Thoracic cage stabilization in the complex treatment of polytrauma patients

Abstract

Introduction: Thoracic injuries in polytrauma are dominated and cause up to 50% mortality. The main causes are: severity, quick progression of pathological processes with injured rib cage and hemopneumothorax and leading to lung ventilation disturbance. Materials and methods: We present treatment outcomes of 136 patients with pelvic fractures, multiple and associated injuries and closed thoracic trauma aged 18-72 years. The main causes of trauma were traffic road accidents in 74,37% cases. Multiple rib fractures (n=114), fractures of the sternum (n=23), clavicle (n=19), scapula (n=19) and long bones (n=87) were associated with traumatic brain injury (n=120) and abdominal organ lesion (n=49). All patients were completely examined according to elaborated scheme. Main group included 61 patient treated by early fracture stabilization of the upper limb, sternum and ribs. Indications for rib cage stabilization were dominated thoracic injuries, with paradoxical breathing associated with fractures of the pelvis and proximal femur. Control group included 75 patients treated by traditional methods for pleural complications: drainage and puncture of the pleural cavity and with systematic X-ray control. The main aim was to maintain permeability of respiratory ways – sanation of the tracheobronchial tree with curative bronchoscopy, use of mucolytic and broncholytic drugs, aerosol inhalations and magnetotherapy. Results of early stabilization of rib cage by fixation of multiple rib fractures, fractures of the sternum, scapula, and clavicle proved its effectiveness; in complex with physiotherapy it significantly decreased the period of hospitalization. The mean duration of mechanical ventilation was reduced, complication rate decreased by 20,8%. Conclusions: Thoracic injuries in multiple and associated trauma are severe lesions that need complex examination and urgent treatment to prevent pleural complications, to reduce the period of hospitalization and to improve long-term results.