Multiple rib fractures: A novel and prognostic CT-based classification system

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 265-272
Author(s):  
Rosalind B Simpson ◽  
Jessica R Dorman ◽  
William J Hunt ◽  
John G Edwards
Keyword(s):  
Clinical Outcomes ◽  
Classification System ◽  
Wide Spectrum ◽  
Flail Chest ◽  
Derived Categories ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Observer Agreement ◽  
Multiple Rib Fractures ◽  
The Impact

Background The accepted classification for multiple rib fractures is binary: flail chest or not. There is a wide spectrum of morphology with subsequent variation in the impact on chest wall mechanics and clinical outcomes. As the practice of surgical stabilisation of rib fractures evolves, there is a need for a better taxonomy. The aim of this study was to create a data-driven radiological classification system for multiple rib fractures, prognostic of both complications and surgical stabilisation of rib fracture. Methods The radiological pattern of injury was assessed for cases undergoing surgical stabilisation of rib fracture (n = 48) over a five-year period and a consecutive sample of non-operative controls (n = 48). Every rib fracture (n = 1032) was assessed on CT scans for location, displacement and comminution. An iterative classification system was developed and tested for inter-observer agreement and outcome prediction. Results The fractures occurred in a ‘series’ (≥3 consecutive ribs at a similar location) in 72% of cases: these were more likely to be displaced (p < 0.001). Variables included in the classification were the anatomical pattern (presence, length and overlap of series) and degree of displacement. The classification was prognostic for complications (p < 0.001), discriminated for fixation (C = 0.907) and had acceptable inter-observer agreement (k = 0.50). Conclusions The Sheffield Multiple Rib Fracture Classification derived categories of short/long series, and short/long flail chest, with sub-division according to the presence of displacement. It was prognostic for clinical outcomes and of surgical fixation. It may facilitate communication, comparison of outcomes and selection for management protocols.

scholarly journals Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023444 ◽  
Author(s):  
Helen MA Ingoe ◽  
Elizabeth Coleman ◽  
William Eardley ◽  
Amar Rangan ◽  
Catherine Hewitt ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Systematic Reviews ◽  
Fracture Fixation ◽  
Flail Chest ◽  
Risk Of Bias ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Multiple Rib Fractures ◽  
Significant Difference ◽  
The Impact

ObjectivesMultiple systematic reviews have reported on the impact of rib fracture fixation in the presence of flail chest and multiple rib fractures, however this practice remains controversial. Our aim is to synthesise the effectiveness of surgical rib fracture fixation as evidenced by systematic reviews.DesignA systematic search identified systematic reviews comparing effectiveness of rib fracture fixation with non-operative management of adults with flail chest or unifocal non-flail rib fractures. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Science Citation Index were last searched 17 March 2017. Risk of bias was assessed using the Risk Of Bias In Systematic reviews (ROBIS) tool. The primary outcome was duration of mechanical ventilation.ResultsTwelve systematic reviews were included, consisting of 3 unique randomised controlled trials and 19 non-randomised studies. Length of mechanical ventilation was shorter in the fixation group compared with the non–operative group in flail chest; pooled estimates ranged from −4.52 days, 95% CI (−5.54 to –3.5) to −7.5 days, 95% CI (−9.9 to –5.5). Pneumonia, length of hospital and intensive care unit stay all showed a statistically significant improvement in favour of fixation for flail chest; however, all outcomes in favour of fixation had substantial heterogeneity. There was no statistically significant difference between groups in mortality. Two systematic reviews included one non-randomised studies of unifocal non-flail rib fracture population; due to limited evidence the benefits with surgery are uncertain.ConclusionsSynthesis of the reviews has shown some potential improvement in patient outcomes with flail chest after fixation. For future review updates, meta-analysis for effectiveness may need to take into account indications and timing of surgery as a subgroup analysis to address clinical heterogeneity between primary studies. Further robust evidence is required before conclusions can be drawn of the effectiveness of surgical fixation for flail chest and in particular, unifocal non-flail rib fractures.PROSPERO registration numberCRD42016053494.

scholarly journals Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

2020 ◽  
Author(s):  
Debkumar Chowdhury ◽  
P. Okoh ◽  
H. Dambappa
Keyword(s):  
Major Trauma ◽  
Significant Proportion ◽  
Fragility Fractures ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Analgesic Requirement ◽  
Multiple Rib Fractures ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

scholarly journals Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

2020 ◽  
Author(s):  
Debkumar Chowdhury ◽  
P. Okoh ◽  
H. Dambappa
Keyword(s):  
Major Trauma ◽  
Significant Proportion ◽  
Fragility Fractures ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Analgesic Requirement ◽  
Multiple Rib Fractures ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

scholarly journals Long-term follow-up after rib fixation for flail chest and multiple rib fractures

2018 ◽  
Vol 45 (4) ◽  
pp. 645-654 ◽  
Author(s):  
Reinier B. Beks ◽  
Mirjam B. de Jong ◽  
Roderick M. Houwert ◽  
Arthur A. R. Sweet ◽  
Ivar G. J. M. De Bruin ◽  
...  
Keyword(s):  
Flail Chest ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Rib Fixation ◽  
Long Term Follow Up

Use of the Animal Trauma Triage Score, RibScore, Modified RibScore and Other Clinical Factors for Prognostication in Canine Rib Fractures

2018 ◽  
Vol 31 (04) ◽  
pp. 239-245 ◽  
Author(s):  
Lenore Bacek ◽  
Kyoung Kim ◽  
George Miller ◽  
Philippe Gaillard ◽  
Kendon Kuo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Hospital Stay ◽  
Flail Chest ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Thoracic Wall ◽  
Puncture Wound ◽  
Severity Of Injury ◽  
Trauma Triage

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.

scholarly journals Long-term outcomes of surgical rib fixation in patients with flail chest and multiple rib fractures

2020 ◽  
Vol 5 (1) ◽  
pp. e000546
Author(s):  
Kenichiro Uchida ◽  
Masahiro Miyashita ◽  
Shinichiro Kaga ◽  
Tomohiro Noda ◽  
Tetsuro Nishimura ◽  
...  
Keyword(s):  
Flail Chest ◽  
Rib Fractures ◽  
Thoracic Wall ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Multiple Rib Fractures ◽  
Rib Fixation ◽  
Premorbid State

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.

scholarly journals Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tsung-Han Yang ◽  
Huan-Jang Ko ◽  
Alban Don Wang ◽  
Wo-Jan Tseng ◽  
Wei-Tso Chia ◽  
...  
Keyword(s):  
Chest Wall ◽  
Hospital Readmission ◽  
Clavicle Fracture ◽  
Flail Chest ◽  
Fracture Repair ◽  
Rib Fractures ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Chest Wall Injury ◽  
The Impact

Abstract Background The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI. Methods A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. A CWI and no-CWI group were distinguished, and the CWI group was subdivided into the minor-CWI (three or fewer rib fractures without flail chest) and complex-CWI (flail chest, four or more rib fractures) subgroup. Demographic data, classification of the clavicle fracture, number of rib fractures, and associated injuries were recorded. Overall complications included surgery-related complications and unplanned hospital readmissions. Univariate analysis and stepwise backward multivariate logistic regression were used to identify potential risk factors for complications. Results A total of 314 patients undergoing 316 clavicle fracture operations were studied; 28.7% of patients (90/314) occurred with associated CWI. Patients with associated CWI showed a significantly higher age, body mass index, and number of rib fractures. The overall and surgical-related complication rate were similar between groups. Unplanned 30-day hospital readmission rates were significantly higher in the complex-CWI group (p = 0.02). Complex CWI and number of rib fractures were both independent factor for 30-day unplanned hospital readmission (OR 1.59, 95% CI: 1.00–2.54 and OR 1.33, 95% CI: 1.06–1.68, respectively). Conclusion CWI did not affect surgery-related complications after clavicle fracture repair. However, complex-CWI may increase 30-day unplanned hospital readmission rates.

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

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.

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

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.

scholarly journals Impact of Penicillin Nonsusceptibility on Clinical Outcomes of Patients with Nonmeningeal Streptococcus pneumoniae Bacteremia in the Era of the 2008 Clinical and Laboratory Standards Institute Penicillin Breakpoints

2012 ◽  
Vol 56 (9) ◽  
pp. 4650-4655 ◽  
Author(s):  
Seong-Ho Choi ◽  
Jin-Won Chung ◽  
Heungsup Sung ◽  
Mi-Na Kim ◽  
Sung-Han Kim ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Clinical Outcomes ◽  
Antimicrobial Agents ◽  
Wide Spectrum ◽  
Median Number ◽  
Clinical Impact ◽  
Content Type ◽  
Duration Of Hospital Stay ◽  
Independent Risk Factors ◽  
The Impact

ABSTRACTTo investigate the impact of penicillin nonsusceptibility on clinical outcomes of patients with nonmeningealStreptococcus pneumoniaebacteremia (SPB), a retrospective cohort study was performed. The characteristics of 39 patients with penicillin-nonsusceptible SPB (PNSPB) were compared to those of a group of age- and sex-matched patients (n= 78) with penicillin-susceptible SPB (PSSPB). Susceptibility to penicillin was redetermined by using the revised Clinical and Laboratory Standards Institute (CLSI) penicillin breakpoints in CLSI document M100-S18. Although the PNSPB group tended to have more serious initial manifestations than the PSSPB group, the two groups did not differ significantly in terms of their 30-day mortality rates (30.8% versus 23.1%;P= 0.37) or the duration of hospital stay (median number of days, 14 versus 12;P= 0.89). Broad-spectrum antimicrobial agents, such as extended-spectrum cephalosporins, vancomycin, and carbapenem, were frequently used in both the PNSPB and PSSPB groups. Multivariate analysis revealed that ceftriaxone nonsusceptibility (adjusted odds ratio [aOR] = 4.88; 95% confidence interval [CI] = 1.07 to 22.27;P= 0.041) was one of the independent risk factors for 30-day mortality. Thus, when the 2008 CLSI penicillin breakpoints are applied and the current clinical practice of using wide-spectrum empirical antimicrobial agents is pursued, fatal outcomes in patients with nonmeningeal SPB that can be attributed to penicillin nonsusceptibility are likely to be rare. Further studies that examine the clinical impact of ceftriaxone nonsusceptibility in nonmningeal SPB may be warranted.

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