Artho...

Date: 18-06-2013

By : Saleh Bakar

Taishan Medical University.

[email protected]

Date: 18-06-2013

By : Saleh Bakar

Taishan Medical University.

[email protected]

Subject : ArthopedicsSubject : Arthopedics

ObjectivesObjectives

• THORACIC TRAUMA

• RIB FRACTURE

• HAEMATHORAX

• THORACIC TRAUMA

• RIB FRACTURE

• HAEMATHORAX

Thoracic TraumaThoracic Trauma

1. Chest trauma (or thoracic trauma) is a serious injury of the chest.

2. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury

1. Chest trauma (or thoracic trauma) is a serious injury of the chest.

2. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury

3. . Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths. The mortality rate is about 1600.Chest injuries were first described in detail in around 1600 BC in Ancient Egypt.

3. . Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths. The mortality rate is about 1600.Chest injuries were first described in detail in around 1600 BC in Ancient Egypt.

ClassificationsClassificationsChest trauma can be classified as blunt or

penetrating. Blunt and penetrating injuries have different pathophysiologies and clinical courses.

Specific types of chest trauma include:1.Injuries to the chest wall2.Pulmonary Injury3.Airway Injury4. Cardiac Injury5.Blood Vessel Injury

Chest trauma can be classified as blunt or penetrating. Blunt and penetrating injuries have different pathophysiologies and clinical courses.

Specific types of chest trauma include:1.Injuries to the chest wall2.Pulmonary Injury3.Airway Injury4. Cardiac Injury5.Blood Vessel Injury

Deteils…Deteils…

Injuries to the chest wall

Chest wall contusions or hematomas.

Rib fractures

Flail chest

Sternal fractures

Fractures of the shoulder girdle

Injuries to the chest wall

Chest wall contusions or hematomas.

Rib fractures

Flail chest

Sternal fractures

Fractures of the shoulder girdle

Pulmonary InjuriesPulmonary Injuries

Pulmonary laceration

Pneumothorax

Hemothorax

Hemopneumothorax

Pulmonary laceration

Pneumothorax

Hemothorax

Hemopneumothorax

Cardiac InjuryCardiac Injury

Pericardial tamponade

Myocardial contusion

Traumatic arrest

BLOOD VESSEL INJURY

Traumatic aortic rupture, thoracic aorta injury, aortic dissection

Pericardial tamponade

Myocardial contusion

Traumatic arrest

BLOOD VESSEL INJURY

Traumatic aortic rupture, thoracic aorta injury, aortic dissection

DaignosisDaignosis

Most blunt injuries are managed with relatively simple interventions like tracheal intubation and mechanical ventilation and chest tube insertion. Diagnosis of blunt injuries may be more difficult and require additional investigations such as CT scanning.

Most blunt injuries are managed with relatively simple interventions like tracheal intubation and mechanical ventilation and chest tube insertion. Diagnosis of blunt injuries may be more difficult and require additional investigations such as CT scanning.

DaignosisDaignosisPenetrating injuries often require surgery, and

complex investigations are usually not needed to come to a diagnosis. Patients with penetrating trauma may deteriorate rapidly, but may also recover much faster than patients with blunt injury.

Penetrating injuries often require surgery, and complex investigations are usually not needed to come to a diagnosis. Patients with penetrating trauma may deteriorate rapidly, but may also recover much faster than patients with blunt injury.

RIB FRACTURERIB FRACTURE

A rib fracture is a break or fracture in one or more of the bones making up the rib cage. The first rib is rarely fractured because of its protected position behind the clavicle (collarbone). However, if it is broken, serious damage can occur to the brachial plexus of nerves and the subclavian vessels. Fractures of the first and second ribs may be more likely to be associated with head and facial injuries than other rib fractures

The middle ribs are the ones most commonly fractured. Fractures usually occur

from direct blows or from indirect crushing injuries. The weakest part of a rib is just anterior to its angle, but a fracture can occur anywhere. The most commonly fractured ribs are the 7th and 10th.[1] A lower rib fracture has the complication of potentially injuring the diaphragm, which could result in a diaphragmatic hernia. Rib fractures are usually quite painful because the ribs have to move to allow for breathing. When several ribs are broken in several places a flail chest results, and the detached bone sections will move separately from the rest of the chest.

  A rib fracture is a break or fracture in one or more of the bones making up the rib cage. The first rib is rarely fractured because of its protected position behind the clavicle (collarbone). However, if it is broken, serious damage can occur to the brachial plexus of nerves and the subclavian vessels..

Fractures of the first and second ribs may be more likely to be associated with head and facial injuries than other rib fractures.[1] The middle ribs are the ones most commonly fractured. Fractures usually occur from direct blows or from indirect crushing injuries..

  A rib fracture is a break or fracture in one or more of the bones making up the rib cage. The first rib is rarely fractured because of its protected position behind the clavicle (collarbone). However, if it is broken, serious damage can occur to the brachial plexus of nerves and the subclavian vessels..

Fractures of the first and second ribs may be more likely to be associated with head and facial injuries than other rib fractures.[1] The middle ribs are the ones most commonly fractured. Fractures usually occur from direct blows or from indirect crushing injuries..

• The weakest part of a rib is just anterior to its angle, but a fracture can occur anywhere. The most commonly fractured ribs are the 7th and 10th.[1] A lower rib fracture has the complication of potentially injuring the diaphragm, which could result in a diaphragmatic hernia. Rib fractures are usually quite painful because the ribs have to move to allow for breathing. When several ribs are broken in several places a flail chest results, and the detached bone sections will move separately from the rest of the chest.

• The weakest part of a rib is just anterior to its angle, but a fracture can occur anywhere. The most commonly fractured ribs are the 7th and 10th.[1] A lower rib fracture has the complication of potentially injuring the diaphragm, which could result in a diaphragmatic hernia. Rib fractures are usually quite painful because the ribs have to move to allow for breathing. When several ribs are broken in several places a flail chest results, and the detached bone sections will move separately from the rest of the chest.

CausesCauses

Rib fractures can occur without direct trauma and have been reported after sustained coughing and in various sports – for example, rowing, karting and golf – often in elite athletes. They can also occur as a consequence of diseases such as cancer or infections (pathological fracture).

.

Rib fractures can occur without direct trauma and have been reported after sustained coughing and in various sports – for example, rowing, karting and golf – often in elite athletes. They can also occur as a consequence of diseases such as cancer or infections (pathological fracture).

.

CausesCauses

Fragility fractures of ribs can occur due to diseased bone

structure, e.g. osteoporosis and metastatic deposits–   

Fragility fractures of ribs can occur due to diseased bone

structure, e.g. osteoporosis and metastatic deposits–   

DaignosisDaignosis• Broken ribs are often indicated by the following

symptoms:• Pain when breathing or with movement• A portion of the chest wall moving separately

from the rest of the chest (flail chest)• A grating sound with breathing or movement• Where the mechanism of injury would indicate

substantial force to the ribs…

• Broken ribs are often indicated by the following symptoms:

• Pain when breathing or with movement• A portion of the chest wall moving separately

from the rest of the chest (flail chest)• A grating sound with breathing or movement• Where the mechanism of injury would indicate

substantial force to the ribs…

DaignosisDaignosis

Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic injuries such as pulmonary contusion.[1] Rib fractures are also a sign of more serious injury in elderly people

Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic injuries such as pulmonary contusion.[1] Rib fractures are also a sign of more serious injury in elderly people

TreatmentTreatment

• There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Adequate analgesia can avoid this.

• • Flail chest is a potentially life-threatening injury

and will often require a period of assisted ventilation. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera

• There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Adequate analgesia can avoid this.

• • Flail chest is a potentially life-threatening injury

and will often require a period of assisted ventilation. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera

HAEMOTHORAXHAEMOTHORAX• Accumulation of blood in Pleural cavity is Accumulation of blood in Pleural cavity is

called Haemothorax..called Haemothorax..• Accumulation of blood in Pleural cavity is Accumulation of blood in Pleural cavity is

called Haemothorax..called Haemothorax..

CausesCauses

Its cause is usually traumatic, from a blunt or Its cause is usually traumatic, from a blunt or penetrating injury to the thorax, resulting in penetrating injury to the thorax, resulting in a rupture of the serous membrane either a rupture of the serous membrane either lining the thorax or covering the lungs. This lining the thorax or covering the lungs. This rupture allows blood to spill into the pleural rupture allows blood to spill into the pleural space, space,

Its cause is usually traumatic, from a blunt or Its cause is usually traumatic, from a blunt or penetrating injury to the thorax, resulting in penetrating injury to the thorax, resulting in a rupture of the serous membrane either a rupture of the serous membrane either lining the thorax or covering the lungs. This lining the thorax or covering the lungs. This rupture allows blood to spill into the pleural rupture allows blood to spill into the pleural space, space,

CausesCauses

• equalizing the pressures between it and the lungs. Blood loss may be massive in people with these conditions, as each side of the thorax can hold 30–40% of a person's blood volume. Even minor injury to the chest wall can lead to significant hemothorax.[1]

• equalizing the pressures between it and the lungs. Blood loss may be massive in people with these conditions, as each side of the thorax can hold 30–40% of a person's blood volume. Even minor injury to the chest wall can lead to significant hemothorax.[1]

Signs and Symptoms

• Tachypnea• Dyspnea• Cyanosis• Decreased or absent breath sounds on affected side• Tracheal deviation to unaffected side• Dull resonance on percussion• Unequal chest rise• Tachycardia• Hypotension• Pale, cool, clammy skin• Possibly subcutaneous emphysema• Narrowing pulse pressure

Management

• A hemothorax is managed by removing the source of bleeding and by draining the blood already in the thoracic cavity. Blood in the cavity can be removed by inserting a drain (chest tube) in a procedure called a tube thoracostomy.

Management• As the blood thickens, it can clot in the pleural space

(leading to a retained hemothorax) or within the chest tube, leading to chest tube clogging or occlusion. Chest tube clogging or occlusion can lead to worse outcomes as it prevents adequate drainage of the pleural space, contributing to the problem of retained hemothorax. In this case, patients can be hypoxic, short of breath, or in some cases, the retained hemothorax can become infected (empyema). Therefore adequately functioning chest tubes are essential in the setting of a hemothorax treated with a chest tube.

Saleh Bakar

Thanks to All…