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KMID : 0364019750080010037
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Korean Journal of Thoracic and Cardiovascular Surgery
1975 Volume.8 No. 1 p.37 ~ p.44
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Treatment of Flail Chest and A Fixation Technique of Flail Segments
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金近鎬/Kim, Kun Ho
朴永寬/池幸玉/金英泰/李宗培/鄭崙采/Park, Young Kwan/Jee, Heng Ok/Kim, Young Tae/Rhee, Chong Bae/Chung Yun Chae
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Abstract
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Authers have reviewed the records of seven patients of multiple rib fractures with severe flail chest who were admitted to Hanyang University Hospital during the 3 years period from 1972 through 1975.
Of the sever patients studied, automobile accidents led to the injuries in 4 cases, two patients were injuried in fall from a tree and on the ox-heading. All who had a blunt trauma without any open wound on the chest.
The numbers of .the fractured ribs accounted for, 6. to 9 of the ribs including double fractures from 3 to 5 ribs. The left side fractures occurred in the 6 patients and in the right only one patient. Thus the flail segment was more often located in the left antero-lateral position than in the right lateral position (the ratio was 6:1)
All cases had associated injuries. The injuries and multiple fractures were the most common associated injuries occurring in four and five of the patients respectively. The patients were classified as habing associated head injuries when they were admitted in comatose or semicomatose state.
When a major degree of instability of the thoracic cage exists adequate respiratory change is not possible. For this reason the tracheostomy was performed in five patients in an acutely injured patient with flail chest only after an endotracheal tube has been inserted or after an endotracheal suction.
All patients had secondary complications in the pleural cavity, such as hemothorax or hemopneumothorax with or without intrapulmonary hemorrhage and subcutaneous emphysema. Therefore, closed thoracostomy was performed in five patients in the emergency room. The thoracotomy was required in four patients: immediate operation without closed thoracostomy was performed in two patients and the thoracotomy was indicated in two patients after closed thoracostomy, because of increasing intrathoracal hemorrhage.
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