Traumatic diaphragmatic injury in patients with multiple rib fractures (Flail chest): A retrospective study

Traumatic diaphragmatic injury has been found in 3%–8% of pa¬tients undergoing surgical exploration after blunt trauma and in 10% of patients with penetrating trauma (Larici et al., 2002; Nchimi et al., 2005). Traumatic diaphragmatic injury (TDI) needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The rate of initial¬ly missed diagnoses on computed tomography (CT) ranges from 12% to 63%. A missed diagnosis can later present as intrathoracic visceral herniation and strangulation with a mortality rate of 30%–60% (Nchimi et al., 2005; Chen et al., 2010). Methods: Between 2005 and 2015 a total of 34 patients were diagnosed with TDI, (Male76% (n: 26) and Female) of these 34 patients with TDI, 18 patient’s combinations of TDI and rib fractures (Male: 88% (n: 15) and Female: 24% (n: 8) 12% (n: 3) following blunt trauma. Table A Results: The Average age was: 57 ± 27 and the mechanism of injury were MVA 47% (n:18), fall 38% (n:13).Tab- 1, Number of patients, age, and sex. The ISS for TDI with multiple rib fractur was (17,9 ± 32,1 * and for TDI following trauma was 25,9 ±26,1), the mechanism of injury was MVA, Fall and other. Tab- 2&3 The TDI was diagnosed by CT/CXR or suspected TDI on CT. Associated injuries in 18 patients were pulmonary contusion and rib fracturs, but we demonstrated other injuries as injury to liver and spleen. Tab- 4&5 Surgical management of our patients included thoracotomy, thoracoplasty (for flail chest or instable thoracic cage) or laparotomy. Tab- 5 * P<0,005 compared to Blunt trauma TDI. Conclusions: Patients suffering multiple rib fractures may have a “silent” TDI despite a normal imaging. When performing rib plating examination of the diaphragm is of paramount importance to rule out TDI.