Traumatic
Injury to the Back of the Chest
The posterior wall of the chest in the midline is formed by
the vertebral column. In severe posterior chest injuries, the possibility of a
vertebral fracture with associated injury to the spinal cord should be considered.
Remember also the presence of the scapula, which overlies the upper seven ribs.
This bone is covered with muscles and is fractured only in cases of severe
trauma.
Traumatic Injury to the Abdominal Viscera and the Chest
When the anatomy of the thorax is reviewed, it is important
to remember that the upper abdominal organs—namely, the liver, stomach, and
spleen—may be injured by trauma to the rib cage. In fact, any injury to the
chest below the level of the nipple line may involve abdominal organs as well
as chest organs.
Flail
Chest
In severe crush injuries, a number of ribs may break. If
limited to one side, the fractures may occur near the rib angles and anteriorly
near the costochondral junctions. This causes flail chest, in which a section of
the chest wall is disconnected to the rest of the thoracic wall. If the
fractures occur on either side of the sternum, the sternum may be flail. In
either case, the stability of the chest wall is lost, and the flail segment is
sucked in during inspiration and driven out during expiration, producing
paradoxical and ineffective respiratory movements
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