Object impaled in the Thorax: Review Study

Abstract

ABSTRACT Aim The aim of this study is to describe the management of a patient who presents with a penetrating chest trauma due to impalement by an offending object, be it a knife, metal structure, or other type of object. Background Until today, many institutions have treated this type of injury with urgent thoracotomy, despite advances in thoracoscopy and radiologic studies. A review was performed principally to discuss the use of nonoperative treatment, thoracoscopy, and thoracotomy. Thirty-two patients described as case reports in 27 articles were reviewed to carry out this descriptive study. For each patient, the following variables were studied: Age, gender, trauma mechanism, hemodynamic stability upon admission, treatment type, injuries encountered and associated with the condition, complications, and the final disposition of death vs survival. Review results Twenty-one patients were treated with thoracotomy or sternotomy, seven patients with removal of the impaling object without surgery, and five patients with removal of the object using thoracoscopic assistance (one patient was treated with the assistance of thoracoscopy on the right side and with direct removal on the left side). A summary of the evidence reviewed is provided in a flowchart. Conclusion With technological advancements, especially in thoracoscopy and computed tomography, many of these injuries are responsive to less invasive treatment. Thoracotomy, considered the standard of care in many trauma centers, can be reserved for specific cases. Clinical significance Pursuant to some of the criteria listed in this study, as occurs in our institution, the thoracotomy rate can be reduced, thereby reducing mortality and benefiting patients. How to cite this article Botelho-Filho F, Drumond DAF, Starling SV, Peixoto LC, Zille DP, Constantino GDC. Object impaled in the Thorax: Review Study. Panam J Trauma Crit Care Emerg Surg 2016;5(3):148-154.