalization by single, multiple, and flail type using a nationally representative sample.

Methods: The national inpatient sample (NIS) was used to identify patients with a primary diagnosis of rib fracture hospitalization 2007-2016. International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes were used to characterize patients as having single, multiple, or flail chest rib fractures. Read More

Indian J Pediatr 2021 May 26. Epub 2021 May 26.

Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342001, India.

Chin J Traumatol 2021 May 6. Epub 2021 May 6.

Department of General Surgery, All India Institute of Medical Sciences, Bhopal, India.

Surgical stabilization of the flail chest is challenging and has no established guidelines. Chest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. Here, we report a novel chest wall reconstruction technique in a 45-year-old man with a traumatic left flail chest and open pneumothorax diagnosed both clinically and radiographically. Read More

Ann R Coll Surg Engl 2021 May 21. Epub 2021 May 21.

Aberdeen Royal Infirmary, UK.

Thoracic chest wall trauma is a common injury in patients admitted to hospital following injury and is associated with high mortality. British Orthopaedic Association Standards for Trauma and Orthopaedics guidelines recommend consideration of rib fracture fixation in patients with flail chest wall injuries with respiratory compromise or uncontrollable pain. Veno-venous extracorporeal membrane oxygenation (ECMO) can be utilised in patients with severe respiratory dysfunction and we present the case of a patient who underwent rib fracture fixation while receiving ECMO. Read More

J Trauma Acute Care Surg 2021 Jun;90(6):967-972

From the Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Background: The National Field Triage Guidelines were created to inform triage decisions by emergency medical services (EMS) providers and include eight anatomic injuries that prompt transportation to a Level I/II trauma center. It is unclear how accurately EMS providers recognize these injuries. Our objective was to compare EMS-identified anatomic triage criteria with International Classification of Diseases-10th revision (ICD-10) coding of these criteria, as well as their association with trauma center need (TCN). Read More

Emerg Med J 2021 May 13. Epub 2021 May 13.

Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.

Background: Recent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.

Methods: This study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010-2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Read More

J Trauma Acute Care Surg 2021 Apr 29. Epub 2021 Apr 29.

Brown University, Alpert Medica School, Department of Surgery.

Background: Surgical stabilization of rib fractures (SSRF) significantly improve the outcomes of patients with rib fractures. Ultrasound is a specific modality for localizing rib fractures. We hypothesized that use of perioperative ultrasound localization of fracture sites optimizes surgical approach and clinical outcomes. Read More

J Trauma Acute Care Surg 2021 Apr 29. Epub 2021 Apr 29.

Harborview Injury Prevention and Research Center University of Washington Department of Surgery University of Washington University of Washington University of Washington Medical College of Wisconsin Gundersen Health System Mercy Health, Muskegon, MI St. Vincent Indianapolis Hospital University of Utah University of Utah Oregon Health and Science University Oregon Health and Science University Mission Trauma Services, Asheville, NC Loma Linda University Loma Linda University Harborview Injury Prevention and Research Center University of Washington University of Washington University of Washington.

Background: Single center data demonstrates that regional analgesia (RA) techniques are associated with reduced risk of delirium in older patients with multiple rib fractures. We hypothesized that a similar effect between RA and delirium would be identified in a larger cohort of patients from multiple Level I trauma centers.

Methods: Retrospective data from seven Level-I trauma centers were collected for ICU patients ≥65 years old with ≥3 rib fractures from 1/2012-12/2016. Read More

Healthcare (Basel) 2021 Apr 1;9(4). Epub 2021 Apr 1.

Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia.

Surgical stabilisation of rib fractures (SSRF) reduces morbidity and mortality. However, its impact in complicated cases, particularly those with underlying thoracic pathologies, is of continued interest. Electronic records were retrospectively reviewed after obtaining informed consent from the patient. Read More

J Surg Res 2021 Apr 7;264:222-229. Epub 2021 Apr 7.

Department of General Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Trauma Service, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia. Electronic address:

Background: Randomized controlled trials have demonstrated that surgical stabilization of rib fractures (SSRF) in selected trauma patients is associated with potential benefits. This study evaluates the real-world outcomes of SSRF since its implementation at Westmead Hospital, Australia. We hypothesize these outcomes to be similar to that reported by best-evidence in the literature. Read More

J Trauma Acute Care Surg 2021 Mar 23. Epub 2021 Mar 23.

Trauma Research Center, Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran Department of Anesthesiology, Critical Care and Pain Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Int J Surg Case Rep 2021 Apr 22;81:105805. Epub 2021 Mar 22.

Division of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy. Electronic address:

Introduction: Flail chest is now usually treated by conservative methods and surgical fixation remains indicated in selected cases. Different techniques can be used for fixation. The aim of this paper is to present a case in which Judet and Sanchez-Loret plates were employed and to discuss the usefulness of this traditional technique. Read More

Acute Med Surg 2020 Jan-Dec;7(1):e586. Epub 2020 Nov 4.

Department of Emergency and Critical Care Medicine Hyogo Emergency Medical Center Hyogo Japan.

Aim: To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies.

Methods: Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases). Read More

BMC Musculoskelet Disord 2021 Mar 20;22(1):294. Epub 2021 Mar 20.

Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan.

Background: The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI.

Methods: A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. Read More

Ann Thorac Surg 2021 Mar 3. Epub 2021 Mar 3.

Department of Cardiothoracic Surgery, Shenzhen Longgang Central Hospital, the Ninth People's Hospital of Shenzhen City, Shenzhen, China.

Background: Video-assisted thoracoscopic surgery (VATS) for internal fixation of rib fracture is a promising approach for treating rib fractures and flail chest. Currently, the standard practice is to make one or several incisions on the chest wall, which will inevitably aggravate the original trauma.

Methods: We retrospectively analyzed the data of patients with rib fractures who were treated with memory alloy for internal fixation by complete VATS using a thoracoscopic transthoracic memory alloy rib coaptation board and an implantation tool through the clip applier method or the puncture, traction and suspension method at our hospital from October 2016 to June 2019. Read More

BMJ Case Rep 2021 Mar 2;14(3). Epub 2021 Mar 2.

Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.

A 73-year-old male patient underwent operative treatment for dislocation of multiple costochondral junctions alongside multiple bony rib fractures and a flail chest following high-energy trauma. During the operative fixation of the flail chest, the costochondral lesions were surgically stabilised with plates and screws, which were fixated on the osseous anterior rib, sternum or the rib cartilage. The patient experienced no pulmonary complications during the primary admission. Read More

Acta Chir Belg 2021 Mar 4:1-5. Epub 2021 Mar 4.

Department of Thoracic Surgery, AZ Sint-Jan, Brugge, Belgium.

Background: Tracheobronchial injury is rare and often has a fatal course. The incidence is estimated from 0.8% to 5% in the scenario of blunt or penetrating chest trauma. Read More

Am J Surg 2021 Feb 16. Epub 2021 Feb 16.

Division of General Surgery, Department of Surgery, Stanford University, USA; Surgeons Writing About Trauma, Stanford University, USA.

Background: We aimed to elucidate management patterns and outcomes of high-risk patients with rib fractures (elderly or flail chest) across non-trauma and trauma centers. We hypothesized highest-capacity (level I) centers would have best outcomes for high-risk patients.

Methods: We queried the 2016 National Emergency Department Sample to identify adults presenting with rib fractures. Read More

Anaesthesiol Intensive Ther 2021 ;53(1):25-29

Department of Anaesthesiology and Critical Care, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer Sheva, Israel.

Introduction: Rib fracture fixation is becoming more popular and widely accepted among trauma surgeons worldwide as the recommended treatment method for flail chest injury. Recent data demonstrate improved results when compared with non-operative treatment. Improved outcomes were reported regarding ICU stay, need for tracheostomy, length of hospital stay, ventilator-associated pneumonia (VAP), and even death. Read More

J Trauma Acute Care Surg 2021 03;90(3):451-458

From the Department of Surgery (J.C., L.T., D.A.S., J.D.F.), Division of General Surgery, Department of Epidemiology and Population Health (J.C.), Surgeons Writing About Trauma (J.C., B.M., R.T., L.T., D.A.S., J.D.F.), and School of Medicine (B.M., R.T.), Stanford University, Stanford, California; Department of Surgery, Chulalongkorn University (W.L.), Bangkok, Thailand; and Stanford Health Policy (J.A.S., J.D.G.-F.), Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California.

Background: Surgical stabilization of rib fracture (SSRF) is increasingly used to manage patients with rib fractures. Benefits of performing SSRF appear variable, and the procedure is costly, necessitating cost-effectiveness analysis for distinct subgroups. We aimed to assess the cost-effectiveness of SSRF versus nonoperative management among patients with rib fractures younger than 65 years versus 65 years or older, with versus without flail chest. Read More

Eur J Trauma Emerg Surg 2021 Feb 6. Epub 2021 Feb 6.

Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

Purpose: The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population.

Methods: A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Read More

Am Surg 2021 Jan 31:3134821991978. Epub 2021 Jan 31.

Division of General Surgery, Department of Surgery, 6429Stanford University, CA, USA.

Background: Sternal and rib fractures are common concomitant injuries. However, the impact of concurrent sternal fractures on clinical outcomes of patients with rib fractures is unclear. We aimed to unveil the pulmonary morbidity and mortality impact of concomitant sternal fractures among patients with rib fractures. Read More

Eur J Trauma Emerg Surg 2021 Jan 26. Epub 2021 Jan 26.

Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Purpose: Rib fractures, though typically associated with blunt trauma, can also result from complications of medical or surgical care, including cardiopulmonary resuscitation. The purpose of this study is to describe the demographics and outcomes of iatrogenic rib fractures.

Methods: Patients with rib fractures were identified in the 2016 National Inpatient Sample. Read More

Injury 2021 May 26;52(5):1133-1137. Epub 2020 Dec 26.

OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, United States.

Introduction: Far posterior, or paraspinal rib fractures, defined as fractures that are medial to the medial border of the scapula (and may involve the costovertebral articulation), are often treated nonoperatively. However, in certain cases, including severe displacement, persistent pain, nonunion, or persistent respiratory distress, stabilization with open reduction and internal fixation (ORIF) may be warranted. There is a paucity of literature regarding the surgical approach and clinical outcomes following ORIF for far posterior rib fractures and fracture-dislocations. Read More

Surgery 2021 Jun 19;169(6):1525-1531. Epub 2020 Dec 19.

Department of Surgery, Tulane University School of Medicine, New Orleans, LA.

Background: How the surgical stabilization of rib fractures after trauma affects the development of acute respiratory distress syndrome and impacts survival has yet to be determined in a large database. We hypothesized that surgical stabilization of rib fractures would not decrease the incidence of acute respiratory distress syndrome.

Methods: The National Trauma Data Bank was queried for all traumatic rib fractures in 2016. Read More

Unfallchirurg 2021 Jan 12. Epub 2021 Jan 12.

Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland.

This article reports the case of a 69-year-old patient with multiple rib fractures and sternal fracture after repetitive cardiopulmonary resuscitation (CPR). Because of secondary respiratory failure due to an unstable thorax, rib fixation was performed 10 days after CPR. Subsequently, ventilation improved resulting in successful extubation 4 days after rib plating. Read More

Emerg Radiol 2021 Apr 4;28(2):333-338. Epub 2021 Jan 4.

Department of Oral and Maxillofacial Surgery, The University of Jordan, Amman, 11942, Jordan.

Purpose: Due to the recently emerging shortage in medical staff during the novel corona virus pandemic, several countries have rushed their undergraduate medical students into the emergency department. The accuracy of diagnosing critical findings on X-rays by senior medical students is not well assessed. In this study, we aim to assess the knowledge and accuracy of undergraduate final-year medical students in diagnosing life-threatening emergency conditions on chest x-ray. Read More

Int J Nephrol Renovasc Dis 2020 15;13:379-383. Epub 2020 Dec 15.

New Jersey Kidney Care, Jersey City, NJ, USA.

End-stage renal disease (ESRD) patients are at much higher risk of cardiac arrest as compared to the general population. In the event of a cardiac arrest, cardiopulmonary resuscitation (CPR) is a lifesaving procedure. In fact, the need for CPR among hospitalized ESRD patients is almost 20 times higher than the general population. Read More

Trop Doct 2020 Dec 23:49475520981264. Epub 2020 Dec 23.

Trauma Surgeon, Department of Trauma Surgery KGMU, Lucknow, India.

The incidence of sternal fracture ranges from 3 to 8%. In more than half, they are associated with other organ trauma such as blunt cardiac injuries, rib, scapular or vertebral fractures. Hence, the presence of sternal fracture is considered a marker for significant transmission of energy. Read More