Dynamics of the complicated post-traumatic period in combined closed chest injury: a clinical case

Оn the example of clinical observation, the possibilities of radiographic methods (x-ray, ultrasound, and CT) in the diagnosis and prognosis of the course of the post-traumatic period are shown.

The use of extracorporeal membrane oxygenation in severe closed chest injury

The clinical case of successful cure of the victim with severe closed chest injury is presented, as a result of which the life-threatening acute respiratory failure could not be compensated by artificial lung ventilation and, in connection with which the use of extracorporeal membrane oxygenation as a «life-saving technology» was required.

The role of natural resistance factors in the development of inflammatory complications in patients with closed thoracic trauma

In recent years, the upward trend in closed severe chest injuries has increased. Closed chest injury with fractures of the ribs is often accompanied by the occurrence of purulent-inflammatory complications. So, the ability of blood serum to lysis Escherichia coli (bactericidal activity of blood serum), micrococcus (indicator of lysozyme content), bacillus subtilis (indicator of beta-lysine content) in 54 patients with a closed chest injury was studied. The indicators of factors of natural resistance were compared with those of 40 healthy people. In addition, the indicators of patients whose trauma proceeded with and without an inflammatory complication were compared with each other. Inflammatory complications in the form of post-traumatic pleurisy and pneumonia were observed in 34 (62.9%) of the examined patients with fractures of 1-3 ribs. In patients with these injuries, we revealed a slight decrease in the bactericidal activity of blood serum: on the first day in the group of patients with a smooth flow to 75.92 + 3.22%, and in the group of patients with complication of the trauma, the inflammatory process (pleurisy, pneumonia) to 72, 83 + 2.65%. On the second day, in the first group, BABS decreases even more to 70.79 + 3.11%, and on the second day it increases to 87.32 + 1.91% (p <0.05). All subsequent days of observation, the bactericidal activity of the blood serum of patients with a favorable flow remained normal or close to normal.The concentration of serum beta-lysine in patients is also subject to large changes depending on the course of the post-traumatic period. In cases of smooth flow, on the first day we noted an increase in the content of beta-lysine in 52.87 + 2.51% (with a norm of 39.3 + 1.4%). Starting from the second day there is a clear downward trend in this indicator. From 4 to 5 days, he approaches the norm (44.32 + 2.40%) and remains within these limits throughout the entire observation period. Thus, a decrease in serum lysozyme and an increase in beta-lysine concentration from the first day after an injury in patients with fractures of 1-3 ribs can serve as a prognostic sign of an inflammatory complication.resistance, which were already registered with minor injuries. However, in cases of the development of the inflammatory process, there is a more significant decrease in the lysozyme content and an increase in the concentration of beta-lysine in the blood serum from the first day after the injury, remaining on all subsequent days.

DYNAMICS OF MORPHOLOGICAL CHANGES IN FRACTURE SITES IN VICTIMS WITH THORACIC TRAUMA AND FLAIL CHEST

Objectives - to improve the treatment results in patients with a closed chest injury complicated by the flail chest through the evaluation of the pathomorphological changes in the fracture sites on the background of their stabilization. Material and methods. The study is based on the autopsy protocols of 402 victims, whose primary cause of death was a closed chest injury with multiple rib fractures. In total 289 histological specimens were studied, including 82 samples taken from the rib fractures zones of the persons with a flail chest died in different periods after the injury. Depending on the time passed from the injury till death, there were identified 5 groups of patients. So It was possible to reveal the consistency of the evolution of morphological changes in the zone of rib fractures on the 1st, 2nd, 5th, 14th, and 21st day after the injury, with preserved breathing without stabilizing the rib cage. Results. We found out that on the 1st, 2nd, 5th day there were no morphologically significant changes in the fracture zone, aimed at its stabilization. With breathing preserved for more than 5 days, there was a delay in the primary callus formation and enhanced bone resorption in the fracture site. Osteoblasts activation, which manifests the proliferation of cellular elements in fragmentary rib fractures, occurred 7-9 days later than in a single fracture. It was conditioned by the persistent "floating" of the rib fragments which impacted the newly formed trabeculae of bone and forced them to rearrange twice during the bony callus formation. The increased time of the rib fractures repair aggravated the lung injury, contributed to the development of pneumonia and purulent-septic complications detected posthumously which, in their turn, were the primary cause of deaths. Conclusion. In 17.4% of victims with severe chest injury and flail chest the death is conditionally preventable. The crucial requirement of the effective treatment of patients with the thoracic trauma and flail chest is the usage of various methods of the thoracic cage stabilization.