Introduction

• Cause: usually road traffic accident (RTA). Rib fracture.
  In all cases of traumatic injury warn owner of potential complications at time of injury.
• Signs: dyspnea, cyanosis, collapse, restlessness. Solitary rib fracture rarely serious; multiple and segmental fractures → severe instability → flail chest.
• Diagnosis: depends on lesions and systems affected. Clinical signs and radiography.
• Treatment: restore cardiopulmonary function, with initial emphasis on maintaining and supporting respiration and circulation. Stabilize flail segment.
• Prognosis: always guarded initially as very volatile situation and acute deterioration may occur at any time, especially the first few hours.

Pathogenesis

Etiology

• Trauma, usually RTA.

Pathophysiology

• A functional thorax is critical for proper respiration and circulation. The thoracic cage, though strong and protective, cannot withstand crushing or high velocity missile injury.
• Thoracic trauma is likely to result in a combination of conditions rather than a single problem.
• Pathophysiologically, these conditions are classified as:
  • Reduction of lung volume (pneumothorax Tension pneumothorax , diaphragmatic rupture Diaphragm: traumatic hernia ).
  • Reduction of functional alveoli (pulmonary contusion Lung: contusion , edema Lung: pulmonary edema ).
  • Thoracic cage injury (rib fracture Thoracic wall trauma Heart: congestive heart failure Endocardiosis: tricuspid valve , open wounds).
  • Airway obstruction (hemorrhage, tracheal rupture).
  • Hypovolemic shock Shock (hemothorax Hemothorax ).

• Pneumothorax Pneumothorax , diaphragmatic rupture Diaphragm: traumatic hernia → decreased lung volume.
• Pulmonary contusion Lung: contusion , edema Lung: pulmonary edema → decreased functional alveoli.
• Rib fracture, open wounds → thoracic cage injury.
• Hemorrhage, tracheal rupture → airway obstruction.
• Hemothorax Pleural: effusion → hypovolemic shock Shock.
• Thoracic injury may be associated with other traumatic injuries, eg abdominal Abdomen: trauma , which may be more significant:
  • Ruptured diaphragm Diaphragm: traumatic hernia.
  • Splenic/hepatic trauma Spleen: trauma Liver: trauma.
  • Urinary tract trauma Bladder: trauma rupture.
• Thoracic wall trauma:
  • Multiple/segmental rib fracture → severe instability → 'paradoxical' movement, thoracic wall sucked in on inspiration and blown out on expiration ('flail chest') → hypoxia, hypercapnia Hypercapnia.

Timecourse

• Acute.

Diagnosis

Treatment

Outcomes