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01.12.2012 | Case report | Ausgabe 1/2012 Open Access

World Journal of Emergency Surgery 1/2012

Thoracic hyperextension injury with complete “bony disruption” of the thoracic cage: Case report of a potentially life-threatening injury

Zeitschrift:
World Journal of Emergency Surgery > Ausgabe 1/2012
Autoren:
James Bailey, Todd VanderHeiden, Clay Cothren Burlew, Sarah Pinski-Sibbel, Janeen Jordan, Ernest E Moore, Philip F Stahel
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1749-7922-7-14) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

PFS, TVH, and CCB designed the case report. PFS, CCB, SSP, and JJ performed the surgical procedures in this patient. JB drafted the first version of the manuscript. PFS and EEM critically revised this paper. All authors contributed and approved the final version of the manuscript.

Abstract

Background

Severe chest wall injuries are potentially life-threatening injuries which require a standardized multidisciplinary management strategy for prevention of posttraumatic complications and adverse outcome.

Case presentation

We report the successful management of a 55-year old man who sustained a complete “bony disruption” of the thoracic cage secondary to an “all-terrain vehicle” roll-over accident. The injury pattern consisted of a bilateral “flail chest” with serial segmental rib fractures, bilateral hemo-pneumothoraces and pulmonary contusions, bilateral midshaft clavicle fractures, a displaced transverse sternum fracture with significant diastasis, and an unstable T9 hyperextension injury. After initial life-saving procedures, the chest wall injuries were sequentially stabilized by surgical fixation of bilateral clavicle fractures, locked plating of the displaced sternal fracture, and a two-level anterior spine fixation of the T9 hyperextension injury. The patient had an excellent radiological and physiological outcome at 6 months post injury.

Conclusion

Severe chest wall trauma with a complete “bony disruption” of the thoracic cage represents a rare, but detrimental injury pattern. Multidisciplinary management with a staged timing for addressing each of the critical injuries, represents the ideal approach for an excellent long-term outcome.
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