Abstract
BackgroundSurgical management of fractured ribs with internal fixation is an increasingly accepted therapy. Concurrently, specific rib fixation prostheses are being developed which should improve results and minimise hardware and rib/splint construct failures. The Synthes titanium intramedullary splint lends itself to difficult to access areas such as posterior rib fractures and fractures under the scapula. We analyse a case series of patients in whom this rib fixation prosthesis has been used.MethodsFifteen patients received 35 intramedullary splints. Follow up at 3 and 6 months was performed with three dimensional computed tomography scanning to assess for bone alignment, callus formation and healing, residual deformity, hardware failure or cut through. Computerized finite element analysis (FEA) was used to model forces acting on a posterior fracture with and without an intramedullary fixation splint in situ.ResultsComplete healing (bony union) was noted in only 3 (9 %) of the fractures fixed with splints by 3 months. Partial healing (cartilaginous union) was noted in 28 of the 33 fractures (85 %), and non healing was noted in only 2 (6 %). In both those two patients, failure at the rib / splint interface was noted after both patients reported sneezing. No hardware failures were noted. By 6 months the fractures which had shown partial healing, had all completely healed. There were no late failures (between 3 and 6 months) of either hardware or rib/splint interfaces.FEA modelling identified sites of increased stress in the rib at the rib / splint interface and in a modelled intramedullary splint where it spans the fracture.ConclusionsFurther analysis of outcomes with intramedullary splints is warranted as well as further development of intramedullary rib fixation solutions.
Highlights
Surgical management of fractured ribs with internal fixation is an increasingly accepted therapy
The remaining fifteen patients received 35 intramedullary splints and are the basis of this study. Of those 15 patients, nine received Synthes Matrix Rib outer cortical plates. In six of those patients the outer cortical plates were for contralateral fractures and in the remaining three, a combination of outer cortical plates and intramedullary splints were used in consecutive ipsilateral fractures
As we demonstrated in the finite element analysis (FEA) modelling, the stainless steel intramedullary construct led to excessive stresses at the bone /implant interface during simulated cough level forces, it demonstrated no likelihood of splint failure in itself
Summary
Surgical management of fractured ribs with internal fixation is an increasingly accepted therapy. The Synthes titanium intramedullary splint lends itself to difficult to access areas such as posterior rib fractures and fractures under the scapula. Surgical management of fractured ribs with internal fixation is becoming an increasingly accepted therapy in patients with flail chest injury. With an increased interest in rib fixation, specific prostheses have become available. The Synthes intramedullary rib splint has been developed as a rib fixation option that overcomes the biomechanical limitations of Kirschner wires. Recommended as an option for single rib fractures, the splint does lend itself to the more difficult to access rib fractures. There is no distal fixation as such, the stabilisation of the rib fracture being achieved by the stiffness of the splint within the intramedullary canal (Fig. 1a)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
