Nonunion of traumatic rib fractures: a suitable indication for surgery?

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

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Two uncommon cases of thoracic aortic injury caused by rib fractures

Journal of Thoracic Disease ◽

10.21037/jtd.2019.03.45 ◽

2019 ◽

Vol 11 (S8) ◽

pp. S1113-S1118

Author(s):

Hao Xie ◽

Shaonan Ning ◽

Nan Li ◽

Lei Song ◽

Yanbin Wang ◽

...

Keyword(s):

Aortic Injury ◽

Rib Fractures ◽

Thoracic Aortic Injury

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Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01662-8 ◽

2021 ◽

Author(s):

Jonne T. H. Prins ◽

Mathieu M. E. Wijffels ◽

Sophie M. Wooldrik ◽

Martien J. M. Panneman ◽

Michael H. J. Verhofstad ◽

...

Keyword(s):

Health Care ◽

Incidence Rate ◽

Health Care Costs ◽

Indirect Costs ◽

Rib Fractures ◽

Work Absence ◽

Lost Productivity ◽

The Mean ◽

Using Data ◽

Care Costs

Abstract Purpose This study aimed to examine population-based trends in the incidence rate, health care consumption, and work absence with associated costs in patients with rib fractures. Methods A retrospective nationwide epidemiologic study was performed with data from patients with one or more rib fractures presented or admitted to a hospital in the Netherlands between January 1, 2015 and December 31, 2018 and have been registered in the Dutch Injury Surveillance System (DISS) or the Hospital Discharge Registry (HDR). Incidence rates were calculated using data from Statistics Netherlands. The associated direct health care costs, costs for lost productivity, and years lived with disability (YLD) were calculated using data from a questionnaire. Results In the 4-year study period, a total of 32,124 patients were registered of which 19,885 (61.9%) required hospitalization with a mean duration of 7.7 days. The incidence rate for the total cohort was 47.1 per 100,000 person years and increased with age. The mean associated direct health care costs were €6785 per patient and showed a sharp increase after the age of 75 years. The mean duration of work absence was 44.2 days with associated mean indirect costs for lost productivity of €22,886 per patient. The mean YLD was 0.35 years and decreased with age. Conclusion Rib fractures are common and associated with lengthy HLOS and work absenteeism as well as high direct and indirect costs which appear to be similar between patients with one or multiple rib fractures and mostly affected by admitted patients and age.

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Application of 3D printing and framework internal fixation technology for high complex rib fractures

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01377-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xuetao Zhou ◽

Dongsheng Zhang ◽

Zexin Xie ◽

Yang Yang ◽

Menghui Chen ◽

...

Keyword(s):

3D Printing ◽

Internal Fixation ◽

Locking Plate ◽

Rating Scale ◽

Preoperative Planning ◽

Numerical Rating Scale ◽

Chest Ct ◽

Rib Fractures ◽

X Rays ◽

With Screws

Abstract Objective To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures. Methods Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). Results The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to 10 months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape. Conclusion The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.

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