11. Flail chest

Flail chest may develop in the event of a fracture of three or more consecutive ribs, and can result in the paradoxical respiration of the thoracic wall in at least two places, preventing the formation of negative inspiratory pressure and lung expansion on the affected side of the thorax. Expiration, on the other hand, is not sufficient, due to the lack of adequate positive airway pressure as the concerned region moves outwards during expiration. This impairs

hemodynamics, and there is always a risk of developing mediastinal shift, decreased cardiac

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Decreased respiratory sounds, as heard on auscultation, suggest hemothorax, pneumothorax and/or a lung contusion. A lung radiography and thoracic CT will show rib fractures accompanied by injuries [4, 37]. The treatment of flail chest is based on the use of strong analgesics (intercostal blockage, epidural analgesia and patient-controlled analgesia) and respiration physiotherapy, and while mechanical ventilation may become necessary, it is currently used less frequently. A bronchoscopy is also very important in preventing secretions. The rate of mortality associated with flail chest varies between 10 and 15%, and the most common causes of mortality are massive hemothorax, lung contusion and ARSD [28]. Nowadays, rib fixation (with MRI-compatible nitinol/titanium plates) is preferred in patients who stay in intensive care for long periods of time, who cannot tolerate other interventions or who need thoracoto-

Sternum fractures mostly occur during in-vehicle traffic accidents, particularly in the elderly and in front-seat passengers. They are generally transverse fractures, and most commonly develop at the point of junction between the manubrium and corpus sterni, or at the corpus sterni. An accurate diagnosis can be made through a lateral radiography and thoracic CT, and patients should be hospitalized and closely monitored with ECHO and ECG assessments

Clavicle fractures have become more common since the use of seatbelts in vehicles became mandatory, and are seen most often in the 1/3rd middle part of the clavicle. A figure of eight bandage is often sufficient for the treatment of a clavicle fracture, and recovery is usually within 3 weeks with conservative therapy, although surgery may be required in rare cases

As the scapula is a thick bone and is well-protected by the muscles in the chest wall, scapula fractures only develop as a result of high-energy trauma. Scapula fractures can be diagnosed with a direct lung radiography or thoracic CT, and may be accompanied by brachial plexus injuries. For treatment, the shoulder is strapped and immobilized. Scapula fractures rarely

output, hypotension, syncope and sudden cardiac arrest [7, 22].

mies due to morbidity.

[26, 31, 38].

12. Sternum fractures

13. Clavicle fractures

(Figure 5) [22, 26, 31].

14. Scapula fractures

require surgical treatment [26, 31].

Figure 4. PA radiography, thorax CT and surgical fixation of the ribs of a patient with left multiple rib fractures developed following blunt thoracic trauma, and the post-operative appearance of the patient's skin incision scar.

hemodynamics, and there is always a risk of developing mediastinal shift, decreased cardiac output, hypotension, syncope and sudden cardiac arrest [7, 22].

Decreased respiratory sounds, as heard on auscultation, suggest hemothorax, pneumothorax and/or a lung contusion. A lung radiography and thoracic CT will show rib fractures accompanied by injuries [4, 37]. The treatment of flail chest is based on the use of strong analgesics (intercostal blockage, epidural analgesia and patient-controlled analgesia) and respiration physiotherapy, and while mechanical ventilation may become necessary, it is currently used less frequently. A bronchoscopy is also very important in preventing secretions. The rate of mortality associated with flail chest varies between 10 and 15%, and the most common causes of mortality are massive hemothorax, lung contusion and ARSD [28]. Nowadays, rib fixation (with MRI-compatible nitinol/titanium plates) is preferred in patients who stay in intensive care for long periods of time, who cannot tolerate other interventions or who need thoracotomies due to morbidity.
