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Introduction
From the beginning of the twentieth century till the current time, an overview is presented of the surgical treatment for rib fractures and flail chest.
Methods
Many techniques have been used to stabilize the thorax wall. There has been no follow-up for the most described techniques and the evidence provided is at its best at L3–4. Th...
Similar publications
Flail chest is defined by fracture of 3 or more adjacent ribs, at 2 or more sites, with paradoxical movement of the affected chest. It occurs in 2 to 4 % of blunt chest trauma, with a mortality of 10 to 15 %. Treatment is conservative, using analgesia and positive pressure ventilation, or surgical osteosynthesis of rib fractures. We present the cas...
Background
The goal of the study was to compare surgical rib fixation using claw-type titanium plate with conservative treatment in the management of patients with flail chest.
Methods
The study retrospectively studied 23 patients suffering from flail chest injury, who admitted to our hospital from October, 2010 to February, 2014. The patients rec...
Purpose
The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population.
Methods
A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management...
Introduction
High rates of morbidity and mortality following flail chest rib fractures are well publicized. Standard of care has been supportive mechanical ventilation, but serious complications have been reported. Internal rib fixation has shown improvements in pulmonary function, clinical outcomes, and decreased mortality. The goal of this study...
Purpose of Review
Surgical stabilization of rib fractures (aka rib plating) is underutilized, partly due to a perceived lack of evidence of benefit and unfamiliarity with the operation. The goal of this review is to identify and summarize the evidence surrounding surgical stabilization of chest wall injury in flail and non-flail injury patterns and...
Citations
... In terms of injury categories, rib fractures may be comparable. Both are known to be painful but often treated conservatively in human patients [48][49][50]. However, it should be noted that, the wild boar's nose has an important function as a digging tool for foraging and that the sense of smell is of much greater importance to an animal. ...
Wild boar trapping has been used as a management tool to control wild boar populations. However, it is increasingly criticized due to animal welfare concerns. While cortisol levels have been used to assess trap-related stress in wild boar, data on trap-related injuries and behavioral data are scarce. We aimed to evaluate three different corral-style traps for wild boar according to available mammal trapping standards to investigate and refine animal welfare in wild boar trapping. We examined 138 wild boars captured and killed by head shot in 27 capture events. Traps were closed by remote control only if the complete group were trapped. The behavior of the animals in the trap and during culling was recorded on video. All wild boars were examined and a pathological and radiological examination of the heads for trap- and shot-related injuries followed. Trap-related injuries occurred in 33% of the animals with superficial mild skin defects to skull fractures. One out of three traps met all the set requirements. A wire-meshed trapping system failed all. After installing an incomplete barrier in the center of the trap to slow down trapped animals, the fracture rate in one trap type was significantly reduced by 29% (p < 0.05). Our data showed that the type of trap (p = 0.007) and the number of animals trapped at once (p = 0.002) had a significant influence on the number of escape attempts. Trapping larger groups reduced the escape attempts. We emphasize the importance of an accurate pathological examination to evaluate animal welfare in traps and call for adjusting the injury categories listed in the standards and make a proposal for wild boar live trapping.
... Consequently, several surgical and non-surgical strategies have been applied in the treatment of rib fractures or flail chest over the years with the aim directed towards maintaining adequate ventilation, decreasing progressive damage, and preventing complications and sequelae [5]. Surgical solutions must be tailored to the individual case. ...
... Rib fixation plates are contoured for the curvature of the rib. According to literature, there are several techniques for ribs fixation [5]. Besides, there is a number of implants that have been specifically designed for ribs fractures fixation These include locking plates (Matri-xRIB, Synthes, West Chester, Pennsylvania), splints (MatrixRIB, Synthes), U plates (Ribloc, Acute Innovations, Hillsboro, Oregon), Judet struts and a mesh wrap (Inion Orthopedic Trauma Plating System, Inion Oy) [22]. ...
Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosyn-thesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homola-teral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient's clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.
... Otherwise, wires or Judet clips are used, which can damage the intercostal nerve being anchored to the lower edge of the rib. This causes permanent pain and sometimes the onset of neural tumor [19]. "U" plates can be adopted as an alternative, fixing them to the upper edge of the rib with screws. ...
This work briefly discusses the applications of Layered Double Hydroxides (LDHs) to medicine and presents a study regarding the growth of LDHs on the biodegradable AZ31 alloy foreseen to manufacture a rib-fixator. Mg is one of the most investigated metallic materials for biomedical applications owing to its high biocompatibility and osteointegration, as well as a value of the elastic modulus close to that of human bone. Since Mg is essential for metabolism, when it degrades forming Mg ²⁺ ions, it promotes healing and growth of bone tissue. Experiments have been carried out to grow LDHs on the alloy surface in view to retard corrosion in human body and intercalate drugs to be released in-situ, with anti-inflammatory, analgesic, and antimicrobial action.
... There are various commercially produced plate-and-screw systems and designs available, and other types of fixation options exist including rib clips (or "struts") and intramedullary rods. Other methods have been described using instruments not designed specifically for SSRF including Kirschner wires in a variety of techniques (10,11). ...
Background
There is no consensus on the effectiveness of surgical stabilization in multiple rib fractures in Asia, especially among patients with a non-flail rib fracture pattern. We aim to synthesize the evidence on the effectiveness of surgical stabilization of rib fractures (SSRF) in an Asian population with multiple non-flail rib fractures.
Methods
The MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews were searched in this systematic literature review and meta-analysis to identify studies conducted in Asia that included patients with multiple non-flail rib fractures in at least one of their treatment groups. The intervention of interest was SSRF, and the comparator was a nonoperative treatment. The duration of mechanical ventilation (DMV) was the primary outcome. Posttreatment pain score, pneumonia, atelectasis, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), need for tracheostomy, respiratory function, functional outcomes, quality of life (QoL), and mortality were identified as the secondary outcomes. A random effects model (REM) was used to pool data for outcomes reported in two or more studies.
Results
A total of 12 studies (n=2,440 patients) were included. There was a significantly shorter DMV {mean difference (MD): –5.23 [95% confidence interval (CI): –9.64 to –0.81], P=0.02}, lower 4-week post-treatment pain score [standard mean difference (SMD): –2.24 (95% CI: –3.18 to –1.31), P<0.00001], lower risk for pneumonia [risk ratio (RR): 0.46 (95% CI: 0.23 to 0.95), P=0.04], lower risk for atelectasis [RR: 0.44, (95% CI: 0.29 to 0.65), P<0.0001], shorter ICU LOS [MD: –4.00 (95% CI: –6.33 to –1.66), P=0.0008], and shorter HLOS [MD: –6.54 (95% CI: –9.28 to –3.79), P<0.00001] in favor of SSRF. Effect estimates for the need for tracheostomy [RR: 0.67 (95% CI: 0.42 to 1.08), P=0.10] and mortality [RR: 0.94 (95% CI: 0.37 to 2.41), P=0.90] were nonsignificant.
Conclusions
In the Asian population with mainly non-flail rib fracture patterns, SSRF was associated with shorter DMV, ICU LOS, and HLOS as well as lower risks for atelectasis and pneumonia, and pain scores after 4 weeks. The risk of mortality was comparable between treatment groups.
... Therefore, the treatment of multiple rib fractures began to turn from conservative treatment to surgical intervention. The expansion of surgical treatment for rib fractures was supported by instruments such as the rib fixation plate system that was developed from various percutaneous traction devices, and intramedullary splints [10]. A study that analyzed 3,467 patients with flail chest from 2007 to 2009 demonstrated that only 0.7% of patients underwent SSRF [11], while another study of 293 patients with flail chest from 2014 to 2016 reported that 7.8% of patients were treated with SSRF [12]. ...
Background:
Multiple rib fractures are common in blunt chest trauma. Until recently, most surgical rib fixations for multiple rib fractures were performed via open thoracotomy. However, due to the invasive nature of tissue dissection and the resulting large wound, an alternative endoscopic approach has emerged that minimizes the postoperative complications caused by the manipulation of injured tissue and lung during an open thoracotomy.
Methods:
Our study concentrated on patients with multiple rib fractures who underwent surgical stabilization of rib fractures (SSRF) between June 2018 and May 2020. We found 27 patients who underwent SSRF using video-assisted thoracoscopic surgery. The study design was a retrospective review of the patients' charts and surgical records.
Results:
No intraoperative events or procedure-related deaths occurred. Implant-related irritation occurred in 4 patients, and 1 death resulted from concomitant trauma. The average hospital stay was 30.2±20.1 days, and ventilators were used for 12 of the 22 patients admitted to the intensive care unit. None of the patients experienced major pulmonary complications such as pneumonia or acute respiratory distress syndrome.
Conclusion:
Minimally invasive rib stabilization surgery with the assistance of a thoracoscope is expected to become more widely used in patients with multiple rib fractures. This method will also assist patients in a quick recovery.
... The effect of SSRF has been studied using a variety of techniques, including wire cerclages, absorbable plates or Judet struts, but, to date, plating the outer cortex of the rib with bicortical screws is the most commonly employed technique (38,39). This procedure often comprises standardized components such as, but not limited to, muscle sparing or minimally invasive incisions, fiberoptic bronchoscopy, video-assisted thoracoscopic surgery (VATS), pleural irrigation, and chest tube placement (40,41). ...
The practice of surgical stabilization of rib fractures (SSRF) for severe chest wall injury has exponentially increased over the last decade due to improved outcomes as compared to nonoperative management. However, regarding in-hospital outcomes, the ideal time from injury to SSRF remains a matter of debate. This review aims to evaluate and summarize currently available literature related to timing of SSRF. Nine studies on the effect of time to SSRF were identified. All were retrospective comparative studies with no detailed information on why patients underwent early or later SSRF. Patients underwent SSRF most often for a flail chest or ≥3 displaced rib fractures. Early SSRF (≤48-72 hours after admission) was associated with shorter hospital and intensive care unit length of stay (HLOS and ICU-LOS, respectively), duration of mechanical ventilation (DMV), and lower rates of pneumonia, and tracheostomy as well as lower hospitalization costs. No difference between early or late SSRF was demonstrated for mortality rate. As compared to nonoperative management, late SSRF (>3 days after admission), was associated with similar or worse in-hospital outcomes. The optimal time to perform SSRF in patients with severe chest wall injury is early (≤48-72 hours after admission) and associated with improved in-hospital outcomes as compared to either late salvage or nonoperative management. These data must however be cautiously interpreted due the retrospective nature of the studies and potential selection and attrition bias. Future research should focus on both factors and pathways that allow patients to undergo early SSRF.
... It is conservatively estimated that the number of patients with rib fractures can reach 1.5 to 2.0 million per year. 2 Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injuries such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, and were unable to retain a full-time job. 3 The surgical treatment of rib fractures, from early chest wall traction to internal fixation with plates in the 1980s, has advanced slowly in the history of nearly 100 years. 4 In the past two decades, thanks to the development of material technology, surgery for rib fractures has become simple and widely applied, achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. ...
Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focused on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. Based on the current research data and clinical practice guidelines at home and abroad, this expert consensus put forward some clear, applicable, and graded recommendations, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.
... Rib fractures may be categorized in anterior (anterior axillar line), lateral (between anterior axillary line and posterior axillary line) and posterior fractures (posterior axillary line). Depending on their location, different type of operative approaches and incisions are practiced (17). "Shaw-Paulson's" approach permits an optimal exposure of the spine and muscles roots, the apex of the thoracic cage (axillar vascular axis) and allows to explore the thoracic cavity and the lung (18). ...
Background: Surgical stabilization in complex chest wall traumas, especially in case of posterior ribs arch destruction and flail chest, still remains a challenge for thoracic and trauma surgeons. Throughout the years different techniques and materials developed to address the complex anatomy of the ribs and reach an adequate fixation. Our aim is to present a prosthetic-free ribs stabilization technique which is easily reproducible and can achieve an efficient mechanical stabilization of the chest wall.
Methods: This surgical technique can be summarized in three steps: muscle sparing thoracotomy following modified “Shaw-Paulson’s” technique (complete section of the latissimus dorsi muscle along the transverse processes of vertebral spine to rich the serratus muscles plane), prosthetic-free ribs fixation with single stiches (Maxon™ 1) and muscles repositioning.
Results: Between January 2018 and June 2020, we retrospectively evaluated ten consecutive patients (six male and four female) which underwent a chest wall stabilization because of a posterior ribs destruction and flail chest. No chest wall deformities were observed during follow-up with CT-scan after 4, 30 and 90 days and no patient underwent additional early or late stabilization procedures.
Conclusions: In the case of severe thoracic trauma with chest wall destruction and flail chest, modified “Shaw-Paulson approach” and prosthetic-free fixation technique with Maxon thread should be considered as a valuable option allowing an adequate stabilization of the chest with optimal respiratory function.
... Rib fixators are used to help the osteosynthesis of multi fractured ribs with solutions that usually are fixed on the bones either by hooks or screws or both. A large variety of designs are available for surgery application with invasive implantation by using several metallic materials, [1]. The treatment of rib fractures is a very debated problem, [2,3]. ...
... Traditional implants on ribs for osteosynthesis use different types of fixation which, however, present problems both for the patient and the function of osteosynthesis. Fixation methods have been variously proposed without meeting a universal consensus, [1][2][3]. In rib implants with flexible hooks, it is very important to check the force used to bend each hook to avoid injuring the vessels or the intercostal nerve. ...
The problems for fixing rib fractures are usually challenged with different rib fixators whose design strongly depends of the material selected for construction. Main issues refer to rib surgery implantation and tissue acceptance for a duration longer than the osteosynthesis. In this paper we discuss how a material selection can strongly suggest different design solutions both in shape of a rib fixator and even constraining or directing the surgical application with an invasive or noninvasive implantation. In particular, in discussing the general issues and specific experiences of the authors the paper illustrates examples of two different solutions under patent request that are dictated by the material whose selection give the design solutions with innovative aspects.
... Киршнера, установленными под флотирующим сегментом после открытой торакотомии. Все же многие авторы отмечали, что основными проблемами фиксации спицами являлись ротационная нестабильность переломов и миграция спиц, сопровождающаяся потерей репозиции переломов и повреждениями мягких тканей [11]. ...
... Первые пластины, предложенные для фиксации переломов ребер, фиксировались к отломкам швами, проволочным серкляжем и крючками (Vecsei plate, Judet plate). По мнению авторов, использование методики существенно не улучшило результаты лечения пациентов с сочетанной травмой, находившихся перед операцией на искусственной вентиляции легких, но ограниченная серия пациентов из 4 человек с изолированной травмой груди, подвергшихся хирургическому лечению, показала хорошие результаты, специфических осложнений лечения зафиксировано не было [11]. бронходилатационную терапию, санацию трахеобронхиального дерева [12]. ...
