The Pattern and Management of Chest trauma at Muhimbili National Hospital, Dar es Salaam

Background: Chest trauma is common and its pattern varies in different places. Majority of patients are managed mainly conservatively. Tube thoracostomy is a simple procedure but it is associated with significant number of complications.The aim of this study was to evaluate the clinical pattern and its management at Muhimbili National Hospital.Methods: A hospital based prospective study of all consecutive patients admitted with chest trauma at Muhimbili National Hospital between November 2007 and September 2008. Clinical assessment and chest x-ray findings were used to diagnose and to evaluate any complications associated with chest tubes using a structured questionnaire.Results: The majority (95/119) of patients were males. Their age ranged from 12 to 72 years with the mode of 32years. Motor traffic injury (MTI) was the commonest cause of chest trauma accounting for 72.3% of the cases. Rib fractures were the most clinical type of chest injury and accounted for about 42.9% of cases. Blunt chest injuries were more common (75.6%) than penetrating injuries. Seventy three (61.3%) patients had other associated injuries, in which fracture of extremities (25.2%) and head injury (21.8%) were the commonest. Sixty seven (56.3%) patients were treated with closed tube thoracostomy only. The overall complication rate of the chest tubes was 32.9% of which infection (24.7%) and Nonfunctional tubes (17.4%) were the commonest. High mortality rate of 24.2% was recorded.Conclusion: The clinical pattern and the management of chest injuries in this study was similar with many other series of study, however, the rate of closed tube thoracostomy remained high with many and avoidable complications

Pattern and Outcome of Chest Injuries at Bugando Medical Centre in Northwestern Tanzania.

Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P < 0.001), whereas mortality was significantly associated with pre-morbid illness, associated injuries, trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P < 0.001). Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region

Massive subcutaneous emphysema with pneumoscrotopenis secondary to chest trauma: Case report

Chest injury commonly leads to subcutaneous emphysema of the chest, neck and face. It is usually non-life threatening. Massive subcutaneous  emphysema may occur and very rarely may spread to involve the scrotal sac and subcutaneous tissue planes of the penis to cause pneumoscrotopenis. This case report presents and discusses a patient who developed massive subcutaneous emphysema and pneumoscrotopenis secondary to bluntchest injury.KEYWORDS:Blunt chest injury, Massive subcutaneous emphysema,Pneumoscrotopenis, Chest tub