Uso de fijador externo en la inestabilidad de la pared torácica anterior (volet esternal). Presentación de un caso / Use of the external fixative in the instability of the anterior thoraxic wall (sternal volet). A case report

Se presenta un paciente con inestabilidad de la pared torácica anterior y esternón tratado previamente con un dispositivo creado por los autores en 1995 para el volet costal. Las costillas artificiales externas del dispositivo, diseñado para el cerclaje subperióstico, actúan como elemento de fijación y han conseguido resultados satisfactorios. Se presenta un paciente, que producto de un accidente automovilístico, sufre lesiones en cráneo, tórax, abdomen y extremidades, entre las que resaltan contusión cerebral, lesión hepática, fractura de fémur e inestabilidad de la pared torácica anterior. Esta última requirió de prioridad extrema, pues habría llevado rápidamente al paciente a la insuficiencia respiratoria de no ser solucionado el problema. Se realizó la estabilización externa mediante un equipo que se utiliza en nuestro hospital, reutilizable y aplicable en cualquier inestabilidad torácica independientemente de la localización de esta. El fijador se confecciona con láminas de duraluminio maleables que permiten su adaptabilidad e introduce una forma de tratamiento en las lesiones torácicas bilaterales con inestabilidad esternal, situación compleja en la que puede resultar un instrumento valioso de tratamiento(AU)

A patient is presented with uncertainty of the previous thoracic wall and breastbone tried previously with a device created by the authors in 1995 for the costal volet. The external artificial ribs of the device, designed for the cerclaje subperióstico, act as fixation element and they have gotten satisfactory results. A patient is presented that product of an automobile accident, suffers lesions in skull, thorax, abdomen and extremities, among those that stand out cerebral bruise, hepatic lesion, femur fracture and uncertainty of the previous thoracic wall. This last one required of extreme priority, because it would have taken to the patient quickly to the breathing inadequacy of not being solved the problem. He/she was carried out the external stabilization by means of a team that is used in our hospital, reutilizable and applicable in any thoracic uncertainty independently of the localization of this. The fixer is made with sheets of malleable duraluminio that allow its adaptability and it introduces a treatment form in the bilateral thoracic lesions with uncertainty esternal, complex situation in which can be a valuable instrument of treatment(AU)

Conservative management of flail chest.

A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.