Missed Injuries in Trauma Patients; The Value of a Diagnostic Thoracotomy or Thoracoscopy During Surgical Stabilisation of Rib Fractures.

Abstract PurposeOver the last decade Surgical Stabilisation of Rib Fractures (SSFR) gained popularity in our hospital. With increased numbers, we noted that frequently injuries were missed during primary/secondary survey and radiological imaging, that were found during the surgical procedure. With this observation, the research question was formulated: What is the value of diagnostics thoracotomy or thoracoscopy during surgical stabilisation of rib fractures?MethodsIn a single centre, retrospective study between February 2010 till December 2019, trauma patients who underwent Surgical Stabilization of Rib Fractures (SSFR) and an inspection thoracotomy were included. All radiological injuries were compared with intraoperative findings. Missed injuries that were discovered during the surgical procedure that weren’t analysed during primary/secondary survey or on radiological imaging were recorded and retrospectively analysed by an independent radiologist. Results51 patients were included. Eight patients had additional injuries; all had a diaphragmatic rupture, one patient had an attending stomach laceration, another patient had an attending significant lung laceration in need of surgical repair. Only 13 out of 56 diaphragm rupture CT-signs were confirmed, therefore still 77% of signs could not be confirmed by initial radiological findings.Conclusion With the recent shift towards surgical stabilisation of rib fractures, an inspection thoracoscopy or thoracotomy during SSFR should be considered to minimize the incidence of missed intrathoracic injuries requiring early or late surgical treatment.