Bridging the Gap: A novel use of rib plating post blast chest wall trauma.

Abstract

Introduction: Surgical rib fixation is an evolving area for trauma medicine and the indications incorporate both physiological and anatomical factors. The level of bony destruction involved in the fracture fragments is only a relative indication, as those with preserved respiratory function may not truly need surgery. We describe a case where the chest injury led to bone loss between the fracture fragments, creating concern for the development of lung herniation. His respiratory function was preserved with an intercostal drain, however the level of tissue loss meant the injury undoubtedly required surgical fixation. Case report: A 37-year-old male sustained a chest wall injury after metal pipe was flung onto his right chest in a workplace accident. The injury led to a significant tissue loss on his chest wall leading to a flail segment involving right sided ribs of 5, 6, and 7. Furthermore, there was such destruction of his 7th rib that there was bone loss. He required mesh repair of his chest wall to prevent lung herniation, along with fixation of ribs 5, 6 and 7. The rib plate on rib 7 was used to bridge the gap of the bone defect and the soft tissue defect was closed with a latissimus dorsi flap. Conclusion: This case report describes a novel use of rib plating used to bridge a bone defect sustained after a secondary blast injury, the first documented case to our knowledge.