Toraks Travmalı Olgularda Travma Mekanizmasının Vertebra Fraktürü Eşlik Etme Sıklığına Etkisi

Öz

Amaç: Toraks travmaları baş-boyun ve ekstremite travmalarından sonra tüm travma olguları içinde üçüncü sıklıkta karşımıza çıkmaktadır. En sık sebepler motorlu araç kazaları, yüksekten düşmeler, ateşli silah yaralanmaları ve kesici-delici alet yaralanmalarıdır. Çalışmamızda bir üniversite hastanesinin acil servisine toraks travması nedeni ile başvuran hastalarda travma mekanizmasının ve vertebra fraktürü eşlik etme sıklığı üzerindeki etkisinin araştırılması amaçlanmıştır. Materyal – Metot: Çalışmamız retrospektif olarak planlanmıştır. 01.01.2017-01.01.2021 tarihleri arasında hastanemiz acil servisine toraks travması nedeniyle başvuran hastaların bilgileri incelenmiştir. Hastaların demografik özellikleri, travma mekanizması, travmaya bağlı toraks yaralanmaları ve eşlik eden vertebra fraktürleri değerlendirilmiştir. Bulgular: Toraks travmasına maruz kalan 515 hastanın verileri incelenmiştir. Çalışmaya dahil edilen hastaların median yaşı 52 ve % 72,4’ü (n: 373) erkekti. Hastaların % 96,3’ü (n: 496) künt travma nedeniyle başvurmuştu. En sık karşılaşılan travma mekanizmaları araç içi trafik kazası (%46,6 n:240) ve yüksekten düşmeydi (% 30,9 n:159). Hastaların % 34,7 (n: 179)’ sinde pnömotoraks, % 40,2 (n: 207)’sinde hemotoraks, % 81.9 (n:422)’sinde kosta fraktürü saptandı. Eşlik eden vertebra fraktürü sıklığı % 33.98 (n: 175)’di. Vertebra fraktürleri en sık lomber bölgede saptandı (%53.1) ve en sık araç dışı trafik kazası sonrası başvuran hastalarda görüldü. Travma mekanizması ile vertebra fraktürü eşlik etmesi arasında anlamlı fark bulundu; araç dışı trafik kazası sonrası başvuran hastaların % 53.8 (n:28)’inde vertebra fraktürü görüldü. (p=0,004) Sonuç: Künt travma sonrası acil servise başvuran ve toraks travması nedeniyle değerlendirilen hastalarda, travma mekanizmasının vertebra fraktürü eşlik etme sıklığını artırabileceği akılda tutulmalıdır.

Anahtar Kelimeler

• Acil servis
• toraks travması
• vertebra fraktürü

The Effect of Trauma Mechanism on the Frequency of Accompanying Vertebral Fracture in Cases with Thoracic Trauma

Öz

Introduction: Thoracic traumas are the third most common trauma among all trauma cases after head-neck and extremity traumas. The most common causes are motor vehicle accidents, falls from height, gunshot wounds, and stab wounds. In our study, it was aimed to investigate the mechanism of trauma and its effect on the frequency of accompanying vertebral fracture in patients who applied to the emergency department of a university hospital due to thoracic trauma. Material – Method: Our study was planned retrospectively. The information of the patients who applied to the emergency department of our hospital between 01.01.2017 and 01.01.2021 due to thoracic trauma was examined. Demographic characteristics of the patients, mechanism of trauma, trauma-related thoracic injuries and accompanying vertebral fractures were evaluated. Results: The data of 515 patients exposed to thoracic trauma were analyzed. The median age of the patients included in the study was 52 and 72.4% (n: 373) were male. 96.3% (n: 496) of the patients presented because of blunt trauma. The most common trauma mechanisms were in-vehicle traffic accident (46.6% n:240) and falling from height (30.9% n:159). Pneumothorax was found in 34.7% (n: 179) of the patients, hemothorax in 40.2% (n: 207), and costal fracture in 81.9% (n: 422). The frequency of concomitant vertebral fracture was 33.98% (n: 175). Vertebral fractures were most commonly detected in the lumbar region (53.1%) and were most common in patients admitted after a non-vehicle traffic accident. A significant difference was found between the mechanism of trauma and accompanying vertebral fracture; vertebral fracture was seen in 53.8% (n:28) of the patients who applied after a non-vehicle traffic accident. (p=0.004) Conclusion: It should be kept in mind that the trauma mechanism may increase the frequency of accompanying vertebral fracture in patients admitted to the emergency department after blunt trauma and evaluated for thoracic trauma.

Anahtar Kelimeler

• Emergency department
• thoracic trauma
• Spinal Fractures
• Acil servis
• toraks travması
• toraks travmalarında vertebra fraktürü.

Kaynakça

1. Afacan MA, Büyükcam F, Çavuş UY, Kesim A, Cevik M,Yilmaz MS et al. Investigation of Blunt Thoracic Trauma Cases Admitted to the Emergency Department. Kocatepe Medical Journal. 2012;13(1): 1-7.
2. Wang H, Zhou Y, Ou L, Li C, Liu J, Xiang L. Traumatic Vertebral Fractures and Concomitant Fractures of the Rib in Southwest China, 2001 to 2010 An Observational Study. Medicine. 2015;94(44):1-6.
3. Dübüş T. Evaluation of 134 Cases with Thorax Trauma. Turkish Thoracic Society. 2012;13:56-9.
4. Alvi MA, Kapurch II JR, Ivanov DV, Kerezoudis P, Bydon M, Freedman BAI. Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting With “Major” Vertebral Fracture Affect Care and Acute Outcomes? J Orthop Trauma. 2019;33:23–30.
5. Vioreanu MH, Quinlan JF, Robertson I, O’Byrne JM. Vertebral fractures and concomitant fractures of the sternum. International Orthopaedics(SICOT). 2005;29:339–342.
6. Morgenstern M, Rüden CV, Callsen H, Friederichs J, Hungerer S, Bühren V, et al. The unstable thoracic cage injury: The concomitant sternal fracture indicates a severe thoracic spine fracture. Injury. 2016;47(11):2465-2472.
7. Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: A meta-analysis. J Orthop. 2016;13:383–8.
8. Meldon SW, Moettus LN. Thoracolumbar spine injuries: clinical presentation and the effect of altered sensorium and major injury. J Trauma. 1995;36:1110–4.

9. Singh R, Taylor DM, D’Souza D, Gorelik A, Page P, Phal P. Injuries significantly associated with thoracic spine fractures: A case–control study. Emergency Medicine Australasia. 2009;21:419–423.
10. Wang H, Xiang Q, Li C, Zhou Y. Traumatic Vertebral Fractures with Concomitant Fractures of the First Rib. Orthopaedic Surgery. 2013;5:100–104.
11. Liu B, Zhu Y, Liu S, Chen W, Zhang F, Zhang Y. National incidence of traumatic spinal fractures in China: Data from China National Fracture Study. Medicine (Baltimore). 2018;97(35):e12190.
12. Hanna TN, Zygmont ME, Harmouche E, Salastekar N, Johnson JO, Khosa F. Association of lumbar fractures, abdominal aortic calcification, and osteopenia. Clin Imaging. 2015;39:662–6.
13. VandenBerg J, Cullison K, Fowler SA, Parsons MS, McAndrew CM, Carpenter CR. Blunt Thoracolumbar-Spine Trauma Evaluation in the Emergency Department: A Meta-Analysis of Diagnostic Accuracy for History, Physical Examination, and Imaging. J Emerg Med. 2019;56(2):153-165.
14. Fernández-de Thomas RJ, De Jesus O. Thoracolumbar Spine Fracture. 2022 Aug 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32965875.
15. Senturk E, Dogan Y, Yoldas E. Thorax Trauma; Analysis of 1142 Cases. Turkish Thoracic Society 2010; 11:47-54.