scholarly journals Early Operative Stabilization for Multiple Rib Fractures Causing Flail Chest in an Elderly Patient

2015 ◽  
Vol 76 (3) ◽  
pp. 488-493
Author(s):  
Hironori MATSUMOTO ◽  
Kensuke UMAKOSHI ◽  
Mayuki AIBIKI
Keyword(s):  
Elderly Patient ◽  
Flail Chest ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Operative Stabilization

A method for operative stabilization of multiple rib fractures in patients with flail chest

1991 ◽  
Vol 6 (2) ◽  
pp. 1-9
Author(s):  
Lawrence X. Webb ◽  
J Wayne Meredith
Keyword(s):  
Flail Chest ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Operative Stabilization

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

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.

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 MODERN ALGORITHMS OF THORACIC CAGE STABILIZATION IN PATIENTS WITH MULTIPLE RIB FRACTURES AND FLAIL CHEST

2018 ◽  
Vol 3 (4) ◽  
pp. 13-19
Author(s):  
A S Benyan ◽  
E A Korymasov ◽  
A Yu Borkovskiy
Keyword(s):  
Flail Chest ◽  
Surgical Techniques ◽  
Rib Fractures ◽  
Full Potential ◽  
Thoracic Cage ◽  
Cage Structure ◽  
Treatment Algorithms ◽  
Multiple Rib Fractures ◽  
Results Of Treatment ◽  
Historical Group

Objectives - to improve the treatment results in patients with multiple rib fractures and flail chest via the development and implementation of modern therapeutic and tactical algorithms. Material and methods. A non-randomized prospective study has been carried out to evaluate the results of treatment in 198 patients with multiple rib fractures and flail chest in the period of 2011-2017. Three clinical types were identified: 1) patients with multiple rib fractures with disordered thoracic cage structure - 77 (38.9%); 2) patients with flail chest - 71 (35.9%); 3) patients with multiple rib fractures without disordered thoracic cage structure - 50 (25.2%). There were developed and applied the diagnostic and treatment algorithms depending on the severity of injures of sternocostal frame and intrapleural organs, the presence and severity of associated injuries and background diseases, the conditions of medical aid. Results. The treatment tactics of all patients was based on the differentiated, staged and combined use of various methods of stabilizing the thoracic cage including the advanced types of medical care. Surgical stabilization methods were used in 162 patients, in 26 of them a combination of surgical techniques was applied, in 20 - the internal pneumatic stabilization, in 42 - the conservative treatment was performed. The retrospective analysis and the obtained results compared to the results of the equivalent historical group allowed us to state the decrease of mechanical ventilation time from 11.0 ± 3.9 to 5.1 ± 3.2 days (t = 1.17; p> 0.05), the length of stay in the ICU from 11.5 ± 5.4 to 6.8 ± 3.7 days (t = 0.72; p> 0.05), the complications frequency from 36.5% to 15.9% and mortality rate from 22.3% to 8.7%. Conclusion. Modern diagnostic and treatment algorithms in patients with multiple rib fractures and flail chest are based on stage-by-stage application, succession and combination of various methods of the thoracic cage stabilization throughout the medical assistance process. The algorithms, allowing to stabilize the thorax and to improve the condition of the patients in general, make it possible to realize the full potential of modern thoracic surgery.

In-Hospital Outcomes after Operative Fixation of Multiple Rib Fractures with Non-Flail Chest: A Propensity Matched Analysis

2019 ◽  
Vol 229 (4) ◽  
pp. e232
Author(s):  
Asad Azim ◽  
Muhammad N. Khan ◽  
Faisal S. Jehan ◽  
Jorge Con
Keyword(s):  
Flail Chest ◽  
Rib Fractures ◽  
Hospital Outcomes ◽  
Multiple Rib Fractures ◽  
Operative Fixation

scholarly journals Surgical management of multiple rib fractures/flail chest

2019 ◽  
Vol 11 (4) ◽  
pp. 1668-1675 ◽  
Author(s):  
Joshil Vinod Lodhia ◽  
Konstantinos Konstantinidis ◽  
Kostas Papagiannopoulos
Keyword(s):  
Surgical Management ◽  
Flail Chest ◽  
Rib Fractures ◽  
Multiple Rib Fractures

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

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e023660 ◽  
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

Multiple rib fractures: does flail chest matter?

2021 ◽  
pp. emermed-2020-210999
Author(s):  
Yaakov Daskal ◽  
Maya Paran ◽  
Alexander Korin ◽  
Vladislav Soukhovolsky ◽  
Boris Kessel
Keyword(s):  
Intensive Care ◽  
Injury Severity ◽  
Medical Center ◽  
Unit Length ◽  
Flail Chest ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Chest Injuries ◽  
Reliable Marker

BackgroundRecent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.MethodsThis study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010–2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Patients with and without radiologically defined flail chest were compared with regard to demographics, Injury Severity Score (ISS), GCS, systolic blood pressure (SBP) on admission, radiological evidence of flail chest, associated chest injuries, length of stay in intensive care unit, length of hospitalisation and mortality.ResultsThe study included 407 patients, of which 79 (19.4%) had flail chest. Overall, pneumothorax and haemothorax were more common among patients with flail chest (p<0.05). When comparing patients with three to five rib fractures, there was no difference in length of intensive care and length of hospitalisation or mortality; however, there was a higher incidence of pneumothorax (24.6% vs 50.0%, p<0.05). When comparing patients with six or more rib fractures, no difference was found between patients with and without flail chest.ConclusionIn patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.

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