Historic overview of treatment techniques for rib fractures and flail chest

Bemelman, Mike; Poeze, Martijn; Blokhuis, Taco J.; Leenen, Luke P. H.

doi:10.1007/s00068-010-0046-5

Cited by 78 publications

(67 citation statements)

References 28 publications

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“…Figure 2 highlights the surgical procedure from the crucial preparatory work through to the actual rib stabilisation (Bottlang et al, 2013). Table 3 outlines the fixation devices commonly used in rib fracture surgical repair and their reported potential advantages and disadvantages (Bemelman et al, 2010;Lafferty et al, 2011;Nirula et al, 2009).…”

Section: Surgical Interventionmentioning

confidence: 99%

Blunt chest wall trauma: A review

Battle

Hutchings

Evans

2013

Trauma

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Blunt chest wall trauma accounts for a large proportion of all trauma presentations to the Emergency Departments in the United Kingdom and has a high reported incidence of morbidity and mortality. The difficulty in the assessment and management of this patient group arises from the possibility that the patient may develop potentially life-threatening complications up to approximately 72 h post-injury, even in patients who have sustained what is initially considered a minor injury. Limited consensus currently exists in the literature regarding optimal assessment or management strategies for this patient group. The aim of this review is to provide an overview of current research investigating the optimal assessment and management strategies for the blunt chest wall trauma patient.

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Section: Surgical Interventionmentioning

confidence: 99%

Blunt chest wall trauma: A review

Battle

Hutchings

Evans

2013

Trauma

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“…Several other methods have since been introduced [5]. Plate and bicortical screw fixation, originally described in 1975, has become the preferred method of chest wall stabilization [3].…”

Section: Introductionmentioning

confidence: 99%

Use of a 90° Drill and Screwdriver for Rib Fracture Stabilization

et al. 2014

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Background Rib fracture stabilization has become a more accepted practice although stabilization of the most cephalad ribs presents a unique challenge. We present our experience with use of a 90° drill and screwdriver to bridge these difficult rib fractures. Methods This retrospective review included patients who underwent rib fracture stabilization from August 1, 2009, through September 30, 2012. Patients were divided into two groups: those whose procedure used the 90° device and those that did not. Data were compared using standard statistical analysis and reported as percentages and medians [interquartile ranges]. P values <0.05 were considered significant. Results We identified 89 patients: 29 (33 %) had 90° devices used and 60 (67 %) did not. There were no differences between groups in age, sex, Trauma-Related Injury Severity Score, the presence of flail chest, occurrence of pneumonia, and intensive care unit or hospital length of stay. The Injury Severity Score was higher in the 90° group (22 vs. 16; P = 0.03). The highest rib stabilized was different between the 2 groups (3 [2–5] vs. 5 [2–9]; P = 0.001), with more third rib stabilizations in the 90° group (38 vs. 20 %; P = 0.04) as well as more total number of ribs fixed (5 vs. 4; P = 0.001). There was no difference in operative time between the 2 groups. Conclusions The surgical reach for rib fracture stabilization has been extended with use of a 90° drill and screwdriver. High fractures under the scapula where access is technically challenging can be stabilized without prolonging operative times.

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“…The reasons for this incongruity are myriad, e.g. lack of evidence-based indications for surgery, lack of familiarity with surgical techniques and lack of specialty ownership for the care of rib fracture patients [5].…”

mentioning

confidence: 99%

“…Several surgical techniques and plate systems have been used to stabilize flail chest over the years [5]. Accordingly, Nirula et al (2009) described six commonly used surgical approaches [6].…”

mentioning

confidence: 99%

Indication and Timing of Surgery Are Essential in Stabilization of the Chest Wall in Flail Chest Trauma Patients

El-Akkawi¹,

Paoli²,

Bendixen³

et al. 2018

OJTS

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Flail chest occur after blunt trauma to the thorax. Most often treatment of flail chest is conservative with analgesia and respiratory support, if needed. New plate systems and surgical approaches have improved outcomes after surgery. Surgical treatment of flail chest is associated with a reduced risk of severe pneumonia, shorter time with mechanical ventilation and a reduced length of stay in the Intensive Care Unit (ICU) compared to conservative treatment. However, currently approximately 1% of patients with flail chest undergo surgery. We are presenting two cases of flail chest treated surgically by fixating the most dislocated posterior fractures. One patient avoided mechanical ventilation, and the other patient was quickly weaned from respirator after surgery. We found that surgical stabilization of posterior fractures in patients with flail chest is a safe method with a high possibility of positive outcomes for the patients. Surgical stabilization of flail chest is indicated in patients with consistent pain (case 1) and increased risk of pneumonia, respiratory failure or prolonged mechanical ventilation (case 2). Furthermore, it was possible to achieve stable thorax wall by only fixating the most dislocated posterior fractures in the flail segment.

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Historic overview of treatment techniques for rib fractures and flail chest

Cited by 78 publications

References 28 publications

Blunt chest wall trauma: A review

Blunt chest wall trauma: A review

Use of a 90° Drill and Screwdriver for Rib Fracture Stabilization

Indication and Timing of Surgery Are Essential in Stabilization of the Chest Wall in Flail Chest Trauma Patients

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