title: Thoracic hyperextension injury with complete "bony disruption" of the thoracic cage: Case report of a potentially life-threatening injury.
abstract: BACKGROUND
  Severe chest wall injuries are potentially life-threatening injuries which require a standardized multidisciplinary management strategy for prevention of posttraumatic complications and adverse outcome.
  
  
  METHODS
  We report the successful management of a 55-year old man who sustained a complete "bony disruption" of the thoracic cage secondary to an "all-terrain vehicle" roll-over accident. The injury pattern consisted of a bilateral "flail chest" with serial segmental rib fractures, bilateral hemo-pneumothoraces and pulmonary contusions, bilateral midshaft clavicle fractures, a displaced transverse sternum fracture with significant diastasis, and an unstable T9 hyperextension injury. After initial life-saving procedures, the chest wall injuries were sequentially stabilized by surgical fixation of bilateral clavicle fractures, locked plating of the displaced sternal fracture, and a two-level anterior spine fixation of the T9 hyperextension injury. The patient had an excellent radiological and physiological outcome at 6 months post injury.
  
  
  CONCLUSIONS
  Severe chest wall trauma with a complete "bony disruption" of the thoracic cage represents a rare, but detrimental injury pattern. Multidisciplinary management with a staged timing for addressing each of the critical injuries, represents the ideal approach for an excellent long-term outcome.
authors.affiliation: Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA. philip.stahel@dhha.org.
authors.forename: James
authors.initials: J
authors.lastname: Bailey
authors.forename: Todd
authors.initials: T
authors.lastname: Vanderheiden
authors.forename: Clay Cothren
authors.initials: CC
authors.lastname: Burlew
authors.forename: Sarah
authors.initials: S
authors.lastname: Pinski-Sibbel
authors.forename: Janeen
authors.initials: J
authors.lastname: Jordan
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel