Mapping of Common Rib Fracture Patterns and the Subscapular Flail Chest Associated With Operative Scapula Fractures

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Claire N. Thomas ◽  
Timothy J. Lindquist ◽  
Thomas Z. Paull ◽  
Joscelyn M. Tatro ◽  
Lisa K. Schroder ◽  
...  
Author(s):  
D Whittaker ◽  
C Edmunds ◽  
I Scott ◽  
M Khalil ◽  
I Stevenson

Thoracic chest wall trauma is a common injury in patients admitted to hospital following injury and is associated with high mortality. British Orthopaedic Association Standards for Trauma and Orthopaedics guidelines recommend consideration of rib fracture fixation in patients with flail chest wall injuries with respiratory compromise or uncontrollable pain. Veno-venous extracorporeal membrane oxygenation (ECMO) can be utilised in patients with severe respiratory dysfunction and we present the case of a patient who underwent rib fracture fixation while receiving ECMO. A 32-year-old male was admitted to our department following a 4.5m fall. He sustained significant thoracic injuries with multiple ribs fractures and a flail segment from the right fourth to ninth ribs. Treatment consisted of bilateral chest drains, ECMO support, tracheostomy and rib fracture fixation to the eighth and ninth ribs. The patient made a rapid recovery following surgery and ECMO support was ceased 2.5 days postoperatively. The case shows that a well-prepared, combined specialty surgical team can safely perform rib fixation for a patient on ECMO.


2018 ◽  
Vol 31 (04) ◽  
pp. 239-245 ◽  
Author(s):  
Lenore Bacek ◽  
Kyoung Kim ◽  
George Miller ◽  
Philippe Gaillard ◽  
Kendon Kuo ◽  
...  

Objectives To characterize the clinical features among dogs sustaining rib fractures and to determine if age, type and severity of injury, entry blood lactate, trauma score and rib fracture score were associated with outcome. Methods A retrospective study was performed to include dogs that were presented with rib fractures. Risk factors evaluation included breed, age, body weight, diagnosis, presence of a flail chest, bandage use, puncture wound presence, rib fracture number, location of the fracture along the thoracic wall, hospital stay length, body weight, other fractures, pleural effusion, pulmonary contusions, pneumothorax and occurrence of an anaesthetic event. A retrospective calculation of an animal trauma triage (ATT) score, RibScore and Modified RibScore was assigned. Results Forty-one medical records were collected. Motor vehicular trauma represented 56% of the rib fracture aetiology, 41% of patients sustained dog bites and one case was of an unknown aetiology. Significant correlations with risk factors were found only with the ATT score. All patients that died had an ATT score ≥ 5. The ATT score correlated positively with mortality (p < 0.05) with an ATT score ≥ 7 was 88% sensitive and 81% specific for predicting mortality. A 1-point increase in ATT score corresponded to 2.1 times decreased likelihood of survival. Mean hospital stay was 3 days longer for dog bite cases. Clinical Significance There was no increased mortality rate in canine patients that presented with the suspected risk factors. The only risk factor that predicted mortality was the ATT score.


1985 ◽  
Vol 25 (9) ◽  
pp. 903-908 ◽  
Author(s):  
GEOFFREY M. GRAEBER ◽  
DAVID J. COHEN ◽  
DARRYL H. PATRICK ◽  
ROBERT E. WOLF ◽  
MICHAEL C. HOTARD ◽  
...  

Author(s):  
Amanda L. Bradley ◽  
Michael V. Swain ◽  
J. Neil Waddell ◽  
Raj Das ◽  
Josie Athens ◽  
...  

2015 ◽  
Vol 78 (6) ◽  
pp. 458-463 ◽  
Author(s):  
Meiguang Qiu ◽  
Zhanjun Shi ◽  
Jun Xiao ◽  
Xuming Zhang ◽  
Shishui Ling ◽  
...  

2015 ◽  
Vol 16 (sup2) ◽  
pp. S115-S123 ◽  
Author(s):  
Ellen L. Lee ◽  
Matthew Craig ◽  
Mark Scarboro

2020 ◽  
Vol 5 (1) ◽  
pp. e000519
Author(s):  
Jared Griffard ◽  
Brian Daley ◽  
Marc Campbell ◽  
Danilo Martins ◽  
Zach Beam ◽  
...  

BackgroundRib fractures are associated with significant morbidity and mortality in polytraumatized patients. There is considerable variability in the management (operative vs. non-operative) and timing of operative intervention. Although Eastern Association for the Surgery of Trauma (EAST) guidelines recommend early operative intervention in patients with flail chest, there are no strong recommendations regarding operative fixation in patients with a non-flail chest rib fracture pattern.MethodsWe reviewed our Trauma Quality Improvement Program database for patients aged 18 to 99 who underwent operative intervention of ribs from January 2016 to July 2019. We examined hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, Injury Severity Score, age, discharge disposition and packed red blood cell transfusions. Similarly, we collected data from patients aged 18 to 99 who had one or more rib fractures in this time frame. We compared results in a 4:1 ratio of patients managed non-operatively to patients managed operatively. The patient groups were matched based on age, number of rib fractures and presence of bilateral rib fractures.ResultsBetween January 2016 and July 2019, 33 of 4189 total patients diagnosed with rib fractures underwent operative fixation; the matched non-operative group consisted of 132 patients. The statistically significant differences included presence of bilateral rib fractures, displaced rib fractures and flail chest segments. The median ICU days were longer in the operative group (6.0 vs. 3.5 days). A subgroup analysis of patients without flail segments demonstrated a significant presence of displaced rib fractures.Our single-institution matched comparison of outcomes in operative intervention versus Non-operative Management (NOM) of rib fractures found an increased median number of ICU days. Patients who underwent operative intervention often stayed in the ICU preoperatively and postoperatively for aggressive pulmonary hygiene and pain control, suggesting observer bias. The increased incidence of displaced rib fractures and the presence of a flail segment in the operative group demonstrate congruence with EAST guidelines. A subgroup analysis of patients without flail segment did not demonstrate differences in outcomes nor shoulder girdle injury characteristics.Level of evidenceThis article presents level III evidence that can be used by other clinicians to analyze eligibility for patients to undergo surgical stabilization of rib fracture (SSRF) and to provide counterarguments for performing SSRF in a heterogenous group of patients.


2011 ◽  
Vol 1 (2) ◽  
pp. 20
Author(s):  
Marco Scarci ◽  
Andrea Billè ◽  
Imran Zahid ◽  
Tom Routledge

Flail chest complicates about 10% of patients with chest trauma and is associated with a mortality rate of 10-20% in older series, while a recent one reports no mortality. The majority of the cases are treated conservatively with internal pneumatic stabilization and pain control. In recent years, nevertheless, we assisted in the resurgence of chest wall fixation due to the availability of new devices. We report our experience in the use of mouldable titanium clips (STRACOS, Strasbourg Thoracic Osteosyntheses System; MedXpert, Heitersheim, Germany) to fix traumatic rib fracture. This device presents an advantage over previous strategies, as it is easy to apply and doesn’t require drilling and screwing of the ribs.


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