The Chinese consensus for surgical treatment of traumatic rib fractures 2021 (C-STTRF 2021) / 中华创伤杂志(英文版)

Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.

Brachiocephalic trunk and left brachiocephalic vein injuries following penetrating right sternoclavicular junction trauma: a case report / 中华创伤杂志(英文版)

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from suprasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years follow-up.

Analysis on care outcome of patients with polytrauma and coma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To make further improvement of outcome of patients with polytrauma and coma.</p><p><b>METHODS</b>The data of 3361 patients (2378 males and 983 females, aged from 5-95 years, 38.2 years on average) with severe polytrauma and coma admitted to Chongqing Emergency Medical Center (Level I Trauma Center), Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study.</p><p><b>RESULTS</b>The overall survival rate and mortality were 93.2% (3133/3361) and 6.8% (228/3361), respectively. The mortalities in patients with coma duration less than 1 hour and combined with neural dysfunction and in patients with coma duration larger than or equal to 1 hour and combined with or without neural dysfunction were significantly higher than that of those with coma duration less than 1 hour but without neural dysfunction [39.5% (136/344) vs 3.0% (92/3017), P less than 0.01]. There existed significant differences in GCS, ISS, and revised trauma score (RTS) between the death group and the survival group (P less than 0.01). RTS was in good correspondence with patient's pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure (SBP). The mortality in patients with SBP less than 90 mm Hg was significantly higher than that of those with SBP larger than or equal to 90 mm Hg [33.3% (68/204) vs 5.1% (160/3157), P less than 0.01]. The mortality in polytrauma patients combined with serious head injury (AIS larger than or equal to 3) was 8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury (23.9%, 61.1% vs 27.3%, 50.0%). The mortality reached up to 61.9% in patients complicated with severe head, chest and abdomen injuries simultaneously.</p><p><b>CONCLUSIONS</b>It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe polytrauma and coma.</p>