Abstract
Purpose
Over the last decade Surgical Stabilisation of Rib Fractures (SSFR) gained popularity in our hospital. With increased numbers, we noted that frequently injuries were missed during primary/secondary survey and radiological imaging that were found during the surgical procedure. With this observation, the research question was formulated: What is the value of diagnostics thoracotomy or thoracoscopy during surgical stabilisation of rib fractures?
Methods
In a single-centre, retrospective study between February 2010 and December 2019, trauma patients who underwent Surgical Stabilisation of Rib Fractures (SSFR) and an inspection thoracotomy were included. All radiological injuries were compared with intraoperative findings. Missed injuries that were discovered during the surgical procedure that were not analysed during primary/secondary survey or on radiological imaging were recorded and retrospectively analysed by an independent radiologist.
Results
Fifty-one patients were included. Eight patients had additional injuries; all had a diaphragmatic rupture, one patient had an additional stomach laceration, and another patient had a significant lung laceration in need of surgical repair. On a CT scan there are 7 signs of predictive value for a diaphragmatic rupture. Only 13 out of the total of 56 diaphragm rupture CT signs were confirmed on the primary CT scans of the eight patients with diaphragmatic injuries; therefore, still 77% of signs could not be confirmed by initial radiological findings.
Conclusion
With the recent shift towards surgical stabilisation of rib fractures, an inspection thoracoscopy or thoracotomy during SSFR should be considered to minimise the incidence of missed intrathoracic injuries requiring early or late surgical treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Anonymous data set available when requested.
References
Tanaka H, Yukioka T, Yamaguti Y et al (2002) Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma 52(4):727–31; discussion 732
Granetzny A, El-Aal MA, Emam ER et al (2005) Surgical versus conservative treatment of flail chest. Evaluation of pulmonary status. Interact Cardiovasc Thorac Surg 4:583–587
Marasco SF, Davies AR, Cooper J et al (2013) Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg 216(5):924–932
Kane ED, Jeremistky E, Pieracci FM et al (2017) Quantifying and exploring the recent national increase in surgical stabilization of rib fractures. J Trauma Acute Care Surg 83(6):1047–1052
Pieracci FM, Leasia K, Bauman Z et al (2020) A multicentre, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns. J Trauma Acute Care Surg 88(2):249–257
Pfeifer R, Pape HC (2008) Missed injuries in trauma patients: a literature review. Patient Saf Surg 2:20
Larici AR, Gotway MB, Litt HI et al (2002) Helical CT with sagittal and coronal reconstructions: accuracy for detection of diaphragmatic injury. AJR Am J Roentgenol 179:451–457
Fair KA, Gordon NT, Barbosa RR et al (2015) Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am Journal Surg 209:864
Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196
Panda A, Kumar A, Gamanagatti S et al (2014) Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol 20(2):121–128
Williams M, Bulger EM, Collins KA (2019) Recognition and management of diaphragmatic injury in adults. UpToDate. Last updated: Mar 04, 2019. Accessed March 10th, 2020
Pieracci FM, Majercik S, Ali-Osman F et al (2016) Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury https://doi.org/10.1016/j.injury.2016.11.026
Schots JPM, Vissers YLJ, Hulsewé KWE et al (2017) Addition of Video-assisted Thorascopic Surgery to the treatment of flail chest. Ann Thorac Surg 103:940–944
Chou YP, Kuo LC, Soo KM et al (2014) The role of repairing lunch laceration during video-assisted thorascopic surgery evacuations for retained haemothorax caused by blunt chest trauma. Eur J Cardiothorac Surgb 46:107–111
Author information
Authors and Affiliations
Contributions
Reinier de Groot, Wim Hogeboom, and Pascal Steenvoorde designed the research. Tess Wemeijer and Dominique Withaar collected the data. All authors analysed the data and contributed to the writing of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Rights and permissions
About this article
Cite this article
Wemeijer, T.M., Hogeboom, W., Steenvoorde, P. et al. Missed injuries in trauma patients: the value of a diagnostic thoracotomy or thoracoscopy during surgical stabilisation of rib fractures. Ir J Med Sci 191, 1285–1289 (2022). https://doi.org/10.1007/s11845-021-02666-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-021-02666-4