Blunt chest trauma: is there a place for rib stabilization?

Mitchell, John D.

doi:10.21037/jtd.2017.04.05

Cited by 24 publications

(19 citation statements)

References 45 publications

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“…Rib fractures are caused by high-energy trauma (HET) in the younger patients, often with concomitant injuries, and in the elderly as a result of low energy trauma (LET) [5–7]. Sustaining multiple rib fractures can result in a flail chest, defined as fracture of three or more consecutive ribs in two or more places, creating a flail segment [8, 9]. Patients may also have multiple simple rib fractures or a combination of both.…”

Section: Introductionmentioning

confidence: 99%

Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial

et al. 2019

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Background Multiple rib fractures are common injuries in both the young and elderly. Rib fractures account for 10% of all trauma admissions and are seen in up to 39% of patients after thoracic trauma. With morbidity and mortality rates increasing with the number of rib fractures as well as poor quality of life at long-term follow-up, multiple rib fractures pose a serious health hazard. Operative fixation of flail chest is beneficial over nonoperative treatment regarding, among others, pneumonia and both intensive care unit (ICU) and hospital length of stay. With no high-quality evidence on the effects of multiple simple rib fracture treatment, the optimal treatment modality remains unknown. This study sets out to investigate outcome of operative fixation versus nonoperative treatment of multiple simple rib fractures. Methods The proposed study is a multicenter randomized controlled trial. Patients will be eligible if they have three or more multiple simple rib fractures of which at least one is dislocated over one shaft width or with unbearable pain (visual analog scale (VAS) or numeric rating scale (NRS) > 6). Patients in the intervention group will be treated with open reduction and internal fixation. Pre- and postoperative care equals treatment in the control group. The control group will receive nonoperative treatment, consisting of pain management, bronchodilator inhalers, oxygen support or mechanical ventilation if needed, and pulmonary physical therapy. The primary outcome measure will be occurrence of pneumonia within 30 days after trauma. Secondary outcome measures are the need and duration of mechanical ventilation, thoracic pain and analgesics use, (recovery of) pulmonary function, hospital and ICU length of stay, thoracic injury-related and surgery-related complications and mortality, secondary interventions, quality of life, and cost-effectiveness comprising health care consumption and productivity loss. Follow-up visits will be standardized and daily during hospital admission, at 14 days and 1, 3, 6, and 12 months. Discussion With favorable results in flail chest patients, operative treatment may also be beneficial in patients with multiple simple rib fractures. The FixCon trial will be the first study to compare clinical, functional, and economic outcome between operative fixation and nonoperative treatment for multiple simple rib fractures. Trial registration www.trialregister.nl , NTR7248. Registered May 31, 2018.

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Section: Introductionmentioning

confidence: 99%

Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial

et al. 2019

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“…There are however, no studies suggesting one device being superior to another, although the most dominant method currently used is plating osteosynthesis. 1 In order to optimize fixation stability, Depuy Synthes recommends at least three screws, per plate, per fracture side. In cases of anterior or anterolateral flail chest wherein the costochondral junction is also compromised, plate osteosynthesis for rib fractures alone is not stable enough, because there is no place for medial insertion of three screws at the fracture site.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with flail chest often struggle with hypoxemic respiratory failure, due to: insufficient ventilatory mechanics, pulmonary contusion, and subsequent pneumonia. 1 The mortality rate can be as high as 9.0-16.0%. 2,3 A combination of adequate pain control, respiratory assistance, and physiotherapy is considered the gold standard in management of rib fractures.…”

Section: Introductionmentioning

confidence: 99%

Fixation of Multiple-Segmented Costosternal Cartilage Fracture in Flail Chest Injury: A Case Report

Dissaneewate

Suksintharanon

Chewakidakarn

et al. 2022

J Health Sci Med Res

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Early internal fixation of rib fractures in the setting of flail chest has proven benefits over traditional conservative treatment. This can decrease pneumonia, time on mechanical ventilation, length of stay in intensive care units, need for tracheostomy and increase in the pulmonary function test. However, there are few reports regarding on how to restore the costochondral junction, or costal cartilage in cases of anterior or anterolateral flail chest involving cartilage matrix of the ribs or costochondral joint. This case report describes a surgical technique to restore the costochondral junction with plate osteosynthesis and the results.

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“…Rib fractures are frequent in trauma victims, seen in up to 39% of patients following blunt chest trauma and present in 10% of all trauma admissions [1,2]. The number of rib fractures is often related to the severity of thoracic trauma [1].…”

Section: Introductionmentioning

confidence: 99%

Preliminary Study of the Characteristics of Rib Fractures and Their Impact on Pulmonary Ventilatory Function

Zhao

et al. 2020

Preprint

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Background: This study aimed to investigate the pulmonary ventilation function (PVF) according to different types of rib fractures and pain levels.Methods: This was a retrospective study of patients with thoracic trauma admitted to our ward from May 1, 2015, to February 1, 2017. Vital capacity (VC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were measured on admission. A numerical rating scale (NRS) was used for pain assessment.Results: A total of 118 (85 males and 33 females) were included. The location of rib fractures did not affect the PVF. When the number of rib fractures was ≥ 5, the PVF was lower than in those with ≤ 4 fractures (VC: 0.40 vs. 0.47, P = 0.009; FEV1: 0.37 vs. 0.44, P = 0.012; PEF: 0.17 vs. 0.20, P = 0.031). There were no difference in PVF values between multiple and non-multiple rib fractures (VC: 0.41 vs. 0.43, P = 0.202; FEV1: 0.37 vs. 0.39, P = 0.692; PEF: 0.18 vs. 0.18, P = 0.684). When there were ≥ 5 breakpoints, the PVF parameters were lower than those with ≤ 4 breakpoints (VC: 0.40 vs. 0.50, P = 0.030; FEV1: 0.37 vs. 0.45, P = 0.022; PEF: 0.18 vs. 0.20, P = 0.013). When the NRS ≥ 7, the PVF values were lower than for those with NRS ≤ 6 (VC: 0.41 vs. 0.50, P = 0.003; FEV1: 0.37 vs. 0.47, P = 0.040; PEF: 0.18 vs. 0.20, P = 0.027).Conclusions: When the total number of fractured ribs is ≥ 5, there are ≥ 5 breakpoints, or NRS is ≥ 7, the VC, FEV1, and PEF are more affected.Trial registration: The trial was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and individual consent for this retrospectively registered analysis was waived.

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Blunt chest trauma: is there a place for rib stabilization?

Cited by 24 publications

References 45 publications

Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial

Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial

Fixation of Multiple-Segmented Costosternal Cartilage Fracture in Flail Chest Injury: A Case Report

Preliminary Study of the Characteristics of Rib Fractures and Their Impact on Pulmonary Ventilatory Function

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