BRONCHIAL RUPTURE ASSOCIATED WITH FLAIL CHEST TREATED BY EXTERNAL TRACTION

Bronchial rupture complicated by flail chest is described. Treatment consisted of bronchial repair at thoracotomy, intra-medullary nailing of a rib and external fixation of the flail segment. The patient made a satisfactory recovery with minimal residual after-effects. In view of the hazards of controlled ventilation in some clinical situations, consideration should be given to alternative methods of fixation. CASE REPORT A 40-year-old African male was admitted to hospital after being crushed between a reversing lorry and a wall. On examination he was conscious, slightly dyspnoeic but not obviously cyanosed. The pulse rate was 80/min and the arterial pressure was 120/80 mm Hg. The main injury was sited in the left nipple region where a large penetrat-ing wound, 8-10 cm in diameter, communicated with the left pleural cavity. This section of the chest wall was moving paradoxically with respiration. Chest X-ray