The evaluation of pulmonary function after rib fixation for multiple rib fractures and flail chest: a retrospective study and systematic review of the current evidence

BackgroundRecently, interest has increased in surgical fixation for severe thoracic wall injury with good short-term outcomes. However, few reports have evaluated long-term outcomes or complications. This study aimed to assess long-term quality of life and implant-related complications after rib fixation for flail chest and multiple rib fractures.MethodsWe interviewed patients who had undergone rib fixation from January 2014 to December 2019 about their current ability to work and their usual life.ResultsTwenty-two patients underwent rib fixation during the study period. Two patients with flail chest had already died after the surgery due to senescence; thus, follow-up information was obtained from 20 patients (91%), with a follow-up duration of 47.5 (IQR 22–58) months. The most undesirable event occurring during the study period was irritation caused by a palpable plate (n=2, 10%), probably due to the thin skin of patients over 70 years old. Eighteen patients were able to return to their usual life or same work as in the premorbid state with no complaints. Two patients are still undergoing rehabilitation due to concomitant extremities fractures. The median EQ-5D-5L index score was 0.89 (IQR 0.84–0.93). There were no implant-related complications requiring plate explantation.DiscussionWe concluded that rib fixation offers good long-term benefits, with the ability of the patient with flail chest or multiple rib fractures to return to activity in the premorbid state. Elderly patients especially with thin, soft tissue may complain of irritation caused by the plate and should be informed of this prior to surgery.Level of evidenceLevel IV therapeutic care/management.

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Multicentre prospective cohort study of nonoperative versus operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: study protocol

BMJ Open ◽

10.1136/bmjopen-2018-023660 ◽

2019 ◽

Vol 9 (8) ◽

pp. e023660 ◽

Cited By ~ 2

Author(s):

Reinier B Beks ◽

Mirjam B de Jong ◽

Arthur Sweet ◽

Jesse Peek ◽

Bas van Wageningen ◽

...

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Prospective Cohort Study ◽

Study Protocol ◽

Prospective Cohort ◽

Flail Chest ◽

Nonoperative Treatment ◽

Rib Fractures ◽

Multiple Rib Fractures ◽

Rib Fixation

IntroductionA trend has evolved towards rib fixation for flail chest although evidence is limited. Little is known about rib fixation for multiple rib fractures without flail chest. The aim of this study is to compare rib fixation with nonoperative treatment for both patients with flail chest and patients with multiple rib fractures.Methods and analysisIn this study protocol for a multicentre prospective cohort study, all patients with three or more rib fractures admitted to one of the five participating centres will be included. In two centres, rib fixation is performed and in three centres nonoperative treatment is the standard-of-care for flail chest or multiple rib fractures. The primary outcome measures are intensive care unit length of stay and hospital length of stay for patients with a flail chest and patients with multiple rib fractures, respectively. Propensity score matching will be used to control for potential confounding of the relation between treatment modality and length of stay. All analyses will be performed separately for patients with flail chest and patients with multiple rib fractures without flail chest.Ethics and disseminationThe regional Medical Research Ethics Committee UMC Utrecht approved a waiver of consent (reference number WAG/mb/17/024787 and METC protocol number 17–544/C). Patients will be fully informed of the purpose and procedures of the study, and signed informed consent will be obtained in agreement with the General Data Protection Regulation. Study results will be submitted for peer review publication.Trial registration numberNTR6833

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Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-018-1037-1 ◽

2018 ◽

Vol 45 (4) ◽

pp. 655-663 ◽

Cited By ~ 6

Author(s):

Reinier B. Beks ◽

David Reetz ◽

Mirjam B. de Jong ◽

Rolf H. H. Groenwold ◽

Falco Hietbrink ◽

...

Keyword(s):

Cohort Study ◽

Operative Treatment ◽

Thoracic Trauma ◽

Flail Chest ◽

Rib Fractures ◽

Blunt Thoracic Trauma ◽

Multicenter Cohort Study ◽

Multiple Rib Fractures ◽

Rib Fixation ◽

Multicenter Cohort

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Massage Therapy for Pulmonary Function in Patients Recovering From Covid-19: A Protocol for Systematic Review and Meta-analysis

10.21203/rs.3.rs-38936/v1 ◽

2020 ◽

Author(s):

Kelin Zhou ◽

Shuo Dong ◽

Guobing Fu ◽

Shusheng Cui ◽

Sheng Guo

Keyword(s):

Systematic Review ◽

Pulmonary Function ◽

Alternative Medicine ◽

Data Extraction ◽

Meta Analysis ◽

Massage Therapy ◽

Respiratory Illness ◽

Current Evidence ◽

Pubmed Database ◽

Tuina Therapy

Abstract Background:Starting in December 2019 in Wuhan (Hubei province, China), a novel coronavirus, designated SARS-CoV-2, has caused an international outbreak of a respiratory illness and rapidly evolved into a pandemic.Given the rapidly growing pandemic and the overwhelmedmedical system, the number of self‐quarantined and recovering patients is increasing.There is an urgentneed of alternative medicine to help patients relieve symptoms duringself‐quarantine, and possibly to help increase their chances of survivaland recovery from COVID-19.Massage (tuina) therapy is one of the widely employed complementary and alternative medicine interventions in the world.Long-term clinicalpractices and experiences have shown that massage therapy could significantly contribute to the healing of most respiratory conditions and lung disease.This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for pulmonary function in COVID-19 recovering patients.Methods:We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy inimproving pulmonary function ofCOVID-19 recovering patients: Wanfang and Pubmed Database, CNKI, CENTRAL, CINAHL, EMBASE and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses.Discussion:This proposed systematic review will evaluate the existing evidence and explore the potential roleof massage therapyon the effectiveness and safety in pulmonary function of COVID-19 recovering patients.The outcomes will include the improvement of pulmonary function and adverse effect.PROSPERO registration number:CRD42020192107

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Rib fractures, a public health issue-a multi regional retrospective study

Jurnalul de Chirurgie ◽

10.7438/jsurg.2021.01.03 ◽

2021 ◽

Vol 17 (1) ◽

pp. 14-19

Author(s):

Irina Drăgan ◽

Ioan Adrian Petrache ◽

Valerian Cristian Păvăloiu ◽

Petruț Giuliano ◽

Ion Mîndrilă ◽

...

Keyword(s):

Retrospective Study ◽

Individual Case ◽

Rib Fractures ◽

Rib Fracture ◽

Public Health Issue ◽

Average Hospital Stay ◽

Average Hospital ◽

Social Reintegration ◽

Multiple Rib Fractures ◽

Total Average

We performed a retrospective study focusing on examining all rib fracture cases discharged from 4 thoracic surgery clinics in Romania. Over a period of 3 years, we analyzed data regarding the patients, diagnosis and number of days spent in the hospital. 2.417 patients were included in this study and all patient evolutions were taken into account. The most patients suffered from multiple rib fractures, involving four or more ribs. In total average hospital stay was 5.46 days. The pneumothorax was the most common encountered complication followed by hemo-pneumothorax, hemothorax and lung contusion. Men seem to be at a higher risk to develop a rib fracture than women. Fracture incidence increased with age in both sexes. The main goal when treating thoracic traumatic pathology is attaining less impairment of pulmonary functions and fast social reintegration. Management of rib fractures must be tailored to each individual case.

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Surgical Treatment of Flail Chest and Rib Fractures: A Systematic Review of the Literature

International Journal of Orthopaedics ◽

10.17554/j.issn.2311-5106.2019.06.284 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1039-1044 ◽

Cited By ~ 1

Author(s):

Tanner T McClure ◽

◽

Paul M Myers ◽

Jacob J Triplet ◽

David B. Johnson ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Flail Chest ◽

Rib Fractures ◽

Review Of The Literature

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The selection of surgical approach in the surgery of multiple rib fractures and flail chest

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2015-8-4-342-350 ◽

2016 ◽

Vol 8 (4) ◽

pp. 342

Author(s):

Е.А Корымасов ◽

А.С Бенян

Keyword(s):

Surgical Approach ◽

Flail Chest ◽

Rib Fractures ◽

Multiple Rib Fractures ◽

Selection Of

Актуальность В хирургии тяжелых повреждений груди достижение стабилизации грудной клетки является одним из ключевых факторов, обеспечивающих положительный исход лечения. Оперативная фиксация переломов является надежным и эффективным способом стабилизации, однако множество технологий обусловливают необходимость уточнения, оценки и совершенствования подходов, в том числе и в вопросе выбора оперативного доступа.Цель исследования Выбор оптимального доступа для выполнения остеосинтеза ребер у пострадавших с тяжелой закрытой травмой грудной клетки.Материал и методы В статье описан опыт хирургического лечения 75 пациентов с множественными и флотирующими переломами ребер. Всем пациентам проведен остеосинтез ребер с помощью системы фиксации «Matrix Rib». Были выделены 2 группы пациентов: I группа – 36 пациентов, у которых доступ осуществляли посредством разреза мягких тканей по ходу межреберий; II группа – 39 пациентов, у которых были применены альтернативные и усовершенствованные варианты хирургического доступа. В работе использованы новые технические приспособления, способствующие усовершенствованию хирургической техники остеосинтеза ребер: сетка для маркировки операционного поля, троакар, двухканальный торакопорт для однопортовой торакоскопии.Результаты и их обсуждение Дана оценка различным видам доступов, приведены их количественные и качественные характеристики. Статистически значимого влияния вида оперативного доступа на показатели морбидности и летальности не выявлено. У пациентов II группы достигнуто уменьшение длины хирургического разреза доступа, сокращение длительности операции, отсутствие необходимости в дополнительных доступах.Выводы Наилучшие условия для выполнения остеосинтеза ребер создает хирургический доступ, осуществляемый в проекции линий переломов предполагаемых для восстановления ребер. Применение специальных приспособлений позволяет выполнять оперативную фиксацию отломков ребер через миниинвазивные доступы, а также проводить торакоскопию для устранения внутриплевральных повреждений.

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Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures

Journal of International Medical Research ◽

10.1177/0300060517710068 ◽

2017 ◽

Vol 45 (6) ◽

pp. 2085-2091 ◽

Cited By ~ 10

Author(s):

Ge Yeying ◽

Yuan Liyong ◽

Chen Yuebo ◽

Zhang Yu ◽

Ye Guangao ◽

...

Keyword(s):

Pain Relief ◽

Pulmonary Function ◽

Pain Treatment ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Rib Fractures ◽

Paravertebral Block ◽

Patient Controlled Analgesia ◽

Thoracic Paravertebral Block ◽

Multiple Rib Fractures

Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management and preservation of pulmonary function compared with intravenous, patient-controlled analgesia (IVPCA) in patients with multiple rib fractures (MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study and randomly assigned to the TPVB or IVPCA group. The visual analogue scale (VAS) pain score, blood gas analysis, and bedside spirometry were measured and recorded at different time points after analgesia. Results TPVB and IVPCA provided good pain relief. VAS scores were significantly lower in the TPVB group than in the IVPCA group at rest and during coughing ( P < 0.05). Patients in the TPVB group had a higher PaO2 and PaO2/FiO2 and lower P(A–a)O2 compared with the IVPCA group ( P < 0.05). Moreover, patients in the TPVB group showed higher FVC, FEV1/FVC, and PEFR, and fewer complications than did the IVPCA group ( P < 0.05). Conclusion TPVB is superior to IVPCA in pain relief and preservation of pulmonary function in patients with MRFs.

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