Extensive rib plating for flail segment

Case contributed by Craig Hacking
Diagnosis certain


MVA. Red blanket. Left chest wall injuries. Post op.

Patient Data

Age: 50 years
Gender: Female

Comparison is made with radiograph performed earlier the same day. AP erect projection.

The tip of the endotracheal tube projects 4.5 cm above the carina. A nasogastric tube projects over the region of the stomach. The tip of the left-sided intercostal catheter projects medially over the left mid-zone. Interval screw and plate fixation of multiple left-sided rib fractures as well as a left clavicular midshaft fracture. Associated subcutaneous emphysema is noted. Subsegmental atelectasis within the left lower lobe. Fracture again noted within the neck of the left scapula.

Case Discussion

CT panscan findings:

  1. Fractures left 1st-10th ribs with multiple ribs significantly displaced and fractured in two locations, with radiological flail.
  2. Non displaced fracture left scapula and left clavicle.
  3. Left sided hemopneumothorax (ICC in situ) and multifocal left lung lacerations with lower lobe/lingula consolidation.
  4. Status post splenectomy with drain in situ LUQ.
  5. Fluid/hemoperitoneum LUQ, right abdomen (adjacent to the ascending colon and proximal duodenum) and pelvis.
  6. Suspected bowel injury at the hepatic flexure with a small hyperdensity in the bowel wall. Post surgical pneumoperitoneum.
  7. Superficial (AAST grade 1) hepatic segment 2 laceration.

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