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Complex chest wall injury and repair complicated by empyema
  1. Lukas Mueller1,
  2. Cecilia Benz1,
  3. Steven Briggs2,
  4. Cornelius Dyke3
  1. 1General Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
  2. 2Trauma, Sanford Medical Center Fargo, Fargo, North Dakota, USA
  3. 3Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
  1. Correspondence to Dr Lukas Mueller; lukas.mueller{at}

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Case summary

A 24-year-old man presented to the emergency department after blunt thoracic trauma. As a vested rider, he was competing in a rodeo bull riding competition when he was thrown and suffered a bull stomp to his left thoracic cage. At presentation, he was hemodynamically stable with an obviously deformed left anterolateral chest wall. Complete trauma evaluation was performed and injury was limited to the chest with fractures of ribs 1–8 and a moderate left pleural effusion. Ribs 3–7 were comminuted and severely displaced (figure 1). Severe pulmonary contusion was present. He underwent left tube thoracostomy with evacuation of the bloody effusion. The patient did not require mechanical ventilation and remained clinically stable.

Figure 1

Preoperative CT. Imaging demonstrates significant chest wall injury of severely displaced left ribs with concern of parenchymal violation.

The patient was stabilized in the surgical intensive care unit and on hospital day 3 underwent left thoracoscopy, left lateral thoracotomy, wedge resection of the lung, and stabilization of left rib fractures with plating due to significant rib displacement, persistent pain, and splinting with inspiration. The displaced fracture line ran obliquely …

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