RESUMO
Traumatic diaphragmatic rupture is reported with increasing frequency and is associated with high morbidity and mortality. The purpose of this study was to present our experience with the management of this injury. Sixty-five patients with TDR were treated in our hospital between January 1989 and May 2000. They were 54 men (83%) and 11 women (17%). Mean age was 36.57 years (range 15-76 years). Rupture of the diaphragm was left-sided in 43 patients (66%), right-sided in 21 (32%), and bilateral in 1 (1.5%). Blunt trauma accounted for the injuries of 52 patients (80%). Early diagnosis was obtained in 57 patients (88%). The diagnosis was established preoperatively in 17 patients (26%), and intra-operatively in 48 (74%). Multiple associated injuries were observed in 62 patients (95%). Postoperative complications were observed in seven patients (11%), and the overall mortality was 14%. Injury severity score (ISS) and haemorrhagic shock upon admission strongly influence the outcome. A high index of suspicion and a thorough examination of both hemi diaphragms during laparotomy is recommended in order to avoid early or late complications.
Assuntos
Diafragma/lesões , Adolescente , Adulto , Idoso , Diafragma/cirurgia , Feminino , Hérnia Diafragmática Traumática/etiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura/diagnóstico , Ruptura/cirurgia , Resultado do Tratamento , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/cirurgiaRESUMO
A review of the management of 239 patients with sternal fractures in a busy trauma center between October 1989 and May 2000 was undertaken to determine the incidence, significance, morbidity, and mortality of this injury. There were 140 men and 99 women with a mean age of 50.3 years (range, 15 to 93 years). Sternal fractures accounted for 8% of admissions for thoracic trauma. The causes were motor vehicle collisions in 215 patients (90%) and falls or direct blows in 24 (10%). Only 64 of 204 car accident patients (31%), 28 men and 36 women, were restrained by seat belts. Complications developed in 13 patients (5.4%). Mortality rate was 0.8%. Mean length of stay in the ward was 6.4 days (range, 1 to 32 days). Four patients (1.7%) underwent surgery. The results show that isolated sternal fractures have low associated morbidity and mortality. Admission is justified for the management of pain and treatment of cardiac complications and concomitant injuries.