IMPROVING THE METHODS OF TREATMENT OF COMPLICATIONS AFTER CLOSED CHEST INJURIES: MODERN APPROACHES
Keywords:
pneumothorax, hemothorax, chest injury, pleural empyema, rib flotation fracture.Abstract
sfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
Relevance. Closed chest injury is more common in mechanical injuries. Currently, one of the most important problems is operative surgery and traumatology. According to international epidemiological studies, chest lesions are detected in 20-25% of patients with various types of injuries, and in the case of polytrauma, their frequency reaches 30-40%.
The purpose of the study. Improvement of diagnostic methods for closed chest injuries and complications and improvement of surgical treatment results.
Material and methods. According to the Global Burden of Disease, injuries annually cause more than 4.4 million deaths worldwide, and in the structure of severe injuries, the proportion of chest lesions ranges from 15 to 30%, depending on the region. Over the past 5 years, 216 patients have been treated with closed chest injury and its complications in the Department of Surgery and Traumatology of Clinical Hospital No. 7 in Almaty.
Results. Summarizing the data obtained, we note that 138 (63.9%) patients were admitted to the hospital in very serious condition in the first 3 hours. Such patients include complicated forms of closed chest injury, heart injury, and chest injury. 53 (24.5%) patients were admitted to the hospital late (over 24 hours). The reasons for late hospitalization include: 1) untimely treatment; 2) late diagnosis before hospitalization; 3) incorrect diagnosis and untimely application of specialized treatment in other hospitals.
Conclusion. The proposed diagnostic and therapeutic algorithm allows not only to establish a diagnosis, but also to establish a comparative diagnosis of various complications of closed chest injury and to determine the approach to surgical treatment to a very high degree. Thus, thoracoscopic surgery is the main method of choice in the treatment of complications of closed chest injury.
References
1. Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg. 2018;55(5):121–158. DOI:10.1067/j.cpsurg.2018.03.002
2. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma. Injury. 2015;46(4):648–652. DOI:10.1016/j.injury.2014.12.005
3. Peek J, Ochen Y, Saillant N, Groenwold RHH, Leenen LPH, Houwert RM. Traumatic rib fractures: a marker of severe injury. J Trauma Acute Care Surg. 2020;88(4):e88–e94. DOI:10.1097/TA.0000000000002586
4. Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, Gamelli RL. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2016;160(4):944–952. DOI:10.1016/j.surg.2016.05.012
5. Miller DL, Mansour KA. Blunt traumatic lung injuries. Thorac Surg Clin. 2017;27(2):113–121. DOI:10.1016/j.thorsurg.2016.12.001
6. Livingston DH, Hauser CJ. Chest wall injury. Surg Clin North Am. 2017;97(5):1047–1064. DOI:10.1016/j.suc.2017.06.002
7. Kulshrestha P, Datt V, Aggarwal P. Thoracic trauma: operative versus nonoperative management. J Emerg Trauma Shock. 2019;12(1):1–7. DOI:10.4103/JETS.JETS_93_18
8. Meyer DM, Jessen ME, Grayburn PA. Video-assisted thoracic surgery in trauma. Ann Thorac Surg. 2016;102(1):356–361. DOI:10.1016/j.athoracsur.2016.02.082
9. Hoth JJ, Stitzel JD, Gayzik FS, Brownlee NA, Miller PR, Yoza BK. The pathophysiology of pulmonary contusion. J Trauma Acute Care Surg. 2018;84(3):S87–S93. DOI:10.1097/TA.0000000000001766
10. Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward T, Rodriguez A, Smith L, Weber D. Management of pulmonary contusion and flail chest. J Trauma Acute Care Surg. 2012;73(5):351–361. DOI:10.1097/TA.0b013e31827019fd
11. Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization. J Trauma. 2016;81(2):314–319. DOI:10.1097/TA.0000000000001063
12. Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, Bosarge PL, Como JJ, Haut ER, Kerwin AJ, Kozar RA, Lee J, Rowell S, Smith JW, Stern EJ, Stuke L, Tominaga GT, Turkstra TP, Whelan JF, Mayberry JC. Operative fixation of rib fractures. J Trauma Acute Care Surg. 2017;82(3):618–626. DOI:10.1097/TA.
0000000000001344
13. Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, Lemaire J. Elderly trauma patients with rib fractures. J Trauma Acute Care Surg. 2016;61(2):348–354. DOI:10.1097/01.ta.0000224220.85736.13
