Rib Fracture Fixation, a new Era in Treatment of Chest Trauma in Albania

Rib fractures are a consequence of the forces of various arthritis that the chest wall and the thoracic cage itself undergo, and are most often due to closed injuries (eg, motor vehicle collision, falls from height, and Hits with strong objects ..), but penetrating injuries (eg, wounds with sharp tools, gunshot injuries ...) can also result in rib fractures. Non-operative treatment is based on pain control and pulmonary support, which mainly aim to avoid the need for intubation, which is associated with increased levels of pulmonary disorders until death. For patients who continue to have acute pain or instability of the chest wall (eg, flail chest), each of which impedes pulmonary function despite maximal medical therapy, or those with non-consolidating rib fractures and causing pain in the persistence and impairment of pulmonary function, surgicaly stabilization of fractured ribs, also known as osteosynthesis, are now well-known procedures that improve the quality of treatment of the traumatized patient. The thoracic wall injury association has been established to better study all aspects related to the consequences, diagnosis and treatment of thoracic wall injuries [1]. Indications for osteosynthesis, patient preparation, operative technique for stabilizing fractured ribs and the results are quite significant.

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Decreased Incidence of Rib Fractures in Pregnant Patients After Motor Vehicle Collisions

American Journal of Critical Care ◽

10.4037/ajcc2021505 ◽

2021 ◽

Vol 30 (5) ◽

pp. 385-390

Author(s):

Marissa Di Napoli ◽

William B. DeVoe ◽

Stuart Leon ◽

Bruce Crookes ◽

Alicia Privette ◽

...

Keyword(s):

Chest Wall ◽

Injury Severity ◽

Motor Vehicle ◽

Rib Fractures ◽

Hormonal Changes ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Vehicle Collision ◽

Chest Wall Injury ◽

Wall Injury

Background Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood. Objectives To compare the incidences of chest wall injury following blunt thoracic trauma between pregnant and nonpregnant women. Methods The authors conducted a retrospective review of female patients seen at a level I trauma center from 2009 to 2017 after a motor vehicle collision. Patient characteristics were compared to determine if pregnancy affected the incidence of chest wall injury. Statistics were calculated with SPSS version 24 and are presented as mean (SD) or median (interquartile range). Results In total, 1618 patients were identified. The incidence of rib/sternal fracture was significantly lower in pregnant patients (7.9% vs 15.2%, P = .047), but the incidence of intrathoracic injury was similar between the groups. Pregnant and nonpregnant patients with rib/sternal fractures had similar Injury Severity Score results (21 [13-27] vs 17 [11-22], P = .36), but pregnant patients without fractures had significantly lower scores (1 [0-5] vs 4 [1-9], P < .001). Conclusions Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.

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Minimally invasive surgery for sternal and bilateral rib fractures

Proceedings of Singapore Healthcare ◽

10.1177/20101058211025994 ◽

2021 ◽

pp. 201010582110259

Author(s):

Tomoki Nakagawa ◽

Ryota Masuda ◽

Shunsuke Yamada ◽

Masayuki Iwazaki

Keyword(s):

Minimally Invasive ◽

Chest Wall ◽

Motor Vehicle ◽

Bone Fractures ◽

Artificial Respiration ◽

Prolonged Mechanical Ventilation ◽

Flail Chest ◽

Anterior Chest Wall ◽

Rib Fractures ◽

Nuss Procedure

Sternal bone fractures with bilateral multiple rib fractures cause serious instability of the anterior chest wall, and prolonged mechanical ventilation may be required. A 45-year-old man was injured in a motor vehicle collision. He suffered from a bilateral flail chest injury accompanied by a transverse sternal fracture. Minimally invasive surgical stabilisation of the anterior chest wall was performed using two bars as per the Nuss procedure. Two days after surgery, he was extubated from artificial respiration and was ultimately discharged without any complications.

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

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1639608 ◽

2018 ◽

Vol 31 (04) ◽

pp. 239-245 ◽

Cited By ~ 1

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.

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

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000546 ◽

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.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04148-1 ◽

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.

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Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000441 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000441 ◽

Cited By ~ 1

Author(s):

Jesse Peek ◽

Yassine Ochen ◽

Noelle Saillant ◽

Rolf H H Groenwold ◽

Loek P H Leenen ◽

...

Keyword(s):

Motor Vehicle ◽

Flail Chest ◽

Ventilatory Support ◽

Data Bank ◽

International Classification Of Diseases ◽

Rib Fractures ◽

Severe Injury ◽

Level Of Evidence ◽

National Trauma ◽

National Trauma Data Bank

BackgroundIn recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.MethodsA retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.ResultsOf the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).DiscussionTraumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.Level of evidenceII/III.

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