1. Date: 18-06-2013
By : Saleh Bakar
Taishan Medical University.
Saleh.malik007@gmail.com
Subject : Arthopedics

2. Objectives
• THORACIC TRAUMA
• RIB FRACTURE
• HAEMATHORAX

3. Thoracic Trauma
1. Chest trauma (or thoracic trauma) is a
serious injury of the chest.
2. Thoracic trauma is a common cause of
significant disability and mortality, the
leading cause of death from physical
trauma after head and spinal cord
injury

4. 3. . Blunt thoracic injuries are the
primary or a contributing cause of
about a quarter of all trauma-related
deaths. The mortality rate is about
1600.Chest injuries were first
described in detail in around 1600 BC
in Ancient Egypt.

5. ClassificationsClassifications
Chest trauma can be classified as blunt or
penetrating. Blunt and penetrating injuries
have different pathophysiologies and clinical
courses.
Specific types of chest trauma include:
1.Injuries to the chest wall
2.Pulmonary Injury
3.Airway Injury
4. Cardiac Injury
5.Blood Vessel Injury

6. Deteils…Deteils…
Injuries to the chest wall
Chest wall contusions or hematomas.
Rib fractures
Flail chest
Sternal fractures
Fractures of the shoulder girdle

7. Pulmonary InjuriesPulmonary Injuries
Pulmonary laceration
Pneumothorax
Hemothorax
Hemopneumothorax

8. Cardiac InjuryCardiac Injury
Pericardial tamponade
Myocardial contusion
Traumatic arrest
BLOOD VESSEL INJURY
Traumatic aortic rupture, thoracic
aorta injury, aortic dissection

9. DaignosisDaignosis
Most blunt injuries are managed with
relatively simple interventions like
tracheal intubation and mechanical
ventilation and chest tube insertion.
Diagnosis of blunt injuries may be more
difficult and require additional
investigations such as CT scanning.

10. Daignosis
Penetrating injuries often require surgery, and
complex investigations are usually not
needed to come to a diagnosis. Patients
with penetrating trauma may deteriorate
rapidly, but may also recover much faster
than patients with blunt injury.

11. RIB FRACTURE
A rib fracture is a break or fracture in one or more of the bones making up
the rib cage. The first rib is rarely fractured because of its protected position
behind the clavicle (collarbone). However, if it is broken, serious damage can
occur to the brachial plexus of nerves and the subclavian vessels. Fractures
of the first and second ribs may be more likely to be associated with head
and facial injuries than other rib fractures
The middle ribs are the ones most commonly fractured. Fractures usually occur
from direct blows or from indirect crushing injuries. The weakest part of a
rib is just anterior to its angle, but a fracture can occur anywhere. The most
commonly fractured ribs are the 7th and 10th.[1] A lower rib fracture has the
complication of potentially injuring the diaphragm, which could result in a
diaphragmatic hernia. Rib fractures are usually quite painful because the ribs
have to move to allow for breathing. When several ribs are broken in several
places a flail chest results, and the detached bone sections will move separately
from the rest of the chest.

12. A rib fracture is a break or fracture in one or more of the
bones making up the rib cage. The first rib is rarely
fractured because of its protected position behind the
clavicle (collarbone). However, if it is broken, serious
damage can occur to the brachial plexus of nerves and the
subclavian vessels..
Fractures of the first and second ribs may be more likely to
be associated with head and facial injuries than other rib
fractures.[1] The middle ribs are the ones most commonly
fractured. Fractures usually occur from direct blows or
from indirect crushing injuries..

13. • The weakest part of a rib is just anterior to its angle,
but a fracture can occur anywhere. The most
commonly fractured ribs are the 7th and 10th.[1] A
lower rib fracture has the complication of potentially
injuring the diaphragm, which could result in a
diaphragmatic hernia. Rib fractures are usually quite
painful because the ribs have to move to allow for
breathing. When several ribs are broken in several
places a flail chest results, and the detached bone
sections will move separately from the rest of the
chest.

14. Causes
Rib fractures can occur without direct trauma
and have been reported after sustained
coughing and in various sports – for
example, rowing, karting and golf – often in
elite athletes. They can also occur as a
consequence of diseases such as cancer
or infections (pathological fracture).
.

15. Causes
Fragility fractures of ribs can occur due to diseased bone
structure, e.g. osteoporosis and metastatic deposits
–

16. Daignosis
• Broken ribs are often indicated by the following
symptoms:
• Pain when breathing or with movement
• A portion of the chest wall moving separately
from the rest of the chest (flail chest)
• A grating sound with breathing or movement
• Where the mechanism of injury would indicate
substantial force to the ribs…

17. Daignosis
Because children have more flexible
chest walls than adults do, their ribs are
more likely to bend than to break;
therefore the presence of rib fractures in
children is evidence of a significant
amount of force and may indicate
severe thoracic injuries such as
pulmonary contusion.[1] Rib fractures
are also a sign of more serious injury in
elderly people

18. Treatment
• There is no specific treatment for rib fractures,
but various supportive measures can be taken.
In simple rib fractures, pain can lead to reduced
movement and cough suppression; this can
contribute to formation of secondary chest
infection. Adequate analgesia can avoid this.
•
• Flail chest is a potentially life-threatening injury
and will often require a period of assisted
ventilation. Flail chest and first rib fractures are
high-energy injuries and should prompt
investigation of damage to underlying viscera

19. HAEMOTHORAX
• Accumulation of blood in Pleural cavity is Accumulation of blood in Pleural cavity is
called Haemothorax..called Haemothorax..

20. Causes
Its cause is usually traumatic, from a blunt or Its cause is usually traumatic, from a blunt or
penetrating injury to the thorax, resulting in penetrating injury to the thorax, resulting in
a rupture of the serous membrane either a rupture of the serous membrane either
lining the thorax or covering the lungs. This lining the thorax or covering the lungs. This
rupture allows blood to spill into the pleural rupture allows blood to spill into the pleural
space, space,

21. Causes
• equalizing the pressures between it
and the lungs. Blood loss may be
massive in people with these
conditions, as each side of the thorax
can hold 30–40% of a person's blood
volume. Even minor injury to the
chest wall can lead to significant
hemothorax.[1]

22. Signs and Symptoms
• Tachypnea
• Dyspnea
• Cyanosis
• Decreased or absent breath sounds on affected side
• Tracheal deviation to unaffected side
• Dull resonance on percussion
• Unequal chest rise
• Tachycardia
• Hypotension
• Pale, cool, clammy skin
• Possibly subcutaneous emphysema
• Narrowing pulse pressure

23. Management
• A hemothorax is managed by removing
the source of bleeding and by draining the
blood already in the thoracic cavity. Blood
in the cavity can be removed by inserting
a drain (chest tube) in a procedure called
a tube thoracostomy.

24. Management
• As the blood thickens, it can clot in the pleural
space (leading to a retained hemothorax) or
within the chest tube, leading to chest tube
clogging or occlusion. Chest tube clogging or
occlusion can lead to worse outcomes as it
prevents adequate drainage of the pleural
space, contributing to the problem of retained
hemothorax. In this case, patients can be
hypoxic, short of breath, or in some cases, the
retained hemothorax can become infected
(empyema). Therefore adequately functioning
chest tubes are essential in the setting of a
hemothorax treated with a chest tube.

25. Saleh Bakar
Thanks to All…