Chest Wall and Diaphragmatic Injuries
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Thoracic trauma is the second leading cause of death in case of trauma, after head trauma. Rib fractures are one of the most common injuries affecting trauma patients, occurring in approximately 10% of all cases, and they are associated with a mortality of 3–13%. Frequent complications of this condition are pneumonia, prolonged ventilator time, prolonged hospitalization, and chronic debilitating pain. It has been shown that a greater number of rib fractures are associated with an increased risk of complications, particularly in older patients. Optimal treatment of rib fractures has not been established; in particular, the role of surgery is a matter of debate.
Diaphragmatic injuries have been reported in 0.8–20% of patients hospitalized for blunt trauma and in 3.4–47% of patients sustaining a penetrating thoracoabdominal trauma. Mechanism of injury may be dissipation of energy from the abdominopelvic cavity to the chest in case of blunt trauma or penetrating thoracoabdominal trauma. These result in a laceration of the diaphragm, causing a hernia, that can be diagnosed in the acute setting or remain silent for months or years.
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