MANAGEMENT OF THORACIC INJURIES: OUR EXPERIENCE AT MILITARY HOSPITALS

Thoracic Injuries

Abstract

Background: Thoracic trauma is a major health care problem accounting for a significant percentage of the morbidity and mortality associated with the management of trauma patients. We performed a prospective study with the purpose to review our experience of the management of thoracic injuries at military hospitals having no proper thoracic surgical set up.

Material and Methods: The study was conducted at Combined Military Hospital Quetta and Combined Military Hospital Peshawar from January 2001 to September 2005 and a total of 84 cases of thoracic trauma with blunt and penetrating injury were managed.

Results: Mean age of patients was 36.5 years and female to male ratio was 1:13. Penetrating trauma was more common cause, 51 (61.7%) cases of chest injuries as compared to the blunt trauma 33 (39.3%) cases.  The clinical conditions resulting ribs fractures in 73 cases (86.9 %), flail chest in 3 patients (3.57%), haemothorax in 24 (28.57%) cases, pneumothorax in 8 (9.52%) cases, haemo-pneumothorax in 43 (51.19%) cases, pulmonary contusions in 5 (5.95%) cases, bronchial injury in 1 patient (1.19%), ruptured left diaphragm in 5 (5.95%) with herniation of abdominal contents in the left chest in 2 patients. Bilateral thoracic involvement was seen in 3 cases (3.57%). Right chest was involved in 48 patients (57.14%) while the left in 36 patients (42.86%). Extra-thoracic associated injuries were seen in 33 (39.3%) cases. Cardiac, great vessels, thoracic duct and esophageal injuries were not encountered during the course of this study. Seventy seven patients (91.66%) were treated initially with tube thoracostomy and it alone was effective in 69 patients (89.61%). Overall thoracotomy rate was 9.52% (8 cases). Emergency thoracotomy was performed in 3 (3.57%) cases and delayed thoracotomy in 5 (5.95%) cases.  Empyema thoracic was seen in 3 patients (3.9%) with tube thoracostomy. Overall percentage of empyema was 3.57%. Seven patients (8.33%) were managed without the need of either tube thoracostomy or thoracotomy.  Minor complications of tube thoracostomy were seen in 10 cases (12.99%). Overall mortality rate was 3.57% (3 deaths).

Conclusions: Tube thoracostomy remains the most effective treatment modality in the management of most of the cases of chest trauma.