• M Zeuner, U Schweigkofler, and R Hoffmann.
• Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland. mike-zeuner@arcor.de
• Unfallchirurg. 2010 Apr 1;113(4):330-4.

AbstractIn cases of multiple trauma in patients with an injury severity score (ISS) > or =16 chest injuries, abbreviated injury scale (AIS) > or =3, are also sustained in 57.2% of all patients. Life-threatening complications may occur with lung contusions and rib fractures also in combination with hemothorax/pneumothorax being the most common diagnoses. In addition the lungs can also be functionally impaired by ruptures of the great thoracic vessels or in isolated cases by herniation of lung tissue following tears in the wall of the thorax. A case of multiple trauma in a 44-year-old male (ISS 29) with blunt thoracic trauma resulting in herniation of the middle lobe of the right lung into the subcutaneous tissue due to a coarsely dislocated fracture of the sternum is reported. This still ventilated lung tissue was surgically resituated 4 weeks after the event and the sternum fracture was simultaneously stabilized by plate osteosynthesis. Clinical examination and awareness of the possibility of other injuries (high level of suspicion) are essential. Therefore, standard diagnostic procedures combined with multislice computed tomography during the first examination and reassessment should be included to avoid missed injuries.

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