Стабилизация грудинно-реберного комплекса при обширных флотирующих переломах ребер у детей: обзор литературы и собственный опыт

Abstract

Thoracic injury is the leading cause of fatal complications. The incidence of chest trauma remains high. There are many fixation methods of the floating ribs of thoracic cage, which are technically challenging and linked to various materials. Objective: to search options for the sternocostal complex stabilization without the expenditures for manufacturing customised devices; to describe and implement the rib cage fixation method for floating fractured ribs in severely injured children, which is used by paediatric surgeons in Tyumen. Material and methods. In the south of the Tyumen Region for the period of 2016–2018, an original method of fixing the thoracic cage with multiple floating fractured ribs by means of a V-shaped modelled Cramer’s wire splint to extend the area of contact with the rib cage was used in four patients aged from 9 to 17 years. The splint was sutured with non-absorbable threads to the edges of stable parts of the ribs and to unstable segment of the rib cage, followed by its external fixation. Results. Having applied this method, it was possible to reliably, minimally invasively stabilize the rib cage in patients, achieve early spontaneous breathing, which reduced the length of stay in the intensive care unit. No purulent septic complications were observed. Conclusions. The proposed restoration method of skeletal function of the chest by using the external fixation with a V-shaped Cramer’s wire splint is simple and acceptable in any hospital.