Year: 2019
Type: dissertation
Study design: Observational Study
Abstract: Background: Surgical management of chest wall injuries has received increasing attention in recent years. The aim of this thesis was to study the mechanism of injury\n(MOI) in relation to chest wall injury patterns and short- and long-term outcome of surgery in patients with multiple rib fractures and unstable thoracic cage injuries. Methods: Paper I is a retrospective study (n=211) of the association of MOI and\ninjury patterns in patients operated for acute chest wall injuries. Paper II is a\nprospective longitudinal study (n=54) of the long-term outcome of surgery in patients with multiple rib fractures and flail chest. Paper III is a cross-sectional study\n(n=37) of the use of CT-lung volume estimation as a marker for lung function in\npatients operated for flail chest. Paper IV is a prospective controlled study (n=139)\nof the short- and long-term outcome of surgery in patients with unstable thoracic cage injuries. \nResults: The MOI differs according to age and is associated with different chest wall\ninjury patterns. Lateral and posterior flail segments are the most commonly seen.\nSymptoms of pain, lung function and Quality of Life (QoL), improve during the first\npost-operative year. CT-lung volume estimates increase significantly from preoperative\nvalues to post-operative values and there is a high correlation between\npost-operative CT-lung volume and lung function. Surgery for unstable thoracic cage\ninjuries does not decrease the need for mechanical ventilation. However, surgically\nmanaged patients have a decreased incidence of pneumonia (17% vs. 36%, p=0.013)\nand less pain (29% vs. 57%, p<0.05) the first months’ post trauma. Patients operated\nwithout thoracotomy have a better residual lung function and lung volume. A gradual\nimprovement in patient symptoms was seen and after one year there was no\ndifference in symptoms, function or QoL between surgically and conservatively\nmanaged patients.\n Conclusions: The MOI influences rib fracture pattern and associated injuries. Lung\nvolume estimated by CT can be used as a marker for lung function. Surgery for\nunstable thoracic cage injuries decreases the incidence of pneumonia and reduces\npain. Patients continue to improve gradually and no difference can be seen between\nthe surgically and conservatively managed patients one year post trauma.
Author: Eva-Corina Caragounis
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2944456687