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KMID : 0360720130260030170
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Journal of the Korean Society Traumatology
2013 Volume.26 No. 3 p.170 ~ p.174
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Comparison of Rib Fracture Location for Morbidity and Mortality in Flail Chest
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Byun Chun-Sung
Park Il-Hwan
Bae Geum-Suk
Jeong Pil-Young
Oh Joong-Hwan
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Abstract
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Purpose: A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality.
Methods: Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups.
Results: Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was 19.08±10.57. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either traumarelated morbidity (p=0.369) or mortality (p=0.189).
Conclusion: An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.
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KEYWORD
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Trauma, Rib fracture, Flail chest
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