Index A incentive spirometry , 151 Abbreviated Injury Severity Score (AIS) , 157 indications , 143–144 Abdominal injuries , 115 insertion technique , 144–145 Acetylsalicylic acid (ASA) , 14 mechanical ventilation , 152 Acromioclavicular (AC) joint , 166, 177 mechanics , 143 Acute respiratory distress syndrome (ARDS) , 28, 157 operative fi xation, of rib fractures , 145 Advanced Trauma Life Support (ATLS) , 3, 101 pneumonia , 151–152 Airway pressure release ventilation (APRV) , 48 Chest X ray , 42, 43 Allman classifi cation , 166 Clavicle fractures , 5 Analgesia , 109, 196 acromioclavicular joint dislocations , 166 comprehensive approach , 148 Allman classifi cation , 166 direct operative exposure , 148 clinical evaluation , 166–167 elderly patients , 149, 151 development , 164 epidural analgesia , 149 distal clavicle fractures , 172–175 intercostal nerve blocks , 149 epidemiology , 164 opioids , 148–149 history , 163 Antibiotic prophylaxis , 145 intramedullary nail fi xation , 172 Antibiotics , 48, 113, 134, 145, 152 muscle groups/deforming forces , 165 Arterial blood gases , 42 nonoperative treatment , 167–168 operative dangers , 165–166 operative treatment , 169–170 B osteology , 164 Bioabsorbable implants , 67–70 plate fi xation , 170–172 Bioabsorbable plates , 127 Computed tomography , 106 Blunt cardiac injury , 107–108 CONsolidated Standards Of Reporting Trials Blunt cerebrovascular injury , 106 (CONSORT) Statement , 192 Blunt thoracic aortic injury , 106–107 Continuous positive airway pressure (CPAP) , 35, 152 Bronchoalveolar lavage (BAL) , 30 Conventional plates advantages and disadvantages , 95 bicortical screws , 96 C cortical screws , 95 Canadian Orthopaedic Trauma Society (COTS) , 195 heavier compression plates , 94 Chest tube management rib fractures , 94 analgesia screw insertion and notches , 93 comprehensive approach , 148 spanning , 96 direct operative exposure , 148 elderly patients , 149, 151 epidural analgesia , 149 D intercostal nerve blocks , 149 Diaphragm , 114–115 opioids , 148–149 Distal clavicle fractures antibiotic prophylaxis , 145 deforming forces , 172 chest tube removal , 147–148 hook plate , 173 complications , 147 sternoclavicular dislocations , 173–175 daily examination , 145–147 tape/tightrope technique , 172 © Springer International Publishing Switzerland 2015 201 M.D. McKee, E.H. Schemitsch (eds.), Injuries to the Chest Wall, DOI 10.1007/978-3-319-18624-5 202 Index E hospital length of stay , 125–126 Eastern Association of the Surgery of Trauma (EAST) ICU days , 125 Practice Management, 76 incidence and severity , 20 Epidural analgesia , 45 in-hospital complications , 157 Evidence based medicine (EBM) , 191 inspiratory muscles , 20, 22 Expiratory muscles long-term clinical outcomes , 128–129 abdominal muscles , 22 long-term morbidity , 20 anterolateral fl ail segment , 24 lung contusion , 20 biomechanics and mathematical calculation , 23 lung parenchyma/intrathoracic structures , 4 bony thoracic cavity , 24 mechanical instability , 3 fl ail segment , 24 mechanical ventilation , 35–36, 156 fl oating segment , 24 mortality , 20, 123–125 multiple comminuted rib fractures , 25 multiple rib fractures , 2 paradoxical movement , 24 nonoperative management (see Nonoperative posterior rib fractures, surgical planning , 25 management) posterolateral fl ail segment , 24 operative indications , 2 sternal fl ail , 25–26 operative management (see Operative management) vertebral fl ail , 26 operative vs, nonoperative management , 15 Extended FAST (E-FAST) , 102 outcomes and complications , 158 Eyres classifi cation , 177 pain management , 36 paradoxical respiration , 2 pediatric subgroup , 20 F pneumonia , 20, 121–122 Flail chest injuries pulmonary contusions , 122–123, 155 blunt chest trauma , 156 randomized controlled trials , 13–14 chest cavity, decompression , 3 rib cage , 3 chest physiotherapy , 36–37 rib/sternal fractures , 3 chest tubes , 157 septicemia , 121–122 clavicle fracture , 5 static deformity , 3 comparative studies , 12–13 sternum , 2 computerized tomography (CT) scan , 2 surgical complications , 126–127 concurrent head injury , 157, 159 surgical fi xation , 37–38 concurrent pulmonary contusion , 157, 159, 160 systematic reviews and meta-analyses , 14 concurrent severe head injury , 155 and thoracic trauma , 4, 26–31 early vs. late operative intervention , 128 tracheostomy , 122 epidemiology , 5–6 traumatic force , 2 expiratory muscles treatment, in North America , 38–39 abdominal muscles , 22 tube thoracostomy , 36 anterolateral fl ail segment , 24 unstable chest wall injuries biomechanics and mathematical calculation , 23 ICU care , 198 bony thoracic cavity , 24 incidence and complications , 196 fl ail segment , 24 nonoperative care , 197 fl oating segment , 24 randomized controlled trial , 197 multiple comminuted rib fractures , 25 ventilator days paradoxical movement , 24 concomitant head injuries , 119 posterior rib fractures, surgical planning , 25 early operative intervention , 120 posterolateral fl ail segment , 24 ICU duration , 121 sternal fl ail , 25–26 large-scale randomized trials , 121 vertebral fl ail , 26 noninvasive ventilatory support , 120 “hinge” site , 2 open reduction and internal fi xation historical perspective , 9–12 (ORIF) , 119 historic treatment open reduction and plate fi xation , 120 chest stabilization, strapping , 34 postoperative intubation , 120 internal pneumatic stabilization , 33 rib fi xation , 120 Kirschner wires, for fi xation , 34 ventilatory process , 3 obligatory mechanical ventilation , 33 Focused Assessment with Sonography for Trauma traction , 34 (FAST) , 102 hospital costs , 126 Forced vital capacity (FVC) , 128 Index 203 G outcome , 49 Glasgow Coma Scale (GCS) , 157 pain relief , 46 radiological investigation chest X ray , 42, 43 H CT thorax , 42, 43 Hemothorax , 113 lung ultrasound , 42–44 Hospital-acquired pneumonia (HAP) , 151 steroids , 48 thoracic paravertebral block , 46 ventilation I fundamentals , 46–47 Injury severity score (ISS) , 26, 49 invasive mechanical ventilation (IMV) , 47 Inspiratory muscles , 20, 22 IPPV , 47–48 Intensive care unit (ICU) , 119, 125, 131, 155, 196 noninvasive ventilation (NIV) , 47 Intercostal nerve block , 45 positive end-expiratory pressure (PEEP) , 47 Intramedullary (IM) nailing , 194 Nonsteroidal anti-infl ammatory drugs , 46 Intrapleural analgesia , 45 Number needed to treat (NNT) , 14 J O Judet struts , 34, 35 Ogawa classifi cation , 177–178 Open pneumothorax , 114 Open reduction internal fi xation (ORIF) , 6, 37, 119 K Operative management Kirschner wires (K-wires) , 13, 34, 55, 61, 62, 64 anterolateral fl ail chest and pulmonary contusion , 73, 76 contraindications fi rst and second rib fractures , 78 L fi xation surgery, injuries preventing , 78 Length of stay (LOS) , 121, 125 pulmonary contusion , 77–78 Limited transthoracic echocardiography (LTTE) , 105 severe head injury , 78 Lung ultrasound , 42–44 failure, wean from ventilator , 76–77 non-intubated FC patients , 76 severe deformity , 77 M thoracotomy , 76 MatrixRIB System , 63–65 Opioids , 148–149 Mediastinum blunt cardiac injury , 107–108 blunt cerebrovascular injury , 106 P blunt thoracic aortic injury , 106–107 Paravertebral nerve blocks , 149 esophageal injury , 108 Patient-controlled analgesia (PCA) , 45 Multidrug-resistant (MDR) organisms , 151 Plate fi xation advantages , 93 angular stable “locked plates,” 93 N bone healing , 90–91 National Trauma Data Bank (NTDB) , 16 conventional plates , 93–98 Noninvasive ventilation (NIV) , 47 indications , 89, 90 Nonoperative management locking plates , 96–97 analgesia pain , 45 mechanical stability, of fractures , 91–93 antibiotics , 48 modern rib-specifi c plating systems , 93 bronchial hygiene , 44–45 stabilization , 89 epidural analgesia , 45 surgical stabilization , 89 fl uid therapy , 46 Pleural empyema , 133 immediate therapy , 42, 44 Pneumonia , 131 intercostal nerve block , 45 diagnosis , 151 intrapleural analgesia , 45 and septicemia , 121–122 IV narcotics , 45 Pneumothorax , 111–113 long-term sequelae , 49 Polymorphonu-clear leukocytes (PMNs) , 29 nonimaging studies , 42 Positive end-expiratory pressure (PEEP) , 35, 47 nonsteroidal anti-infl ammatory drugs , 46 Positive pressure ventilation (PPV) , 113 204 Index Pulmonary contusion , 49, 122–123 preoperative CT scan , 58 acute respiratory distress syndrome , 28 prospective clinical studies , 54 blood/fl uid-fi lled alveoli , 108 rib loading , 54 bronchoalveolar lavage (BAL) , 30 single fi xation device , 58 characteristics , 108 surgical approaches continuous positive airway pressure (CPAP) , 109 axial and three-dimensional (3D) fatalities and morbidity , 26 reconstructions , 81 histological fi ndings , 28 computed tomography (CT) scans , 81 implosion effect , 28 guidelines , 81 inertial effect , 28 inframammary approach , 85–87 infl ammatory mediators , 29 lateral thoracotomy , 82–84 injury severity score (ISS) , 26 posterior paramedian approach , 84–85 life-threatening complications , 26 ventilator days , 120 local and systemic effects , 30 RibLoc system , 65–66 monocytes and macrophage , 30 Rib osteomyelitis , 131 mortality , 26 multidisciplinary approach , 109 neutrophil accumulation , 29 S pathogenic mechanism , 28 Scapula fractures pathological change/hepatization , 29 acromion , 181 polymorphonu-clear leukocytes (PMNs) , 29, 30 coracoid , 181–182 positive pressure ventilation , 109 embryology , 176–177 potent chemotactic factors , 29 epidemiology , 175–176 pulmonary contusion , 26, 27 extra-articular fracture patterns severity , 29 callus and interposed tissue