Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Comparison of Rib Fracture Location for Morbidity and Mortality in Flail Chest

늑골 골절의 위치가 동요흉의 이환율 및 사망률에 미치는 요인

  • Byun, Chun Sung (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital) ;
  • Park, Il Hwan (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital) ;
  • Bae, Geum Suk (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital) ;
  • Jeong, Pil Yeong (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital) ;
  • Oh, Joong Hwan (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital)
  • 변천성 (연세대학교 원주의과대학 원주세브란스기독병원 중증외상센터) ;
  • 박일환 (연세대학교 원주의과대학 원주세브란스기독병원 중증외상센터) ;
  • 배금석 (연세대학교 원주의과대학 원주세브란스기독병원 중증외상센터) ;
  • 정필영 (연세대학교 원주의과대학 원주세브란스기독병원 중증외상센터) ;
  • 오중환 (연세대학교 원주의과대학 원주세브란스기독병원 중증외상센터)
  • Received : 2013.07.08
  • Accepted : 2013.09.02
  • Published : 2013.09.30
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Abstract

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 $19.08{\pm}10.57$. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related 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.

Keywords

References

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