Comparative studies of different types of osteosynthesis on the human corpse preparation in bilateral antero-lateral flail chest

Grupp, Sina; Fürst, Veronika; Buder, Thomas; Fichte, Alexander; Krinner, Sebastian; Carbon, R.; Hennig, F. F.; Langenbach, Andreas; Schulz-Drost, Stefan

doi:10.1016/j.injury.2017.10.015

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…There are multiple mentions in the flail chest literature regarding the ability to restore normal breathing mechanics with fixation of fractured segments (Grupp et al, 2017;Leinicke et al, 2013;Swart et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Our study is helpful in quantifying this conclusion as we demonstrate increased interfragmentary motion at both anterior and lateral fracture sites without reduction and fixation, making it sensible that stabilizing both sites would provide the optimum construct. Further, Grupp et al (2017) explored which method of fixation would be most beneficial in stabilizing flail chest segments, demonstrating that locked plating restored 60% of normal stability. While they noted less restoration of stability compared to our study, the principle of plating decreasing interfragmentary motion and providing rigid fixation aligns with basic guidelines of osteosynthesis.…”

Section: Discussionmentioning

confidence: 99%

“…These benefits are supported by several studies demonstrating the significant improvements in pulmonary function tests post-operatively compared to pre-operatively (Caragounis et al, 2019;Slobogean et al, 2015;Sm et al, 2014). It is thought that by restoring the anatomic relationship of the ribs in a flail chest segment that improved rib biomechanics and respiratory function may be restored (Grupp et al, 2017;Leinicke et al, 2013;Swart et al, 2017). However, to our knowledge few models exist to define normal rib biomechanics or demonstrate effects of rib plating after fracture on this model.…”

Section: Introductionmentioning

confidence: 99%

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A model for evaluating the biomechanics of rib fracture fixation

Myers

McGowan

Taylor

et al. 2020

Clinical Biomechanics

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High rates of morbidity and mortality following flail chest rib fractures are well publicized. Standard of care has been supportive mechanical ventilation, but serious complications have been reported. Internal rib fixation has shown improvements in pulmonary function, clinical outcomes, and decreased mortality. The goal of this study was to provide a model defining the biomechanical benefits of internal rib fixation. Methods: One human cadaver was prepared with an actuator providing anteroposterior forces to the thorax and rib motion sensors to define interfragmentary motion. Cadaveric model was validated using a prior study which defined costovertebral motion to create a protocol using similar technology and procedure. Ribs 4-6 were fixed with motion sensors anteriorly, laterally and posteriorly. Motion was recorded with ribs intact before osteotomizing each rib anteriorly and laterally. Flail chest motion was record with fractures subsequently plated and analyzed. Motion was recorded in the sagittal, coronal and transverse axes. Findings: Compared to the intact rib model, the flail chest model demonstrated an 11.3 times increase in sagittal plane motion, which was reduced to 2.1 times the intact model with rib plating. Coronal and sagittal plane models also saw increases of 9.7 and 5.1 times, respectively, with regards to flail chest motion. Both were reduced to 1.2 times the intact model after rib plating. Interpretation: This study allows quantification of altered ribcage biomechanics after flail chest injuries and suggests rib plating is useful in restoring biomechanics as well as contributing to improving pulmonary function and clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A model for evaluating the biomechanics of rib fracture fixation

Myers

McGowan

Taylor

et al. 2020

Clinical Biomechanics

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“…Another benefit of this approach is the prevention of recurrence as the plate is laterally fixed to the ribs and therefore, for physical reasons, no impression in the central area can take place. This property is also of crucial importance for cardiopulmonary resuscitation during the rarely necessary, but extremely vital, external thoracic wall compression (21)(22)(23). Chest compression may not be possible when using the rigid steel bar essential to the Nuss procedure (24).…”

Section: Discussionmentioning

confidence: 99%

“…It is reasonable on the basis of these case studies that ESCR enables successful resuscitation with impressive physiological performance of the chest wall in this stressful situation. However, very few accounts of resuscitation in patients after open chest wall correction have yet to be reported in the literature (21,24).…”

Section: Discussionmentioning

confidence: 99%

Elastic stable chest repair and its hybrid variants in 86 patients with pectus excavatum

et al. 2018

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Background: Complex and mature funnel chest deformities are traditionally managed with open surgical procedures. Elastic stable chest repair (ESCR) has been used successfully and safely for relapse corrections. Does pure plate osteosynthesis in ESCR allow comparable corrective potency and implant safety as hybrid methods with metal bars? Methods: Data from 86 patients with open funnel chest correction between 2011 and 2015 were analyzed in this retrospective study. Exclusion criteria included being under 12 years of age, and having a history of septic wound healing disorder or other malignant diseases. Main groups consisted of ESCR and hybrid techniques, subgroups were primary and recurrence correction. Correction results and follow-up examinations at six and 12 weeks and at 1 year were statistically analyzed. Results: A total of 38 ESCR and 48 hybrid methods were analyzed. Bar implantation was required in 77% (recurrence 34%) of patients. All patients received plates with different combinations e.g., longitudinalsternal, costosternal and costo-sterno-costal. In all groups, follow-up uptake showed a funnel chest correction result at the anatomical level with healthy values according to the Haller index (ESCR 4.36-2.84, hybrid 6.99-2.74, P<0.001). No material dislocations were observed in any subgroup. Conclusions: ESCR and hybrid techniques represent promising and safe therapeutic approaches.

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Epidemiologie, Verletzungsentitäten und Behandlungspraxis der Thoraxwandverletzungen

Schulz-Drost

Stengel

2018

Unfallchirurg

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Multimodal therapy concepts and closely controlled follow-up examinations of fractures avoid complications or can detect them early. Bony chest wall injuries should still be evaluated for complications and typical fracture patterns identified and classified. Modern osteosynthesis procedures with high patient safety and soft tissue-preserving tissue preparation for the surgical access route to the ribs and sternum provide an excellent opportunity for successful restoration of the anatomical and physiological integrity of the bony thorax.

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Comparative studies of different types of osteosynthesis on the human corpse preparation in bilateral antero-lateral flail chest

Cited by 4 publications

References 28 publications

A model for evaluating the biomechanics of rib fracture fixation

A model for evaluating the biomechanics of rib fracture fixation

Elastic stable chest repair and its hybrid variants in 86 patients with pectus excavatum

Epidemiologie, Verletzungsentitäten und Behandlungspraxis der Thoraxwandverletzungen

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