Fixation Of Multiple Rib Fractures Research Articles

CO91 Surgical Fixation of Multiple Rib Fractures in Asian Population: A Systematic Literature Review and Meta-Analysis

CO91 Surgical Fixation of Multiple Rib Fractures in Asian Population: A Systematic Literature Review and Meta-Analysis

Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis.

Multiple rib fractures and flail chest are common in trauma patients and may result in significant morbidity and mortality. While rib fractures have historically been treated conservatively, there is increasing interest in the benefits of surgical fixation. However, strong evidence that supports surgical rib fixation and identifies the most appropriate patients for its application is currently sparse. A systematic review and meta-analysis following PRISMA guidelines was performed to identify all peer-reviewed papers that examined surgical compared to conservative management of rib fractures. We undertook a subgroup analysis to determine the specific effects of rib fracture type, age, the timing of fixation and study design on outcomes. The primary outcomes were the length of hospital and ICU stay, and secondary outcomes included mechanical ventilation time, rates of pneumonia, and mortality. Our search identified 45 papers in the systematic review, and 40 were included in the meta-analysis. There was a statistical benefit of surgical fixation compared to conservative management of rib fractures for length of ICU stay, mechanical ventilation, mortality, pneumonia, and tracheostomy. The subgroup analysis identified surgical fixation was most favorable for patients with flail chest and those who underwent surgical fixation within 72h. Patients over 60y had a statistical benefit of conservative management on length of hospital stay and mechanical ventilation. Surgical fixation of flail and multiple rib fractures is associated with a reduction in morbidity and mortality outcomes compared to conservative management. However, careful selection of patients is required for the appropriate application of surgical rib fixation.

In-Hospital Outcomes after Operative Fixation of Multiple Rib Fractures with Non-Flail Chest: A Propensity Matched Analysis

Azim, Asad MD; Khan, Muhammad N. MD; Jehan, Faisal S. MD; Con, Jorge MD, FACS Author Information

Comparison of the therapeutic effect between anatomical plates and claw-type bone plates in fixation of multiple rib fractures

Objective To compare the therapeutic effect of claw-type bone plates and anatomical plates in fixation of traumatic multiple rib fractures. Methods Clinical data of 70 patients with traumatic multiple rib fractures between January 2016 and November 2017 was analyzed retrospectively. Based on the treatments, patients were assigned to two groups: the claw-type bone plates fixation group (n=33) and anatomical plates fixation group (n =37). The variables including operation time, intraoperative blooding, postoperative thoracic hemorrhage rate, wound drainage, plate loosening and breakage, postoperative chest pain were compared. Data were analyzed using SPSS17.0 statistical software. Student’s t test and rank sum test were used to compare the measurement data, and χ2test was used to compare the counting data. Results The operation time after the full exposure of fractures were recorded. Operation time for each fracture [(11.04±1.81) min vs (12.30±0.47) min], intraoperative bleeding [(120.76±7.19) mL vs (110.00±7.45) mL] and wound drainage [(114.06±7.24) mL vs (107.98±7.23) mL] in the claw-type rib bone plates fixation group were statistically significant different compared with the anatomical plates fixation group (P<0.05).There were 1case of screw abscission in the anatomical plates fixation group (suffering from osteoporosis) and 2 cases in the claw-type bone plates fixation group (without osteoporosis and other complications).Two cases suffered from chest pain and 2 cases suffered from massive hemorrhage in the chest in the claw-type bone plates fixation group, with secondary operation removing internal fixations. Conclusions The two kinds of internal fixation have their own advantages and disadvantages. The claw-type bone plates fixation is cheaper, easier to shape and has shorter operation time, which is especially suitable for comminuted fracture. Although the anatomical plates fixation is more expensive than claw-type bone plates fixation, the anatomical plates fixation on multiple fractured ribs has less postoperative blood loss, lower postoperative thoracic hemorrhage rate, plate loosening, chest pain, which significantly reduces second operation and possesses a higher clinical application value. Key words: Rib fractures; Claw-type bone plates; Anatomical plates; Fixation

Does Surgery Reduce the Risk of Complications Among Patients with Multiple Rib Fractures? A Meta-analysis.

Multiple rib fractures are common in trauma patients, who are prone to trauma-associated complications. Surgical or nonsurgical interventions for the aforementioned conditions remain controversial. The purpose of our study was to perform a meta-analysis to evaluate the clinical prognosis of surgical fixation of multiple rib fractures in terms of (1) hospital-related endpoints (including duration of mechanical ventilation, ICU length of stay [LOS] and hospital LOS), (2) complications, (3) pulmonary function, and (4) pain scores. We screened PubMed, Embase, and Cochrane databases for randomized and prospective studies published before January 2018. Individual effect sizes were standardized; the pooled effect size was calculated using a random-effects model. Primary outcomes were duration of mechanical ventilation, intensive care unit length of stay (ICU LOS), and hospital LOS. Moreover, complications, pulmonary function, and pain were assessed. The surgical group had a reduced duration of mechanical ventilation (weighted mean difference [WMD], -4.95 days; 95% confidence interval [CI], -7.97 to -1.94; p = 0.001), ICU LOS (WMD, -4.81 days; 95% CI, -6.22 to -3.39; p < 0.001), and hospital LOS (WMD, -8.26 days; 95% CI, -11.73 to -4.79; p < 0.001) compared with the nonsurgical group. Complications likewise were less common in the surgical group, including pneumonia (odds ratio [OR], 0.41; 95% CI, 0.27-0.64; p < 0.001), mortality (OR, 0.24; 95% CI, 0.07-0.87; p = 0.030), chest wall deformity (OR, 0.02; 95% CI. 0.00-0.12; p < 0.001), dyspnea (OR, 0.23; 95% CI, 0.09-0.54; p < 0.001), chest wall tightness (OR, 0.11; 95% CI, 0.05-0.22; p < 0.001) and incidence of tracheostomy (OR, 0.34; 95% CI, 0.20-0.57; p < 0.001). There were no differences between the surgical and nonsurgical groups in terms of pulmonary function, such as forced vital capacity (WMD, 6.81%; 95% CI: -8.86 to 22.48; p = 0.390) and pain scores (WMD, -11.41; 95% CI: -42.09 to 19.26; p = 0.470). This meta-analysis lends stronger support to surgical fixation, rather than conservative treatment, for multiple rib fractures. Nevertheless, additional trials should be conducted to investigate surgical indications, timing, and followup for quality of life. Level I, therapeutic study.

Surgical plate fixation of multiple rib fractures: a case report

BackgroundThe healthcare system in developing countries is limited; particularly, medical specialties such as emergency and trauma medicine are underdeveloped. Consequently, trauma injuries sustained in traffic accidents result in chronic morbidity more often than similar cases in developed countries. Multiple rib fractures induce significant patient morbidity. Current international guidelines recommend a multidisciplinary, surgery-based treatment approach to achieve optimal clinical benefit.Case presentationWe admitted a 41-year-old Albanian man to our emergency department following a pedestrian-vehicle accident 5 days earlier. He presented with severe upper thoracic pain, chest deformity, dyspnea, tachycardia, subcutaneous emphysema, and hematoma. Chest radiography pointed to hypoventilated lung fields and a minor pleural effusion. Computed tomographic scans indicated displaced fractures of right lateral ribs 5 –11, hyperdensity regions from bone fragments, and pulmonary contusion. The treatment consisted of surgical fixation of ribs 7–10 using titanium reconstruction plates and cortical locking screws. The patient’s clinical condition rapidly improved postoperatively. Follow-up at 6 weeks confirmed a full return to preoperative daily activities and a high quality of life.ConclusionsIn this case report, we present a novel and promising development in the field of trauma medicine in the Republic of Macedonia. Trauma injuries can be treated via advanced multidisciplinary medical care according to international standards, allowing optimal health recovery.

Meta-analysis of open reduction internal fixation and non-operative treatment of multiple rib fractures

Objective To compare the efficacy between open reduction internal fixation and non-operative treatment of multiple rib fractures. Methods Pubmed, Embase, Chinese National Knowledge Infrastructure database (CNKI), Chinese Biological Medical Literature database (CBM), Wanfang database and VIP database were searched for relevant studies comparing the effect of open reduction internal fixation and non-operative treatment of multiple rib fractures during 1990 and 2016. RevMan 5.3 software was used for the meta-analysis to compare differences of the two treatments concerning hospital stay, total ICU stay, duration of mechanical ventilation, proportion of pneumonia and atelectasis and pulmonary function. Results Eleven studies containing 799 patients met the inclusion criteria, including 431 patients in internal fixation group and 368 patients in non-operative group. Two groups had significant differences in hospital stay (95%CI -11.00--3.34, P<-0.05), total ICU stay (95%CI -4.48--1.29, P<0.05), duration of mechanical ventilation (95%CI-7.52--1.54, P<0.05), proportion of pneumonia (95%CI 0.19-0.42, P<0.05), proportion of atelectasis (95%CI 0.24-0.57, P<0.05) and total lung capacity (95%CI 1.57-1.97, P<0.05), forced vital capacity (FVC) (95%CI 0.98-1.27, P<0.05) and forced expiratory volume in one second (FEV1) (95%CI 0.68-0.95, P<0.05). Conclusion Open reduction internal fixation of multiple rib fractures can significantly improve rehabilitation rate, reduce incidence of pulmonary complications during hospitalization, and facilitate recovery of lung function. Key words: Rib fractures; Flail chest; Surgical procedures, operative; Meta-analysis

O-075TIMING FOR SURGICAL FIXATION OF MULTIPLE SIMPLE RIB FRACTURES AND FLAIL CHEST: A SINGLE-CENTRE EXPERIENCE

Objectives: The performance and timing of surgical fixation of multiple simple rib fractures and flail chest wall remains controversial. We report our experience with acute and delayed multiple simple rib fracture and flail chest wall surgical fixation. Methods: Since December 2006, 46 patients had surgical fixation using external titanium plates and bicortical screws for either multiple simple rib fractures or flail chest. We analysed operation details, hospital stay and complications. Results: 29 patients [Group 1, 21 males, median age 54 (range 31-77) years] underwent fixation within 6 days following injury (range 1-43). Indications included: significant deformity/displacement, n= 19; respiratory failure, n= 6; uncontrolled pain, n = 3; persistent pneumothorax, n= 1. 17 patients [Group 2, 12 males, median age 58 (range 25-76) years] had delayed fixation at 12 (range 4-159) months following injury due to persistent pain, dyspnoea or deformity. 24 patients in Group 1 had flail chest vs 5 in Group 2 (P < 0.001). Critical care stay was zero in Group 2. Eighteen patients in Group 1 had median critical care stay of 4 (range 0.5-34) days. Postoperative length of stay (PLOS) was longer in Group 1 for both flail chest and multiple simple rib fractures (13.6 ± 10 days vs 3.6 ± 0.6 days, P =0 .1, and 7.4 ±3 .8 days vs 7 ± 1.7 days, P = 0.01, respectively). Nine patients in Group 1 (31%) developed complications (chest infection, n = 5; sputum retention, n =1 ; deep wound infection, n = 1; prolonged respiratory wean, n = 1; internal jugular vein thrombosis, n = 1) vs 3 patients in Group 2 (17.6%, P =N S; surgical infection, n = 1; neurogenic pain, n =1 ; haemothorax,n =1 ). Although symptomatic improvement was noted in most Group 2 patients, 18% had persistent pain. Conclusions: Fixation of multiple rib fractures is safe and effective in both the acute and delayed setting. Patients undergoing acute repair have an acceptable critical care stay. Although early repair is recommended, delayed fixation may still be of benefit. Disclosure: All authors have declared no conflicts of interest. Interactive CardioVascular and Thoracic Surgery

ステロイド長期内服患者の多発肋骨骨折に対する外固定の1例

Wegener肉芽腫症に対してステロイド長期投与を受けていた患者の転落による多発外傷例を経験した。症例は49歳の男性。来院時，頻呼吸，ショック状態であった。来院後呼吸状態はさらに悪化し，疼痛も強くショックに伴って不穏状態となったため救急外来で気管挿管，胸腔ドレナージを施行した。その後，脾損傷に対し緊急脾動脈塞栓術を行った。多発肋骨骨折に対しては鎮静・鎮痛の上，人工呼吸下で保存的に加療したが1週間経過後も高い呼気終末陽圧を要する状態が続いた。第7病日から区域麻酔を併用したが人工呼吸器からの離脱が困難であり，第15病日に観血的肋骨固定術を施行した。術後は経過良好で第60病日に退院となった。Flail chestの患者において，前側方の骨折などで内固定により固定が得られにくい場合や肺炎などの合併症を生じやすい高齢者や，ステロイド長期内服など易感染性患者では早期から外固定を考慮すべきである。

Surgical Fixation vs Nonoperative Management of Flail Chest: A Meta-Analysis

Flail chest is a life-threatening injury typically treated with supportive ventilation and analgesia. Several small studies have suggested large improvements in critical care outcomes after surgical fixation of multiple rib fractures. The purpose of this study was to compare the results of surgical fixation and nonoperative management for flail chest injuries. A systematic review of previously published comparative studies using operative and nonoperative management of flail chest was performed. Medline, Embase, and the Cochrane databases were searched for relevant studies with no language or date restrictions. Quantitative pooling was performed using a random effects model for relevant critical care outcomes. Sensitivity analysis was performed for all outcomes. Eleven manuscripts with 753 patients met inclusion criteria. Only 2 studies were randomized controlled designs. Surgical fixation resulted in better outcomes for all pooled analyses including substantial decreases in ventilator days (mean 8 days, 95% CI 5 to 10 days) and the odds of developing pneumonia (odds ratio [OR] 0.2, 95% CI 0.11 to 0.32). Additional benefits included decreased ICU days (mean 5 days, 95% CI 2 to 8 days), mortality (OR 0.31, 95% CI 0.20 to 0.48), septicemia (OR 0.36, 95% CI 0.19 to 0.71), tracheostomy (OR 0.06, 95% CI 0.02 to 0.20), and chest deformity (OR 0.11, 95% CI 0.02 to 0.60). All results were stable to basic sensitivity analysis. The results of this meta-analysis suggest surgical fixation of flail chest injuries may have substantial critical care benefits; however, the analyses are based on the pooling of primarily small retrospective studies. Additional prospective randomized trials are still necessary.