Skip to main content

Chest Trauma: Classification and Influence on the General Management

  • Chapter
  • First Online:
Textbook of Polytrauma Management

Abstract

Chest trauma is one of the most common injuries in multiple trauma patients and is associated with an increased risk for the development of posttraumatic complications and an adverse outcome. This chapter summarizes specific aspects of thoracic injuries after blunt and penetrating chest trauma. Furthermore, typical diagnostic procedures and different scoring systems for classification of chest trauma are outlined. Besides general treatment algorithms for thoracic injuries, a special focus lies on the impact of chest trauma for the management of concomitant extremity injury in multiple-trauma patients. In this context, diverse surgical strategies for fracture stabilization—early total care, damage control orthopedics, early appropriate care, safe definitive surgery, and prompt individualized safe management—are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D. Epidemiology of the severely injured patient. A prospective assessment of preclinical and clinical management. AG polytrauma of DGU. Unfallchirurg. 2000;103(5):355–63.

    Article  CAS  PubMed  Google Scholar 

  2. Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000;90(4):523–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43(1):8–17.

    Article  PubMed  Google Scholar 

  4. Unsworth A, Curtis K, Asha SE. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scand J Trauma Resusc Emerg Med. 2015;23:17.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hoff SJ, Shotts SD, Eddy VA, Morris JA Jr. Outcome of isolated pulmonary contusion in blunt trauma patients. Am Surg. 1994;60(2):138–42.

    CAS  PubMed  Google Scholar 

  6. Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982;196(4):481–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Stellin G. Survival in trauma victims with pulmonary contusion. Am Surg. 1991;57(12):780–4.

    CAS  PubMed  Google Scholar 

  8. Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS, Menchine MD. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med. 2009;10(2):79–84.

    PubMed  PubMed Central  Google Scholar 

  9. El-Menyar A, Latifi R, AbdulRahman H, Zarour A, Tuma M, Parchani A, Peralta R, Al Thani H. Age and traumatic chest injury: a 3-year observational study. Eur J Trauma Emerg Surg. 2013;39(4):397–403.

    Article  CAS  PubMed  Google Scholar 

  10. Galan G, Penalver JC, Paris F, Caffarena JM Jr, Blasco E, Borro JM, Garcia-Zarza A, Padilla J, Pastor J, Tarrazona V. Blunt chest injuries in 1696 patients. Eur J Cardiothorac Surg. 1992;6(6):284–7.

    Article  CAS  PubMed  Google Scholar 

  11. Pape HC, Regel G, Dwenger A, Sturm JA, Tscherne H. Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients. Injury. 1993;24(Suppl 3):S82–S103.

    Article  PubMed  Google Scholar 

  12. Pinilla JC. Acute respiratory failure in severe blunt chest trauma. J Trauma. 1982;22(3):221–6.

    Article  CAS  PubMed  Google Scholar 

  13. Johnson JA, Cogbill TH, Winga ER. Determinants of outcome after pulmonary contusion. J Trauma. 1986;26(8):695–7.

    Article  CAS  PubMed  Google Scholar 

  14. Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988;28(3):298–304.

    Article  CAS  PubMed  Google Scholar 

  15. Pape HC, Auf'm'Kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion—a cause of posttraumatic ARDS? J Trauma. 1993;34(4):540–7; discussion 547–548.

    Article  CAS  PubMed  Google Scholar 

  16. Inthorn D, Huf R. Thoracic trauma in multiple trauma. Anasthesiol Intensivmed Notfallmed Schmerzther. 1992;27(8):498–501.

    Article  CAS  PubMed  Google Scholar 

  17. Gaillard M, Hervé C, Mandin L, Raynaud P. Mortality prognostic factors in chest injury. J Trauma. 1990;30(1):93–6.

    Article  CAS  PubMed  Google Scholar 

  18. Trupka A, Nast-Kolb D, Schweiberer L. Thoracic trauma. Unfallchirurg. 1998;101(4):244–58.

    Article  CAS  PubMed  Google Scholar 

  19. Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, Lemaire J, Martin M. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–85.

    Article  PubMed  Google Scholar 

  20. Lema MK, Chalya PL, Mabula JB, Mahalu W. Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania. J Cardiothorac Surg. 2011;6:7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Morley EJ, Johnson S, Leibner E, Shahid J. Emergency department evaluation and management of blunt chest and lung trauma (Trauma CME). Emerg Med Pract. 2016;18(6):1–20.

    PubMed  Google Scholar 

  22. Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017;25(1):42.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Di Bartolomeo S, Sanson G, Nardi G, Scian F, Michelutto V, Lattuada L. A population-based study on pneumothorax in severely traumatized patients. J Trauma. 2001;51(4):677–82.

    Article  PubMed  Google Scholar 

  24. Maslov VI, Takhtamysh MA, Kretov AI. Treatment of multiple ribs fractures. Khirurgiia (Mosk). 2000;4:32–5.

    Google Scholar 

  25. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975–9.

    Article  CAS  PubMed  Google Scholar 

  26. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–6; discussion 1046–1047.

    Article  CAS  PubMed  Google Scholar 

  27. Shorr RM, Rodriguez A, Indeck MC, Crittenden MD, Hartunian S, Cowley RA. Blunt chest trauma in the elderly. J Trauma. 1989;29(2):234–7.

    Article  CAS  PubMed  Google Scholar 

  28. Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg. 2003;196(4):549–55.

    Article  PubMed  Google Scholar 

  29. LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989;69(1):15–9.

    Article  PubMed  Google Scholar 

  30. Segers P, Van Schil P, Jorens P, Van Den Brande F. Thoracic trauma: an analysis of 187 patients. Acta Chir Belg. 2001;101(6):277–82.

    Article  CAS  PubMed  Google Scholar 

  31. Waydhas C. Thoracic trauma. Unfallchirurg. 2000;103(10):871–89; quiz 890, 910.

    Article  CAS  PubMed  Google Scholar 

  32. Krinner S, Grupp S, Oppel P, Langenbach A, Hennig FF, Schulz-Drost S. Do low profile implants provide reliable stability in fixing the sternal fractures as a “fourth vertebral column” in sternovertebral injuries? J Thorac Dis. 2017;9(4):1054–64.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Thomas KP, Sainudeen S, Jose S, Nadhari MY, Macaire PB. Ultrasound-guided parasternal block allows optimal pain relief and ventilation improvement after a sternal fracture. Pain Ther. 2016;5(1):115–22.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zhao Y, Yang Y, Gao Z, Wu W, He W, Zhao T. Treatment of traumatic sternal fractures with titanium plate internal fixation: a retrospective study. J Cardiothorac Surg. 2017;12(1):22.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Buckley BJ, Hayden SR. Posterior sternoclavicular dislocation. J Emerg Med. 2008;34(3):331–2.

    Article  PubMed  Google Scholar 

  36. Horst K, Hildebrand F, Kobbe P, Pfeifer R, Lichte P, Andruszkow H, Lefering R, Pape HC. Detecting severe injuries of the upper body in multiple trauma patients. J Surg Res. 2015;199(2):629–34.

    Article  PubMed  Google Scholar 

  37. Horst K, Dienstknecht T, Pfeifer R, Pishnamaz M, Hildebrand F, Pape HC. Risk stratification by injury distribution in polytrauma patients—does the clavicular fracture play a role? Patient Saf Surg. 2013;7:23.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Weening B, Walton C, Cole PA, Alanezi K, Hanson BP, Bhandari M. Lower mortality in patients with scapular fractures. J Trauma. 2005;59(6):1477–81.

    Article  PubMed  Google Scholar 

  39. Butters KP. Fractures of the scapula. In: Buchholz RW, Heckmann JD, Courth-Brown C, editors. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 1257–84.

    Google Scholar 

  40. Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma. 2006;20(3):230–3.

    Article  PubMed  Google Scholar 

  41. Livingston DH, Haurer CJ. Trauma to the chest wall and lung. In: Moore EE, Felciano DV, Mattox KL, editors. Trauma. Philadelphia: McGraw-Hill; 2004. p. 507–37.

    Google Scholar 

  42. Miller LA. Chest wall, lung, and pleural space trauma. Radiol Clin North Am. 2006;44(2):213–24.

    Article  PubMed  Google Scholar 

  43. Mayberry JC. Imaging in thoracic trauma: the trauma surgeon’s perspective. J Thorac Imaging. 2000;15(2):76–86.

    Article  CAS  PubMed  Google Scholar 

  44. Brar MS, Bains I, Brunet G, Nicolaou S, Ball CG, Kirkpatrick AW. Occult pneumothoraces truly occult or simply missed: redux. J Trauma. 2010;69(6):1335–7.

    PubMed  Google Scholar 

  45. Bridges KG, Welch G, Silver M, Schinco MA, Esposito B. CT detection of occult pneumothorax in multiple trauma patients. J Emerg Med. 1993;11(2):179–86.

    Article  CAS  PubMed  Google Scholar 

  46. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004;57(2):288–95.

    Article  CAS  PubMed  Google Scholar 

  47. Omar HR, Abdelmalak H, Mangar D, Rashad R, Helal E, Camporesi EM. Occult pneumothorax, revisited. J Trauma Manag Outcomes. 2010;4:12.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29(3):312–5; discussion 315–316.

    Article  CAS  PubMed  Google Scholar 

  49. Malekpour M, Widom K, Dove J, Blansfield J, Shabahang M, Torres D, Wild JL. Management of computed tomography scan detected hemothorax in blunt chest trauma: What computed tomography scan measurements say? World J Radiol. 2018;10(12):184–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mirvis SE, Shanmuganagthan K. Imaging hemidiaphragmatic injury. Eur Radiol. 2007;17(6):1411–21.

    Article  PubMed  Google Scholar 

  51. Sliker CW. Imaging of diaphragm injuries. Radiol Clin North Am. 2006;44(2):199–211.

    Article  PubMed  Google Scholar 

  52. Bergeron E, Clas D, Ratte S, Beauchamp G, Denis R, Evans D, Frechette P, Martin M. Impact of deferred treatment of blunt diaphragmatic rupture: a 15-year experience in six trauma centers in Quebec. J Trauma. 2002;52(4):633–40.

    PubMed  Google Scholar 

  53. Gavelli G, Canini R, Bertaccini P, Battista G, Bnà C, Fattori R. Traumatic injuries: imaging of thoracic injuries. Eur Radiol. 2002;12(6):1273–94.

    Article  CAS  PubMed  Google Scholar 

  54. Nchimi A, Szapiro D, Ghaye B, Willems V, Khamis J, Haquet L, Noukoua C, Dondelinger RF. Helical CT of blunt diaphragmatic rupture. AJR Am J Roentgenol. 2005;184(1):24–30.

    Article  PubMed  Google Scholar 

  55. Panda A, Kumar A, Gamanagatti S, Patil A, Kumar S, Gupta A. Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol. 2014;20(2):121–8.

    PubMed  PubMed Central  Google Scholar 

  56. Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, Gurrado A. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg. 2017;12:23.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Bonatti M, Lombardo F, Vezzali N, Zamboni GA, Bonatti G. Blunt diaphragmatic lesions: Imaging findings and pitfalls. World J Radiol. 2016;8(10):819–28.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Iochum S, Ludig T, Walter F, Sebbag H, Grosdidier G, Blum AG. Imaging of diaphragmatic injury: a diagnostic challenge? Radiographics. 2002;22:S103–16; discussion S116–S118.

    Article  PubMed  Google Scholar 

  59. Mahmood I, El-Menyar A, Younis B, Ahmed K, Nabir S, Ahmed MN, Al-Yahri O, Mahmood S, Consunji R, Al-Thani H. Clinical Significance and prognostic implications of quantifying pulmonary contusion volume in patients with blunt chest trauma. Med Sci Monit. 2017;23:3641–8.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol. 2009;192(3):599–612.

    Article  PubMed  Google Scholar 

  61. Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg. 1987;206(2):200–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Obertacke U, Neudeck F, Hellinger A, Schmit-Neuburg KP. Pathophysiologie, Diagnostik und Therapie der Lungenkontusion. Akt Chir. 1997;32:32–48.

    Google Scholar 

  63. Miller HAB, Taylor GA. Flail chest and pulmonary contusion. In: McMutry RY, McLellan BA, editors. Management of blunt trauma. Baltimore: Williams & Wilkins; 1990. p. 186–98.

    Google Scholar 

  64. Gams E, Kalweit G. Thoraxverletzungen. In: Mutschler W, Haas N, editors. Praxis der Unfallchirurgie. Stuttgart: Thieme; 1998. p. 275–304.

    Google Scholar 

  65. Avcı A, Özyılmaz Saraç E, Eren T, Onat S, Ülkü R, Özçelik C. Risk factors affecting post-traumatic acute respiratory distress syndrome development in thoracic trauma patients. Turk Gogus Kalp Damar Cerrahisi Derg. 2019;27(4):540–9.

    Article  PubMed  PubMed Central  Google Scholar 

  66. El Mestoui Z, Jalalzadeh H, Giannakopoulos GF, Zuidema WP. Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center. Eur J Emerg Med. 2017;24(1):49–54.

    Article  PubMed  Google Scholar 

  67. Donnelly SC, Haslett C, Dransfield I, Robertson CE, Carter DC, Ross JA, Grant IS, Tedder TF. Role of selectins in development of adult respiratory distress syndrome. Lancet. 1994;344(8917):215–9.

    Article  CAS  PubMed  Google Scholar 

  68. Windsor AC, Mullen PG, Fowler AA, Sugerman HJ. Role of the neutrophil in adult respiratory distress syndrome. Br J Surg. 1993;80(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  69. Allen GS, Coates NE. Pulmonary contusion: a collective review. Am Surg. 1996;62(11):895–900.

    CAS  PubMed  Google Scholar 

  70. Watkins TR, Nathens AB, Cooke CR, Psaty BM, Maier RV, Cuschieri J, Rubenfeld GD. Acute respiratory distress syndrome after trauma: development and validation of a predictive model. Crit Care Med. 2012;40(8):2295–303.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Hildebrand F, Stuhrmann M, van Griensven M, Meier S, Hasenkamp S, Krettek C, Pape HC. Association of IL-8-251A/T polymorphism with incidence of acute respiratory distress syndrome (ARDS) and IL-8 synthesis after multiple trauma. Cytokine. 2007;37(3):192–9.

    Article  CAS  PubMed  Google Scholar 

  72. Miller PR, Croce MA, Kilgo PD, Scott J, Fabian TC. Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg. 2002;68(10):845–50; discussion 850–851.

    PubMed  Google Scholar 

  73. Karmy-Jones R, Wood DE. Traumatic injury to the trachea and bronchus. Thorac Surg Clin. 2007;17(1):35–46.

    Article  PubMed  Google Scholar 

  74. Kiser AC, O'Brien SM, Detterbeck FC. Blunt tracheobronchial injuries: treatment and outcomes. Ann Thorac Surg. 2001;71(6):2059–65.

    Article  CAS  PubMed  Google Scholar 

  75. van Roozendaal LM, van Gool MH, Sprooten RTM, Maesen BAE, Poeze M, Hulsewé KWE, Vissers YLJ, de Loos ER. Surgical treatment of bronchial rupture in blunt chest trauma: a review of literature. J Thorac Dis. 2018;10(9):5576–83.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Bertelsen S, Howitz P. Injuries of the trachea and bronchi. Thorax. 1972;27(2):188–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Lee WT, Eliashar R, Eliachar I. Acute external laryngotracheal trauma: diagnosis and management. Ear Nose Throat J. 2006;85(3):179–84.

    Article  PubMed  Google Scholar 

  78. Díaz C, Carvajal DF, Morales EI, Sangiovanni S, Fernández-Trujillo L. Right main bronchus rupture associated with blunt chest trauma: a case report. Int J Emerg Med. 2019;12(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Zhao Z, Zhang T, Yin X, Zhao J, Li X, Zhou Y. Update on the diagnosis and treatment of tracheal and bronchial injury. J Thorac Dis. 2017;9(1):E50–6.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Salehian O, Teoh K, Mulji A. Blunt and penetrating cardiac trauma: a review. Can J Cardiol. 2003;19(9):1054–9.

    PubMed  Google Scholar 

  81. Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW. Signs in thoracic imaging. J Thorac Imaging. 2006;21(1):76–90.

    Article  PubMed  Google Scholar 

  82. Bertinchant JP, Polge A, Mohty D, Nguyen-Ngoc-Lam R, Estorc J, Cohendy R, Joubert P, Poupard P, Fabbro-Peray P, Monpeyroux F, Poirey S, Ledermann B, Raczka F, Brunet J, Nigond J, de la Coussaye JE. Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma. J Trauma. 2000;48(5):924–31.

    Article  CAS  PubMed  Google Scholar 

  83. Bayer MJ, Burdick D. Diagnosis of myocardial contusion in blunt chest trauma. Jacep. 1977;6(6):238–42.

    Article  CAS  PubMed  Google Scholar 

  84. Fadel R, El-Menyar A, ElKafrawy S, Gad MG. Traumatic blunt cardiac injuries: An updated narrative review. Int J Crit Illn Inj Sci. 2019;9(3):113–9.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Mielczarek M, Fijałkowska J, Burakowski S, Ciećwierz D, Gruchała M, Fijałkowski M. Contrast-enhanced computed tomography for early detection of acute myocardial infarction due to blunt chest trauma. Postepy Kardiol Interwencyjnej. 2017;13(4):343–4.

    PubMed  PubMed Central  Google Scholar 

  86. Di Marco L, Pacini D, Di Bartolomeo R. Acute traumatic thoracic aortic injury: considerations and reflections on the endovascular aneurysm repair. Aorta (Stamford). 2013;1(2):117–22.

    Article  Google Scholar 

  87. DuBose JJ, Leake SS, Brenner M, Pasley J, O'Callaghan T, Luo-Owen X, Trust MD, Mooney J, Zhao FZ, Azizzadeh A. Contemporary management and outcomes of blunt thoracic aortic injury: a multicenter retrospective study. J Trauma Acute Care Surg. 2015;78(2):360–9.

    Article  PubMed  Google Scholar 

  88. Gombert A, Barbati ME, Storck M, Kotelis D, Keschenau P, Pape HC, Andruszkow H, Lefering R, Hildebrand F, Greiner A, Jacobs MJ, Grommes J. Treatment of blunt thoracic aortic injury in Germany-Assessment of the TraumaRegister DGU®. PLoS One. 2017;12(3):e0171837.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Cubash H, Degiannis E. The deadly dozen of chest trauma. CME. 2004;22(7):369–72.

    Google Scholar 

  90. Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med. 2002;30(11 Suppl):S409–15.

    Article  PubMed  Google Scholar 

  91. Pauzé DR, Pauzé DK. Emergency management of blunt chest trauma in children: an evidence-based approach. Pediatr Emerg. Med Pract. 2013;10(11):1–22; quiz 22–23.

    Google Scholar 

  92. Peclet MH, Newman KD, Eichelberger MR, Gotschall CS, Garcia VF, Bowman LM. Thoracic trauma in children: an indicator of increased mortality. J Pediatr Surg. 1990;25(9):961–5; discussion 965–966.

    Article  CAS  PubMed  Google Scholar 

  93. Sartorelli KH, Vane DW. The diagnosis and management of children with blunt injury of the chest. Semin Pediatr Surg. 2004;13(2):98–105.

    Article  PubMed  Google Scholar 

  94. Sharma S, Mishra B, Gupta A, Soni KD, Aggarwal R, Kumar S. Challenges in management of pediatric life-threatening neck and chest trauma. J Indian Assoc Pediatr Surg. 2018;23(1):10–5.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med. 2018;6(19):384.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Uffmann M, Fuchs M, Herold CJ. Radiologic imaging of thoracic trauma. Radiologe. 1998;38(8):683–92.

    Article  CAS  PubMed  Google Scholar 

  97. Dörr F. Differential diagnosis and treatment control of blunt chest trauma with computed tomography. Anasthesiol Intensivmed Notfallmed Schmerzther. 1999;34(Suppl 1):S41–4.

    PubMed  Google Scholar 

  98. Schild HH, Strunk H, Weber W, Stoerkel S, Doll G, Hein K, Weitz M. Pulmonary contusion: CT vs plain radiograms. J Comput Assist Tomogr. 1989;13(3):417–20.

    Article  CAS  PubMed  Google Scholar 

  99. Fulton RL, Peter ET. The progressive nature of pulmonary contusion. Surgery. 1970;67(3):499–506.

    CAS  PubMed  Google Scholar 

  100. Regel G, Sturm JA, Neumann C, Bosch U, Tscherne H. Bronchoscopy of lung contusion in severe thoracic trauma. Unfallchirurg. 1987;90(1):20–6.

    CAS  PubMed  Google Scholar 

  101. Perry JF Jr, Galway CF. Chest injury due to blunt trauma. J Thorac Cardiovasc Surg. 1965;49:684–93.

    Article  PubMed  Google Scholar 

  102. Marts B, Durham R, Shapiro M, Mazuski JE, Zuckerman D, Sundaram M, Luchtefeld WB. Computed tomography in the diagnosis of blunt thoracic injury. Am J Surg. 1994;168(6):688–92.

    Article  CAS  PubMed  Google Scholar 

  103. Greene R. Lung alterations in thoracic trauma. J Thorac Imaging. 1987;2(3):1–11.

    Article  CAS  PubMed  Google Scholar 

  104. Hwang EG, Lee Y. Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures. J Exerc Rehabil. 2016;12(6):637–41.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Traub M, Stevenson M, McEvoy S, Briggs G, Lo SK, Leibman S, Joseph T. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury. 2007;38(1):43–7.

    Article  PubMed  Google Scholar 

  106. Rodriguez RM, Anglin D, Langdorf MI, Baumann BM, Hendey GW, Bradley RN, Medak AJ, Raja AS, Juhn P, Fortman J, Mulkerin W, Mower WR. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013;148(10):940–6.

    Article  PubMed  Google Scholar 

  107. Blostein PA, Hodgman CG. Computed tomography of the chest in blunt thoracic trauma: results of a prospective study. J Trauma. 1997;43(1):13–8.

    Article  CAS  PubMed  Google Scholar 

  108. Rizzo AG, Steinberg SM, Flint LM. Prospective assessment of the value of computed tomography for trauma. J Trauma. 1995;38(3):338–42; discussion 342–343.

    Article  CAS  PubMed  Google Scholar 

  109. Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg. 2001;67(7):660–4.

    CAS  PubMed  Google Scholar 

  110. Guerrero-López F, Vázquez-Mata G, Alcázar-Romero PP, Fernández-Mondéjar E, Aguayo-Hoyos E, Linde-Valverde CM. Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma. Crit Care Med. 2000;28(5):1370–5.

    Article  PubMed  Google Scholar 

  111. McGonigal MD, Schwab CW, Kauder DR, Miller WT, Grumbach K. Supplemental emergent chest computed tomography in the management of blunt torso trauma. J Trauma. 1990;30(12):1431–4; discussion 1434–1435.

    Article  CAS  PubMed  Google Scholar 

  112. Trupka A, Kierse R, Waydhas C, Nast-Kolb D, Blahs U, Schweiberer L, Pfeifer KJ. Shock room diagnosis in polytrauma. Value of thoracic CT. Unfallchirurg. 1997;100(6):469–76.

    Article  CAS  PubMed  Google Scholar 

  113. Kaiser M, Whealon M, Barrios C, Dobson S, Malinoski D, Dolich M, Lekawa M, Hoyt D, Cinat M. The clinical significance of occult thoracic injury in blunt trauma patients. Am Surg. 2010;76(10):1063–6.

    Article  PubMed  Google Scholar 

  114. Kea B, Gamarallage R, Vairamuthu H, Fortman J, Lunney K, Hendey GW, Rodriguez RM. What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma? Am J Emerg Med. 2013;31(8):1268–73.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Matsumoto S, Sekine K, Funabiki T, Orita T, Shimizu M, Hayashida K, Kazamaki T, Suzuki T, Kishikawa M, Yamazaki M, Kitano M. Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography. World J Emerg Surg. 2016;11:5.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Brink M, Deunk J, Dekker HM, Edwards MJ, Kool DR, van Vugt AB, van Kuijk C, Blickman JG. Criteria for the selective use of chest computed tomography in blunt trauma patients. Eur Radiol. 2009;20(4):818–28.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Brink M, Kool DR, Dekker HM, Deunk J, Jager GJ, van Kuijk C, Edwards MJ, Blickman JG. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature. Clin Radiol. 2009;64(3):272–83.

    Article  CAS  PubMed  Google Scholar 

  118. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest. 2008;133(1):204–11.

    Article  PubMed  Google Scholar 

  119. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, Jiang GY. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care. 2006;10(4):R112.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Röthlin MA, Näf R, Amgwerd M, Candinas D, Frick T, Trentz O. Ultrasound in blunt abdominal and thoracic trauma. J Trauma. 1993;34(4):488–95.

    Article  PubMed  Google Scholar 

  121. Walz M, Muhr G. Sonographic diagnosis in blunt thoracic trauma. Unfallchirurg. 1990;93(8):359–63.

    CAS  PubMed  Google Scholar 

  122. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844–9.

    Article  PubMed  Google Scholar 

  123. Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231–8.

    Article  PubMed  Google Scholar 

  124. Soldati G, Testa A, Pignataro G, Portale G, Biasucci DG, Leone A, Silveri NG. The ultrasonographic deep sulcus sign in traumatic pneumothorax. Ultrasound Med Biol. 2006;32(8):1157–63.

    Article  PubMed  Google Scholar 

  125. Wüstner A, Gehmacher O, Hämmerle S, Schenkenbach C, Häfele H, Mathis G. Ultrasound diagnosis in blunt thoracic trauma. Ultraschall Med. 2005;26(4):285–90.

    Article  PubMed  Google Scholar 

  126. Hara KS, Prakash UB. Fiberoptic bronchoscopy in the evaluation of acute chest and upper airway trauma. Chest. 1989;96(3):627–30.

    Article  CAS  PubMed  Google Scholar 

  127. Regel G, Seekamp A, Aebert H, Wegener G, Sturm JA. Bronchoscopy in severe blunt chest trauma. Surg Endosc. 1990;4(1):31–5.

    Article  CAS  PubMed  Google Scholar 

  128. Hoffmann P, Gahr R. Comment on the contribution by Th. Joka et al.: Early diagnosis of lung contusion by bronchoscopy. Unfallchirurg (1987) 90:286. Unfallchirurg. 1989;92(2):92–6.

    CAS  PubMed  Google Scholar 

  129. Chen YY, Lin KH, Huang HK, Chang H, Lee SC, Huang TW. The beneficial application of preoperative 3D printing for surgical stabilization of rib fractures. PLoS One. 2018;13(10):e0204652.

    Article  PubMed  PubMed Central  Google Scholar 

  130. Baskaran V, Štrkalj G, Štrkalj M, Di Ieva A. Current applications and future perspectives of the use of 3D printing in anatomical training and neurosurgery. Front Neuroanat. 2016;10:69.

    Article  PubMed  PubMed Central  Google Scholar 

  131. McMenamin PG, Quayle MR, McHenry CR, Adams JW. The production of anatomical teaching resources using three-dimensional (3D) printing technology. Anat Sci Educ. 2014;7(6):479–86.

    Article  PubMed  Google Scholar 

  132. Tyburski JG, Collinge JD, Wilson RF, Eachempati SR. Pulmonary contusions: quantifying the lesions on chest X-ray films and the factors affecting prognosis. J Trauma. 1999;46(5):833–8.

    Article  CAS  PubMed  Google Scholar 

  133. Wagner RB, Jamieson PM. Pulmonary contusion. Evaluation and classification by computed tomography. Surg Clin North Am. 1989;69(1):31–40.

    Article  CAS  PubMed  Google Scholar 

  134. Chen J, Jeremitsky E, Philp F, Fry W, Smith RS. A chest trauma scoring system to predict outcomes. Surgery. 2014;156(4):988–93.

    Article  PubMed  Google Scholar 

  135. Harde M, Aditya G, Dave S. Prediction of outcomes in chest trauma patients using chest trauma scoring system: a prospective observational study. Indian J Anaesth. 2019;63(3):194–9.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma. 2000;49(3):496–504.

    Article  CAS  PubMed  Google Scholar 

  137. Eren S, Balci AE, Ulku R, Cakir O, Eren MN. Thoracic firearm injuries in children: management and analysis of prognostic factors. Eur J Cardiothorac Surg. 2003;23(6):888–93.

    Article  PubMed  Google Scholar 

  138. Oestern HJ, Kabus K. The classification of the severely and multiply injured—what has been established? Chirurg. 1997;68(11):1059–65.

    Article  CAS  PubMed  Google Scholar 

  139. Esme H, Solak O, Yurumez Y, Yavuz Y, Terzi Y, Sezer M, Kucuker H. The prognostic importance of trauma scoring systems for blunt thoracic trauma. Thorac Cardiovasc Surg. 2007;55(3):190–5.

    Article  CAS  PubMed  Google Scholar 

  140. Athanassiadi K, Gerazounis M, Theakos N. Management of 150 flail chest injuries: analysis of risk factors affecting outcome. Eur J Cardiothorac Surg. 2004;26(2):373–6.

    Article  PubMed  Google Scholar 

  141. Joosse P, Soedarmo S, Luitse JS, Ponsen KJ. Trauma outcome analysis of a Jakarta University Hospital using the TRISS method: validation and limitation in comparison with the major trauma outcome study. Trauma and Injury Severity Score. J Trauma. 2001;51(1):134–40.

    Article  CAS  PubMed  Google Scholar 

  142. Sharma BR. The injury scale—a valuable tool for forensic documentation of trauma. J Clin Forensic Med. 2005;12(1):21–8.

    Article  CAS  PubMed  Google Scholar 

  143. Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Frömke C, Puljic P, van Griensven M, Frink M, Krettek C, Hildebrand F. Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma. J Surg Res. 2012;176(1):239–47.

    Article  PubMed  Google Scholar 

  144. Okgun Alcan A, Yavuz van Giersbergen M, Dincarslan G, Hepcivici Z, Kaya E, Uyar M. Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients. Aust Crit Care. 2017;30(5):267–S272.

    Article  PubMed  Google Scholar 

  145. Bein T. Patient positioning-kinetic therapy in intensive medicine. Anaesthesist. 1998;47(1):74–80.

    Article  CAS  PubMed  Google Scholar 

  146. Léonet S, Fontaine C, Moraine JJ, Vincent JL. Prone positioning in acute respiratory failure: survey of Belgian ICU nurses. Intensive Care Med. 2002;28(5):576–80.

    Article  PubMed  Google Scholar 

  147. Muhl E, Hansen M, Bruch HP. Kinetic therapy within the scope of treating septic surgical patients. Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32(4):249–52.

    Article  CAS  PubMed  Google Scholar 

  148. Gordon A, Rabold E, Thirumala R, Husain AA, Patel S, Cheema T. Prone positioning in ARDS. Crit Care Nurs Q. 2019;42(4):371–5.

    Article  PubMed  Google Scholar 

  149. Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, Uleryk E, Mancebo J, Pesenti A, Ranieri VM, Fan E. Prone position for acute respiratory distress syndrome. a systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14(Supplement_4):S280–8.

    Article  PubMed  Google Scholar 

  150. Pappert D, Rossaint R, Slama K, Grüning T, Falke KJ. Influence of positioning on ventilation-perfusion relationships in severe adult respiratory distress syndrome. Chest. 1994;106(5):1511–6.

    Article  CAS  PubMed  Google Scholar 

  151. Mure M, Domino KB, Lindahl SG, Hlastala MP, Altemeier WA, Glenny RW. Regional ventilation-perfusion distribution is more uniform in the prone position. J Appl Physiol. 2000;88(3):1076–83.

    Article  CAS  PubMed  Google Scholar 

  152. Lamm WJ, Graham MM, Albert RK. Mechanism by which the prone position improves oxygenation in acute lung injury. Am J Respir Crit Care Med. 1994;150(1):184–93.

    Article  CAS  PubMed  Google Scholar 

  153. Walz M, Muhr G. Continuously alternating prone and supine positioning in acute lung failure. Chirurg. 1992;63(11):931–7.

    CAS  PubMed  Google Scholar 

  154. Marini JJ. How to recruit the injured lung. Minerva Anestesiol. 2003;69(4):193–200.

    CAS  PubMed  Google Scholar 

  155. Guerin C, Badet M, Rosselli S, Heyer L, Sab JM, Langevin B, Philit F, Fournier G, Robert D. Effects of prone position on alveolar recruitment and oxygenation in acute lung injury. Intensive Care Med. 1999;25(11):1222–30.

    Article  CAS  PubMed  Google Scholar 

  156. Gattinoni L, Pelosi P, Vitale G, Pesenti A, D'Andrea L, Mascheroni D. Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology. 1991;74(1):15–23.

    Article  CAS  PubMed  Google Scholar 

  157. Albert RK, Hubmayr RD. The prone position eliminates compression of the lungs by the heart. Am J Respir Crit Care Med. 2000;161(5):1660–5.

    Article  CAS  PubMed  Google Scholar 

  158. Reutershan J, Schmitt A, Dietz K, Unertl K, Fretschner R. Alveolar recruitment during prone position: time matters. Clin Sci (Lond). 2006;110(6):655–63.

    Article  Google Scholar 

  159. Lee DL, Chiang HT, Lin SL, Ger LP, Kun MH, Huang YC. Prone-position ventilation induces sustained improvement in oxygenation in patients with acute respiratory distress syndrome who have a large shunt. Crit Care Med. 2002;30(7):1446–52.

    Article  PubMed  Google Scholar 

  160. McAuley DF, Giles S, Fichter H, Perkins GD, Gao F. What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome? Intensive Care Med. 2002;28(4):414–8.

    Article  CAS  PubMed  Google Scholar 

  161. Bein T, Sabel K, Scherer A, Papp-Jambor C, Hekler M, Dubb R, Schlitt HJ, Taeger K. Comparison of incomplete (135 degrees) and complete prone position (180 degrees) in patients with acute respiratory distress syndrome. Results of a prospective, randomised trial. Anaesthesist. 2004;53(11):1054–60.

    Article  CAS  PubMed  Google Scholar 

  162. Staudinger T, Kofler J, Müllner M, Locker GJ, Laczika K, Knapp S, Losert H, Frass M. Comparison of prone positioning and continuous rotation of patients with adult respiratory distress syndrome: results of a pilot study. Crit Care Med. 2001;29(1):51–6.

    Article  CAS  PubMed  Google Scholar 

  163. Hering R, Vorwerk R, Wrigge H, Zinserling J, Schröder S, von Spiegel T, Hoeft A, Putensen C. Prone positioning, systemic hemodynamics, hepatic indocyanine green kinetics, and gastric intramucosal energy balance in patients with acute lung injury. Intensive Care Med. 2002;28(1):53–8.

    Article  PubMed  Google Scholar 

  164. Hering R, Wrigge H, Vorwerk R, Brensing KA, Schröder S, Zinserling J, Hoeft A, Spiegel TV, Putensen C. The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg. 2001;92(5):1226–31.

    Article  CAS  PubMed  Google Scholar 

  165. Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;345(8):568–73.

    Article  CAS  PubMed  Google Scholar 

  166. Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, Palmier B, Le QV, Sirodot M, Rosselli S, Cadiergue V, Sainty JM, Barbe P, Combourieu E, Debatty D, Rouffineau J, Ezingeard E, Millet O, Guelon D, Rodriguez L, Martin O, Renault A, Sibille JP, Kaidomar M. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004;292(19):2379–87.

    Article  CAS  PubMed  Google Scholar 

  167. Pape HC, Remmers D, Weinberg A, Graf B, Reilmann H, Evans S, Regel G, Tscherne H. Is early kinetic positioning beneficial for pulmonary function in multiple trauma patients? Injury. 1998;29(3):219–25.

    Article  CAS  PubMed  Google Scholar 

  168. Fink MP, Helsmoortel CM, Stein KL, Lee PC, Cohn SM. The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma. A prospective study. Chest. 1990;97(1):132–7.

    CAS  PubMed  Google Scholar 

  169. Stiletto R, Gotzen L, Goubeaud S. Kinetic therapy for therapy and prevention of post-traumatic lung failure. Results of a prospective study of 111 polytrauma patients. Unfallchirurg. 2000;103(12):1057–64.

    Article  CAS  PubMed  Google Scholar 

  170. Pape HC, Regel G, Borgmann W, Sturm JA, Tscherne H. The effect of kinetic positioning on lung function and pulmonary haemodynamics in posttraumatic ARDS: a clinical study. Injury. 1994;25(1):51–7.

    Article  CAS  PubMed  Google Scholar 

  171. Mullins CD, Philbeck TE Jr, Schroeder WJ, Thomas SK. Cost effectiveness of kinetic therapy in preventing nosocomial lower respiratory tract infections in patients suffering from trauma. Manag Care Interface. 2002;15(8):35–40.

    PubMed  Google Scholar 

  172. Pape HC, Weinberg A, Graf B, Reilmann H, Tscherne H, Regel G. Continuous axial position change in post-traumatic lung failure—preventive or therapeutic indications? Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32(4):245–9.

    Article  CAS  PubMed  Google Scholar 

  173. Bein T, Reber A, Metz C, Jauch KW, Hedenstierna G. Acute effects of continuous rotational therapy on ventilation-perfusion inequality in lung injury. Intensive Care Med. 1998;24(2):132–7.

    Article  CAS  PubMed  Google Scholar 

  174. Wyen H, Wutzler S, Maegele M, Lefering R, Nau C, Seidel D, Marzi I. Rotational bed therapy after blunt chest trauma: a nationwide online-survey on current concepts of care in Germany. Injury. 2013;44(1):70–4.

    Article  PubMed  Google Scholar 

  175. deBoisblanc BP, Castro M, Everret B, Grender J, Walker CD, Summer WR. Effect of air-supported, continuous, postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest. 1993;103(5):1543–7.

    Article  CAS  PubMed  Google Scholar 

  176. Traver GA, Tyler ML, Hudson LD, Sherrill DL, Quan SF. Continuous oscillation: outcome in critically ill patients. J Crit Care. 1995;10(3):97–103.

    Article  CAS  PubMed  Google Scholar 

  177. Delaney A, Gray H, Laupland KB, Zuege DJ. Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients: a systematic review and meta-analysis. Crit Care. 2006;10(3):R70.

    Article  PubMed  PubMed Central  Google Scholar 

  178. Goldhill DR, Imhoff M, McLean B, Waldmann C. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis. Am J Crit Care. 2007;16(Supplement_4):S280–8:50–61; quiz 62.

    Google Scholar 

  179. Clemmer TP, Green S, Ziegler B, Wallace CJ, Menlove R, Orme JF Jr, Thomas F, Tocino I, Crapo RO. Effectiveness of the kinetic treatment table for preventing and treating pulmonary complications in severely head-injured patients. Crit Care Med. 1990;18(6):614–7.

    Article  CAS  PubMed  Google Scholar 

  180. Zeckey C, Wendt K, Mommsen P, Winkelmann M, Frömke C, Weidemann J, Stübig T, Krettek C, Hildebrand F. Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center. Technol Health Care. 2015;23(1):63–73.

    Article  CAS  PubMed  Google Scholar 

  181. Mahlke L, Oestern S, Drost J, Frerichs A, Seekamp A. Prophylactic ventilation of severely injured patients with thoracic trauma - does it always make sense? Unfallchirurg. 2009;112(11):938–41.

    Article  CAS  PubMed  Google Scholar 

  182. Sutyak JP, Wohltmann CD, Larson J. Pulmonary contusions and critical care management in thoracic trauma. Thorac Surg Clin. 2007;17(1):11–23.

    Article  PubMed  Google Scholar 

  183. O'Brien PJ. Fracture fixation in patients having multiple injuries. Can J Surg. 2003;46(2):124–8.

    PubMed  PubMed Central  Google Scholar 

  184. Bose D, Tejwani NC. Evolving trends in the care of polytrauma patients. Injury. 2006;37(1):20–8.

    Article  CAS  PubMed  Google Scholar 

  185. Pape HC, Hildebrand F, Krettek C, Green J, Giannoudis PV. Experimental background—review of animal studies. Injury. 2006;37(Suppl 4):S25–38.

    Article  PubMed  Google Scholar 

  186. Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, Gruner A, Oestern HJ, Bayeff-Filoff M, Garving C, Pardini D, van Griensven M, Krettek C, Giannoudis P. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg. 2007;246(3):491–9; discussion 499–501.

    Article  PubMed  PubMed Central  Google Scholar 

  187. Weninger P, Figl M, Spitaler R, Mauritz W, Hertz H. Early unreamed intramedullary nailing of femoral fractures is safe in patients with severe thoracic trauma. J Trauma. 2007;62(3):692–6.

    PubMed  Google Scholar 

  188. Harwood PJ, Giannoudis PV, van Griensven M, Krettek C, Pape HC. Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients. J Trauma. 2005;58(3):446–52; discussion 452–454.

    Article  PubMed  Google Scholar 

  189. Gray AC, White TO, Clutton E, Christie J, Hawes BD, Robinson CM. The stress response to bilateral femoral fractures: a comparison of primary intramedullary nailing and external fixation. J Orthop Trauma. 2009;23(2):90–7; discussion 98–99.

    Article  CAS  PubMed  Google Scholar 

  190. Robinson CM. Current concepts of respiratory insufficiency syndromes after fracture. J Bone Joint Surg Br. 2001;83(6):781–91.

    Article  CAS  PubMed  Google Scholar 

  191. Taeger G, Ruchholtz S, Waydhas C, Lewan U, Schmidt B, Nast-Kolb D. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma. 2005;59(2):409–16; discussion 417.

    PubMed  Google Scholar 

  192. Brundage SI, McGhan R, Jurkovich GJ, Mack CD, Maier RV. Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries. J Trauma. 2002;52(2):299–307.

    PubMed  Google Scholar 

  193. Dunham CM, Bosse MJ, Clancy TV, Cole FJ Jr, Coles MJ, Knuth T, Luchette FA, Ostrum R, Plaisier B, Poka A, Simon RJ. Practice management guidelines for the optimal timing of long-bone fracture stabilization in polytrauma patients: the EAST Practice Management Guidelines Work Group. J Trauma. 2001;50(5):958–67.

    Article  CAS  PubMed  Google Scholar 

  194. Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48(4):613–21; discussion 621–623.

    Article  CAS  PubMed  Google Scholar 

  195. Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, Krettek C, Reed RL 2nd. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma. 2002;53(3):452–61; discussion 461–462.

    Article  PubMed  Google Scholar 

  196. Giannoudis PV. Surgical priorities in damage control in polytrauma. J Bone Joint Surg Br. 2003;85(4):478–83.

    Article  CAS  PubMed  Google Scholar 

  197. Pape HC, Andruszkow H, Pfeifer R, Hildebrand F, Barkatali BM. Options and hazards of the early appropriate care protocol for trauma patients with major fractures: towards safe definitive surgery. Injury. 2016;47(4):787–91.

    Article  CAS  PubMed  Google Scholar 

  198. Vallier HA, Dolenc AJ, Moore TA. Early appropriate care: a protocol to standardize resuscitation assessment and to expedite fracture care reduces hospital stay and enhances revenue. J Orthop Trauma. 2016;30(6):306–11.

    PubMed  Google Scholar 

  199. D'Alleyrand JC, O’Toole RV. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care. Orthop Clin North Am. 2013;44(4):499–507.

    Article  PubMed  Google Scholar 

  200. Vallier HA, Wang X, Moore TA, Wilber JH, Como JJ. Timing of orthopaedic surgery in multiple trauma patients: development of a protocol for early appropriate care. J Orthop Trauma. 2013;27(10):543–51.

    Article  PubMed  Google Scholar 

  201. Nahm NJ, Como JJ, Wilber JH, Vallier HA. Early appropriate care: definitive stabilization of femoral fractures within 24 hours of injury is safe in most patients with multiple injuries. J Trauma. 2011;71(1):175–85.

    PubMed  Google Scholar 

  202. Pape HC, Pfeifer R. Safe definitive orthopaedic surgery (SDS): repeated assessment for tapered application of Early Definitive Care and Damage Control?: an inclusive view of recent advances in polytrauma management. Injury. 2015;46(1):1–3.

    Article  CAS  PubMed  Google Scholar 

  203. Giannoudis PV, Giannoudis VP, Horwitz DS. Time to think outside the box: 'Prompt-Individualised-Safe Management' (PR.I.S.M.) should prevail in patients with multiple injuries. Injury. 2017;48(7):1279–82.

    Article  CAS  PubMed  Google Scholar 

  204. Pape HC, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients—an update on principles, parameters and strategies for 2020. Injury. 2019;50(10):1656–70.

    Article  PubMed  Google Scholar 

  205. Schreiber VM, Tarkin IS, Hildebrand F, Darwiche S, Pfeifer R, Chelly J, Giannoudis P, Pape HC. The timing of definitive fixation for major fractures in polytrauma—a matched-pair comparison between a US and European level I centres: analysis of current fracture management practice in polytrauma. Injury. 2011;42(7):650–4.

    Article  PubMed  Google Scholar 

  206. Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP. Operative chest wall stabilization in flail chest—outcomes of patients with or without pulmonary contusion. J Am Coll Surg. 1998;187(2):130–8.

    Article  CAS  PubMed  Google Scholar 

  207. Pettiford BL, Luketich JD, Landreneau RJ. The management of flail chest. Thorac Surg Clin. 2007;17(1):25–33.

    Article  PubMed  Google Scholar 

  208. Leinicke JA, Elmore L, Freeman BD, Colditz GA. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg. 2013;258(6):914–21.

    Article  PubMed  Google Scholar 

  209. Schuurmans J, Goslings JC, Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg. 2017;43(2):163–8.

    Article  PubMed  Google Scholar 

  210. He Z, Zhang D, Xiao H, Zhu Q, Xuan Y, Su K, Liao M, Tang Y, Xu E. The ideal methods for the management of rib fractures. J Thorac Dis. 2019;11(Suppl 8):S1078–89.

    Article  PubMed  PubMed Central  Google Scholar 

  211. Halvachizadeh S, Pape HC. Determining the patient at risk—are scoring systems helpful to develop individualized concepts for safe definitive fracture fixation and damage control techniques? Injury. 2019;50(7):1269–71.

    Article  CAS  PubMed  Google Scholar 

  212. Martin TJ, Eltorai AS, Dunn R, Varone A, Joyce MF, Kheirbek T, Adams C Jr, Daniels AH, Eltorai AEM. Clinical management of rib fractures and methods for prevention of pulmonary complications: a review. Injury. 2019;50(6):1159–65.

    Article  PubMed  Google Scholar 

  213. Lichte P, Kalverkamp S, Spillner J, Hildebrand F, Kobbe P. Chest trauma from a surgical perspective. Unfallchirurg. 2018;121(5):403–12.

    Article  PubMed  Google Scholar 

  214. Marasco S, Quayle M, Summerhayes R, Šutalo ID, Liovic P. An assessment of outcomes with intramedullary fixation of fractured ribs. J Cardiothorac Surg. 2016;11(1):126.

    Article  PubMed  PubMed Central  Google Scholar 

  215. Wiese MN, Kawel-Boehm N, Moreno de la Santa P, Al-Shahrabani F, Toffel M, Rosenthal R, Schäfer J, Tamm M, Bremerich J, Lardinois D. Functional results after chest wall stabilization with a new screwless fixation device. Eur J Cardiothorac Surg. 2015;47(5):868–75.

    Article  PubMed  Google Scholar 

  216. Mitchell JD. Blunt chest trauma: is there a place for rib stabilization? J Thorac Dis. 2017;9(Suppl 3):S211–7.

    Article  PubMed  PubMed Central  Google Scholar 

  217. Klei DS, de Jong MB, Öner FC, Leenen LPH, van Wessem KJP. Current treatment and outcomes of traumatic sternal fractures-a systematic review. Int Orthop. 2019;43(6):1455–64.

    Article  PubMed  Google Scholar 

  218. Chiang TY, Yin MF, Yang SM, Chen KC. Thoracoscopic management of incarcerated lung herniation after blunt chest trauma: a case report and literature review. J Thorac Dis. 2017;9(3):E253–7.

    Article  PubMed  PubMed Central  Google Scholar 

  219. Sesma J, Alvarez M, Lirio F, Galvez C, Galiana M, Baschwitz B, Fornes F, Bolufer S. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park. Ann Transl Med. 2017;5(16):328.

    Article  PubMed  PubMed Central  Google Scholar 

  220. Shi J, Wang Y, Geng W. Thoracoscope and thoracotomy in the treatment of thoracic trauma. Pak J Med Sci. 2019;35(5):1238–42.

    Article  PubMed  PubMed Central  Google Scholar 

  221. Goodman M, Lewis J, Guitron J, Reed M, Pritts T, Starnes S. Video-assisted thoracoscopic surgery for acute thoracic trauma. J Emerg Trauma Shock. 2013;6(2):106–9.

    Article  PubMed  PubMed Central  Google Scholar 

  222. Jin J, Song B, Lei YC, Leng XF. Video-assisted thoracoscopic surgery for penetrating thoracic trauma. Chin J Traumatol. 2015;18(1):39–40.

    Article  PubMed  Google Scholar 

  223. Kalverkamp S, Spillner J, Kobbe P, Hildebrand F, Lichte P. Stabilization of the chest wall with plate osteosynthesis. Unfallchirurg. 2018;121(5):413–8.

    Article  CAS  PubMed  Google Scholar 

  224. Dennis BM, Bellister S, Guillamondegui OD. Thoracic trauma. Surg Clin North Am. 2017;97(5):1047–64.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ümit Mert .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mert, Ü., Andruszkow, H., Hildebrand, F. (2022). Chest Trauma: Classification and Influence on the General Management. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-95906-7_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95905-0

  • Online ISBN: 978-3-030-95906-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics