Case report

Skeletal traction in the treatment of multiple fractures of the thoracic cage

The extent of chest wall and lung injury after nonpenetrating injury to the chest (NIC) determine how aggressive and invasive management modalities should be. We investigated the value of ventilation (¹³³Xe) and perfusion (^99mTc) studies as indicators of extent of lung injury in 28 patients with moderate to severe unilateral NIC. The ventilation-perfusion (S

O₂) abnormalities were compared with parameters conventionally used to evaluate NIC. All studies were carried out within 24 h of NIC and repeated 24 h later. Ventilation (p<0.001) and perfusion (p<0.01) abnormalities were more extensive soon after NIC than suggested by chest roentgenograms. Chest x-ray film changes lagged behind S

O₂ changes on admission and also after 24 h. The extent of ventilation, perfusion, and chest x-ray film abnormalities on admission were all predictors of increased morbidity. S

O₂ studies may be useful to define the extent as well as the changes in regional lung function following NIC.