Unstable thorax
| Classification according to ICD-10 | |
|---|---|
| S22.5 | Unstable thorax |
| ICD-10 online (WHO version 2019) | |
The unstable thorax ( flail chest ) is an abnormal mobility of the chest due to an injury to its bony structures.
distribution
An unstable thorax occurs in only 3% of all rib fractures . In the case of such severe injuries to the chest wall, however, injuries inside the chest (in particular injuries to the lungs ) are usually present, which additionally endanger the patient. The lethality in the unstable thorax is between 20 and 50%.
root cause
The cause is usually a significant chest trauma . In particular, bilateral serial rib fractures , serial rib fractures with a sternum fracture , and serial rib fractures are possible reasons for an unstable thorax.
An unstable thorax can also arise as a result of surgical removal of the chest wall (e.g. as part of a tumor resection ).
Disease emergence
If a segment develops during trauma that is no longer connected to the remaining bony structures of the chest wall, the negative intrathoracic pressure when inhaling causes the segment to move inward. In combination with the pain caused by the trauma and the lung contusion that is often present as an accompanying injury, this can lead to breathing restrictions and hypoxemia .
Clinical manifestations
Symptoms include pain , fast, shallow, and paradoxical breathing, and crepitations . Depending on the severity of the breathing restriction, hypoxia with or without cyanosis can occur.
Investigation methods
The diagnosis of an unstable chest is usually made on the basis of the typical clinical appearance and the evidence of the fractures on chest X-ray and / or CT . Pulse oximetry and arterial blood gas analysis can be used to quantify shortness of breath .
treatment
As with simple rib fractures, therapy is usually conservative. In addition to oxygen therapy and analgesia , a patient with an unstable chest is closely monitored. This so that any complications can be discovered and treated as quickly as possible.
If respiratory insufficiency occurs , ventilation may be necessary for 10–14 days to internally splint the fracture. Depending on the severity of the injury, surgical rehabilitation of the chest wall using plate osteosynthesis of the ribs should also be considered.
In children, treatment is provided by ventilation with positive end-expiratory pressure , which results in an internal splint. Surgical fixation is very rarely necessary.
Complications
If the patient's breathing is significantly restricted by the chest instability, one speaks of decompensation . This can happen if the patient is no longer breathing properly due to the pain. In addition, breathing is more strenuous with an unstable thorax, which leads to fatigue in the respiratory muscles . The direct pressure of the free chest segment on the lungs can also seriously hinder breathing.
In addition, fracture fragments can injure the chest organs. This can lead to a ( tension ) pneumothorax and / or a hemothorax .
literature
- Hachenberg among others: Anesthesia and intensive therapy in thoracic surgery . Georg Thieme Verlag, 2010, ISBN 978-3-13-148771-1 .
- HL Lindenmaier, EH Kuner, H. Walz: The operative treatment of the chest wall instability . In: Trauma Surgery . tape 16 , no. 4 , 1990, pp. 172–177 ( springer.com [accessed January 7, 2016]).
Web links
- Chest trauma. (PDF) Retrieved January 7, 2016 .
Individual evidence
- ↑ A.-M. Weinberg, H. Tscherne (Ed.): Tscherne trauma surgery - trauma surgery in childhood - lower extremities, body cavities, peculiarities of the child's skeleton. Springer-Verlag, Heidelberg 2006, ISBN 978-3-540-63287-0 , p. 857.
