Kesulitan “Weaning” pada Kasus Flail Chest Akibat Fraktur Sternum yang Tidak Teridentifikasi

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Background: Thoracic trauma causes 20% of all deaths from trauma. One that has high morbidity and mortality is flail chest and the sternum fracture is a small part of the cause flail chest. Given its extremely rare occurrence the sternal fracture is often a forgotten diagnostic trap on flail chest.

Case report: There were 2 cases reported with thoracic trauma. The first case was multitrauma with Injury Severity Score (ISS) 50, head trauma, abdominal trauma and limb trauma. After hemodynamic stabilization for 3 days, the patient is difficult to wean from mechanical ventilation. After no longer found a source of bleeding and hemodynamically stable patients were immediately prepared for emergency surgery and the cause was found to be a sternum fracture that was not identified before. The second case is thoracic trauma with ISS 17, clinically seen flail chest and normal antero-posterior chest X-ray. After continued CT scan of thorax was found a fracture of the sternum which caused inadequate breathing. External fixation is carried out immediately and the results are satisfactory.

Discussion: Sternum fractures are often caused by severe anterior thoracic trauma mechanisms and can produce flail chest manifestations so as to increase morbidity and mortality even more if accompanied by trauma to other organ systems and the use of long-term mechanical ventilators and sepsis. The incidence of sternum fractures is very rare and lateral chest X-rays in cases of trauma are also rarely performed so that sternum fractures are often not identified. By knowing the mechanism of trauma, clinical symptoms that do not match the antero-posterior chest X-ray picture and the difficulty of weaning from mechanical ventilation, the use of ultrasound for screening is expected to help avoid the trap of late identification of the sternum fracture.

Conclusion: the existence of a fail chest, early diagnostics followed by external fixation will reduce morbidity and mortality in patients with sternal fractures.

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