Management of thoracic injuries: our experience at military hospitals

Thoracic trauma is a major health care problem accounting for a significant percentage of the morbidity and mortality associated with the management of trauma patients. We performed a prospective study with the purpose to review our experience of the management of thoracic injuries at military hospitals having no proper thoracic surgical set up. The study was conducted at Combined Military Hospital Quetta and Combined Military Hospital Peshawar from January 2001 to September 2005 and a total of 84 cases of thoracic trauma with blunt and penetrating injury were managed. Mean age of patients was 36.5 years and female to male ratio was 1:13. Penetrating trauma was more common cause, 51 [61.7%] cases of chest injuries as compared to the blunt trauma 33 [39.3%] cases. The clinical conditions resulting ribs fractures in 73 cases [86.9%], flail chest in 3 patients [3.57%], haemothorax in 24 [28.57%] cases, pneumothorax in 8 [9.52%] cases, haemo-pneumothorax in 43 [51.19%] cases, pulmonary contusions in 5 [5.95%] cases, bronchial injury in 1 patient [1.19%], ruptured left diaphragm in 5 [5.95%] with herniation of abdominal contents in the left chest in 2 patients. Bilateral thoracic involvement was seen in 3 cases [3.57%]. Right chest was involved in 48 patients [57.14%] while the left in 36 patients [42.86%]. Extra-thoracic associated injuries were seen in 33 [39.3%] cases. Cardiac, great vessels, thoracic duct and esophageal injuries were not encountered during the course of this study. Seventy seven patients [91.66%] were treated initially with tube thoracostomy and it alone was effective in 69 patients [89.61%]. Overall thoracotomy rate was 9.52% [8 cases]. Emergency thoracotomy was performed in 3 [3.57%] cases and delayed thoracotomy in 5 [5.95%] cases. Empyema thoracic was seen in 3 patients [3.9%] with tube thoracostomy. Overall percentage of empyema was 3.57%. Seven patients [8.33%] were managed without the need of either tube thoracostomy or thoracotomy. Minor complications of tube thoracostomy were seen in 10 cases [12.99%]. Overall mortality rate was 3.57% [3 deaths]. Tube thoracostomy remains the most effective treatment modality in the management of most of the cases of chest trauma