Long-term follow up of traumatic multiple rib fractures

We investigated the prognosis of patients with multiple rib fractures for 2 years after discharge from the hospital, and whether the pain control management during the initial respiratory care influence the respiratory function or neurological findings. The ethical committee in Fukushima Medical University approved this study.

221 patients with chest blunt trauma were admitted in our hospital from 1990 to 1996. We found 61 cases that had more than 4 rib fractures with or without pulmonary contusion. The subjects that were 51 patients who had traffic or some other accidents can be followed by phone and investigated. Forty-one cases were received mechanical ventilation for from 5 to 18 days. All of 51 cases were administrated oxygen and drugs that controlled the chest pain. Nineteen of 51 patients (EPI group) were undergone the epidural anesthesia with xylocain for the first 7 days (5–9 days). The other patients (non-EPI group) were administrated narcotics or non-steroid anti-inflammatory agents.

Measurements were arterial blood gasses, respiratory functions, chest X-ray, physical and neurological findings. The subjects were 48 patients who had traffic or some other accidents. Respiratory care was required in 20 cases for 5 to 18 days. PaO₂, %VC, PEFR (peak expiratory flow rate) were gradually increased after discharge. The improvement was not associated between both of pain controls. Chest deformities were seen in 12 of 51 cases. Râle sound was audible in three cases. Neurological findings (spontaneous pain, tenderness, hypersthesia, sensory disturbance) were found less frequent in patients who were treated under epidural anesthesia. The epidural anesthesia sometimes induced hypotension, however, fluid resuscitation improved. The epidural anesthesia was better than the other narcotics or anti-inflammatory drugs from the points of neurological prognosis. Sensory disturbance is not associated with chest deformities but pain control.

Epidural anesthesia was one of the useful pain management to avoid neurological complications after long-term of multiple rib fractures of chest trauma.