• Journal of Chest Surgery
• /
• v.10 no.2
• /
• pp.327-336
• /
• 1977

A chinical analysis was performed on 383 ases of hest injurjes eperienced at Department of thoraci Surgery, Seoul National University Hospital during 21 year period From 1957 to 1977. Of 383 patients o hest injuries, 209 cases were result from nonpenetrating injuries whereas 175 were from penetrating injuries, and there were 258 cases of hemothorax or/and pneumothorax, 162 of rib fracture, 33 of foreign body, 26 of clavicle frcture, 26 of lung contusion, 17 of diaphragmati laceration, 14 of hemoperiardium, 14 of flail chest and others. Stab wound was the most common in penetrating injuries and followed by gunshot and shell fragments. The majority of nonpenetrating chest injury paiens were traffi accident vitims and falls accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 16 and 50 years, and 321 patients were male comparing to 62 of female. In blunt hest injuries the patients with five or more rib fractures had a 85 per ent incidence of intrathoracic injury and 19 per cent had an intraabdominal organ damage, whereas those with four or less rib fractures had a 69 per cent and a 6 per cent incidence respectively. The principal associated injuries were cerebral contusion on 19 cases, renal contusion on 10, liver laceration on 7, peripheral vessel laceration on 5, spleen laceration on 3 and extremity fracture on 18 patients. The principles of therapy for early complications of chest trauma were rapid reexpansion of the lungs by thoracentesis (46 cases) and closed thoracotomy (125 cases) but open thoracotomy had to be done on 90 cases (23.5%) because of massive bleeding or intrapleural hematoma, foreign body, cardiac injury, diaphragmatic laceration and bronhial rupture. The over all mortality was 2.87 per cent (11 among 383 cases), 8 cases were from penetrating injuries and 3 from nonpenetrating injuries.

• Journal of Chest Surgery
• /
• v.23 no.5
• /
• pp.905-915
• /
• 1990

A clinical evaluation was performed on 545 cases of the chest trauma those had been admitted and treated at the department of thoracic and cardiovascular surgery in Chosun University Hospital during the past 11 years 5 months period from January 1978 to may 1989. Obtained results were as follows: 1. The ratio of male to female was 3.9: 1 in male predominance, and the majority[66.6%] was distributed from 3rd to 5th decade. 2. Nonpenetrating chest trauma was more common than penetrating about 4.6 times, and the most common cause of the nonpenetrating injuries was traffic accident[241/448, 53.8%] and of the penetrating injuries was stab wound[88/97, 90.7%]. 3. Only 79 cases[14.5%] were arrived to our emergency room within one hour after trauma. 4. The most common lesion due to trauma among these admitted patients was rib fracture[390/545, 71.6%], and the others were lung contusion[217/545, 39.8%], hemothorax[35%], hemopneumothorax[19.6%], and pneumothorax[11.8%] et al in decreasing order. 5. The associated injuries those required special treatment of other departments were 223 cases and its distributions were bone fractures[178/545, 32.7%], head injury[5.3%], and abdominal injury[6.6%]. 6. The others, but interesting chest injuries were follows: sternum fracture[3.1%], diaphragm rupture[2.6%], myocardial laceration and rupture[2 cases], bronchial rupture and laceration[2 cases], and traumatic thymoma rupture[1 case]. 7. The incidence of flail chest was 5.8%a[26/448] in the nonpenetrating injury, and the causes were multiple rib fracture which was in rows more than 4 rib fracture[20 cases], and sternum fracture[6 cases]. 8. We could managed the most of the patient with conservative treatment[43.1%] or closed tube thoracostomy[52.7%], but required emergency open thoracotomy in 64 cases

• Journal of Trauma and Injury
• /
• v.37 no.1
• /
• pp.48-59
• /
• 2024

Purpose: Research on rib fracture management has exponentially increased. Predicting fracture patterns based on the mechanism of injury (MOI) and other possible correlations may improve resource allocation and injury prevention strategies. The Chest Injury International Database (CIID) is the largest prospective repository of the operative and nonoperative management of patients with severe chest wall trauma. The purpose of this study was to determine whether the MOI is associated with the resulting rib fracture patterns. We hypothesized that specific MOIs would be associated with distinct rib fracture patterns. Methods: The CIID was queried to analyze fracture patterns based on the MOI. Patients were stratified by MOI: falls, motor vehicle collisions (MVCs), motorcycle collisions (MCCs), automobile-pedestrian collisions, and bicycle collisions. Fracture locations, associated injuries, and patient-specific variables were recorded. Heat maps were created to display the fracture incidence by rib location. Results: The study cohort consisted of 1,121 patients with a median RibScore of 2 (range, 0-3) and 9,353 fractures. The average age was 57±20 years, and 64% of patients were male. By MOI, the number of patients and fractures were as follows: falls (474 patients, 3,360 fractures), MVCs (353 patients, 3,268 fractures), MCCs (165 patients, 1,505 fractures), automobile-pedestrian collisions (70 patients, 713 fractures), and bicycle collisions (59 patients, 507 fractures). The most commonly injured rib was the sixth rib, and the most common fracture location was lateral. Statistically significant differences in the location and patterns of fractures were identified comparing each MOI, except for MCCs versus bicycle collisions. Conclusions: Different mechanisms of injury result in distinct rib fracture patterns. These different patterns should be considered in the workup and management of patients with thoracic injuries. Given these significant differences, future studies should account for both fracture location and the MOI to better define what populations benefit from surgical versus nonoperative management.

• Journal of Chest Surgery
• /
• v.23 no.5
• /
• pp.929-935
• /
• 1990

Violence in our society, combined with improving transport system, resulted in increased numbers of patients with cardiac wounds reaching the hospital alive. Most patients with penetrating cardiac injury, rather than blunt injury, present with a syndrome of either hemorrhagic shock or cardiac tamponade. And they should be operated upon as soon as possible. Often the atrioventricular valves and other important cardiac structures are also damaged by the penetrating instruments or missile. Both intracardiac communications and atrioventricular fistulas may result in significant left-to-right shunts accompanied by congestive heart failure, necessitating surgical correction. Usually, retained cardiac foreign bodies, which are almost always bullets or fragments of missiles, may lie within a cardiac chamber or in the myocardium. Emboli of bullets or other missiles from distant sites to the right side of the heart are numerous enough to require attention. Recently we experienced a case with intracardiac foreign body due to penetrating cardiac injury. A 19 year-old man was admitted to our hospital due to penetrating anterior chest wound by iron segment. The roentgenogram of the chest revealed a radio-opaque metallic shadow in left lower chest around the cardiac apex, mild blunting of left costophrenic space, but no cardiomegaly. During operation the foreign body was noted to be present in the cardiac chamber by the portable C-arm fluoroscopy. But during the manipulation it moved into left inferior pulmonary vein from left ventricle by way of left atrium. So we could manage to remove it from left inferior pulmonary vein by direct approach to the vein. It was iron segment, sized 0.lcm x0.6cmx0.5cm, with sharp margins. The patient had an uneventful postoperative recovery except for chylopericardium and was discharged.

• Journal of Trauma and Injury
• /
• v.28 no.3
• /
• pp.219-221
• /
• 2015

Subclavian injuries in blunt trauma are reported in less than 1% of all arterial injuries or chest related injuries. We report a female 68 yr-old patient whom has visited our emergency center due to a motorcycle traffic accident with complaints of right chest wall and shoulder pain. Her injury severity score was 22 and she was found with a comminuted clavicle fracture and subclavian artery injury. She developed delayed symptoms of pallor, pain and motor weakness with loss of pulse in her right arm. Attempts at intervention failed and thus, she underwent emergency artificial graft bypass from her subclavian artery to her brachial artery. Her postoperative course was uneventful and she is happy with the results. Although rare, a high index of suspicion for the injury must be noted and the inevitable surgical option must always be considered.

• Journal of Chest Surgery
• /
• v.25 no.11
• /
• pp.1278-1281
• /
• 1992

We have experienced two cases of traumatic subclavian artery rupture at the department of thoracic and cardiovascular surgery, Youngdong Severance hospital, Yonsei University college of medicine. One was combined with brachial plexus injury and the other was combined with brachial plexus injury and subclavian vein rupture. They were treated with graft interposition after segmental resection of ruptured subclavian artery and neurorrhaphy for brachial plexus injury. Post operative courses were not eventful.

• Journal of Chest Surgery
• /
• v.27 no.4
• /
• pp.331-334
• /
• 1994

Pneumatic rupture is a rare cause of esophageal injury, as evidenced by only 19 cases reported in the literature. We experienced one case of esophageal rupture due to bursting of a truck inner tube. The patient, who was a 45-year old male, had severe chest pain, respiratory distress, flushing in the face and neck, and subcutaneous emphysema after tire explosion. Three days after the incident, a diagnosis of rupture of the thoracic esophagus was established by esophagogram using water soluble contrast media, and then emergency operation was done. The operation involved mediastinal and thoracic drainage and resection of the esophagus combined with cervical esophagostomy and feeding gastrostomy. On the 105th day after the operation, cervical esophagogastrostomy via substernal route was performed. The patient was successfully treated with the staged operations. As in the other reported cases, the injury was located in the lower one third of the esophagus. Four main characteristics of the clinical signs of pneumatic rupture are 1] wounds or burns to the face or mouth, 2] chest pain or epigastric pain, 3] subcutaneous emphysema, and 4] respiratory distress. We emphasize that the high index of suspicion of esophageal rupture is very important in diagnosis and that diagnosis should be based on the same findings common to other forms of esophageal injury.

• Journal of Trauma and Injury
• /
• v.35 no.2
• /
• pp.76-83
• /
• 2022

Purpose: Ventilator-associated pneumonia is the most common nosocomial infection in patients with mechanical ventilation. In 2013, the new concept of ventilator-associated events (VAEs) replaced the traditional concept of ventilator-associated pneumonia. We analyzed risk factors for VAE occurrence and in-hospital mortality in trauma patients who received mechanical ventilatory support. Methods: In this retrospective review, the study population comprised patients admitted to the Jeju Regional Trauma Center from January 2020 to January 2021. Data on demographics, injury characteristics, and clinical findings were collected from medical records. The subjects were categorized into VAE and no-VAE groups according to the Centers for Disease Control and Prevention/National Healthcare Safety Network VAE criteria. We identified risk factors for VAE occurrence and in-hospital mortality. Results: Among 491 trauma patients admitted to the trauma center, 73 patients who received ventilator care were analyzed. Patients with a chest Abbreviated Injury Scale (AIS) score ≥3 had a 4.7-fold higher VAE rate (odds ratio [OR], 4.73; 95% confidence interval [CI], 1.46-17.9), and those with a glomerular filtration rate (GFR) <75 mL/min/1.73 m² had 4.1-fold higher odds of VAE occurrence (OR, 4.15; 95% CI, 1.32-14.1) and a nearly 4.2-fold higher risk for in-hospital mortality (OR, 4.19; 95% CI, 1.30-14.3). The median VAE-free duration of patients with chest AIS ≥3 was significantly shorter than that of patients with chest AIS <3 (P=0.013). Conclusions: Trauma patients with chest AIS ≥3 or GFR <75 mL/min/1.73 m² on admission should be intensively monitored to detect at-risk patients for VAEs and modify the care plan accordingly. VAEs should be closely monitored to identify infections early and to achieve desirable results. We should also actively consider modalities to shorten mechanical ventilation in patients with chest AIS ≥3 to reduce VAE occurrence.

• Journal of Chest Surgery
• /
• v.19 no.4
• /
• pp.722-725
• /
• 1986

Rupture of the main bronchus following closed injury to the chest is a comparatively rare accident. The late recognition of this injury is attended by difficulties in management which may endanger life or expose the patient to distressing months and years of arduous therapy. This case was a 17 year old female who was a high school student. The patient had sustained a crushing injury to her right hemithorax and had been taken to an emergency hospital where right closed thoracostomy had been performed for a tension pneumothorax. She improved following this procedure but massive atelectasis of the right lung developed on the 13th day after trauma and transferred to our hospital. Bronchoscopy disclosed granulation tissue in the right main stem bronchus and end to end anastomosis of the bronchus was performed. Postoperative course was uneventful.

• Journal of Chest Surgery
• /
• v.22 no.2
• /
• pp.364-370
• /
• 1989

22 Cases of traumatic diaphragmatic injuries treated at the Department of Thoracic and Cardiovascular Surgery in Chon-Buk National University Hospital from Jan. 1979 to Oct. 1988 were reviewed in this study. Of the 22 cases, 18 were male and 3 were female, a ratio of 4.5:1. This ratio revealed high incidence in male patient. The age distribution ranged from 2 to 60 years and mean age was 31 years. The modes of injury were as follows: 11 stab wound, 5 traffic accident, 2 fall down, 2 fighting injury, 1 compression wound by sand bag, and 1 slip down injury. Useful diagnostic tools were chest X-ray with or without radiopaque dye swallowing, which was the most commonly diagnostic, UGI series, and thoracoscope. Operations were performed in 22 cases, and 18 cases were through thoracotomy. The herniated organs through the ruptured diaphragm were stomach, omentum, liver, spleen, colon, and small bowel. There were associated injuries, and the most commonly associated was rib fracture. There was no postoperative death.