Treatment of blunt thoracic trauma in a Level 1 Trauma Center

Bence Adam; Zsolt Szentkereszty; Zoltan Szentkereszty; Kitti Katalin  Vass; Ferenc Urban

doi:10.21755/MTO.2024.067.0001.001

Bence Adam Institute of Orthopaedics and Traumatology, University of Debrecen, Hungary https://orcid.org/0009-0005-7280-4678
Zsolt Szentkereszty University of Debrecen, Institute of Surgery, Hungary
Zoltan Szentkereszty University of Debrecen, Institute of Anesthesiology and Intensive Care, Hungary
Kitti Katalin Vass University of Debrecen, Institute of Orthopedics and Traumatology, Hungary
Ferenc Urban University of Debrecen, Institute of Orthopedics and Traumatology, Hungary

DOI: https://doi.org/10.21755/MTO.2024.067.0001.001

Absztrakt

Blunt chest trauma has a significant high morbidity and mortality rate. In general, the treatment is conservative; in the case of hemothorax, pneumothorax, and hemopneumothorax chest tube drainage is often required. Immediate surgery is indicated in massive bleeding, tracheal and oesophageal injuries, and pericardial tamponade. Elective surgery should be performed in the case of retained hematoma, unresolved pneumothorax and flail chest. The first prioritized procedure is video-assisted thoracoscopy. The aim of this study is to analyze the treatment options and therapeutic results in reviewing 8,108 patients afflicted with blunt thoracic trauma. In over a three-year period 7,853 patients’ data were analyzed. Altogether 1,624 (20.68%) patients suffered severe injuries, such as sternal or rib fracture(s), pleural or lung injuries. In this group, a simple rib fracture (1-3) was diagnosed in 1,466 (90.27%), unilateral serial rib fracture (≥4) in 84 (5.17%), bilateral rib fracture in 16 (0.99%) and flail chest in 47 (2.89%) patients. In 11 (0.68%) cases, only parenchymal injuries without rib fracture were found. Altogether, 190 (11.70%) patients were afflicted with pneumothorax, hemothorax, or both, and only 86 (45.26%) of these cases required chest tube drainage. One immediate thoracotomy was needed to staunch massive bleeding and elective video-assisted thoracoscopy was performed in 6 cases. Lung contusion was diagnosed in 57 (3.51%) patients. The most frequent complication was pneumonia with a rate of 0.19% (15 patients). Empyema (3 patients), unresolved pneumothorax (1 patient), and retained hematoma (4 patients) occurred in 0.04%, 0.01% and 0.05% of the cases, respectively. Altogether, 13 (0.17%) patients succumbed at a mean age of 63.54±21.92 years. Three of these cases (23.08%) experienced multiple trauma and 12 (92.31%) suffered from concomitant chronic diseases. Patients with blunt chest trauma rarely required immediate operation. Overall, in the case of unresolved pneumothorax and retained hematoma, surgery is indicated, in which these cases video-assisted thoracoscopy is the first and primary option.

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