Operative Orthopadie und Traumatologie · 2020
[Osteosynthesis of the unstable thoracic wall].
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Spering Christopher, von Hammerstein-Equord Alexander, Lehmann Wolfgang, Dresing Klaus
Аннотация
OBJECTIVE: Surgical stabilization of patients with flail chest, dislocated serial rib and sternal fractures, posttraumatic deformities of the thorax, symptomatic non-unions of the ribs and/or sternum, and weaning failure to biomechanically stabilize the thorax and avoid respirator-dependent complications.
INDICATIONS: Combination of clinically and radiologically observed parameters, such as pattern of thoracic injuries, grade of fracture dislocation, pathological changes to breathing biomechanics, and failure of nonsurgical treatment.
CONTRAINDICATIONS: Acute hemodynamical instability and signs of systemic infection.
SURGICAL TECHNIQUE: Detailed preoperative planning. Open, minimally invasive reduction and osteosynthesis using precontoured, low-profile locking plates and/or intramedullary splints. Careful reduction drilling/implantation of screws due to proximity of the pleura, lungs and pericardium.
POSTOPERATIVE MANAGEMENT: Weaning from respirator as early as possible and early therapy of pneumothorax perioperatively. Removal of implants usually not necessary.
RESULTS: In a retrospective study, 15 polytraumatized patients with flail chest benefitted from an early interdisciplinary surgical treatment strategy within 24-48 h. Early osteosynthesis after severe thoracic trauma significantly reduced ventilator dependency and lowered the risk of pneumonia compared to patients who underwent surgery at a later time point. Patients with severe thoracic injury and life-threatening polytrauma, who meet the indication criteria for open reduction and surgical stabilization of the thorax, are in need of a throughly planned and interdisciplinary synchronized priorization and strategy. Longer intensive care unit stay, overall prolonged duration of admission in hospital, and higher level of respirator-associated complication should be expected in patients with life-threatening severe thoracic trauma (Abbreviated Injury Score (AIS) ≥ 3) compared to patients without thoracic trauma.
INDICATIONS: Combination of clinically and radiologically observed parameters, such as pattern of thoracic injuries, grade of fracture dislocation, pathological changes to breathing biomechanics, and failure of nonsurgical treatment.
CONTRAINDICATIONS: Acute hemodynamical instability and signs of systemic infection.
SURGICAL TECHNIQUE: Detailed preoperative planning. Open, minimally invasive reduction and osteosynthesis using precontoured, low-profile locking plates and/or intramedullary splints. Careful reduction drilling/implantation of screws due to proximity of the pleura, lungs and pericardium.
POSTOPERATIVE MANAGEMENT: Weaning from respirator as early as possible and early therapy of pneumothorax perioperatively. Removal of implants usually not necessary.
RESULTS: In a retrospective study, 15 polytraumatized patients with flail chest benefitted from an early interdisciplinary surgical treatment strategy within 24-48 h. Early osteosynthesis after severe thoracic trauma significantly reduced ventilator dependency and lowered the risk of pneumonia compared to patients who underwent surgery at a later time point. Patients with severe thoracic injury and life-threatening polytrauma, who meet the indication criteria for open reduction and surgical stabilization of the thorax, are in need of a throughly planned and interdisciplinary synchronized priorization and strategy. Longer intensive care unit stay, overall prolonged duration of admission in hospital, and higher level of respirator-associated complication should be expected in patients with life-threatening severe thoracic trauma (Abbreviated Injury Score (AIS) ≥ 3) compared to patients without thoracic trauma.