Placement of KANI® plate inside the chest wall for rib fixation: Prevention for organ injuries caused by crossed rib edges and plate claws

Abstract

The claw‐type titanium plate has been successfully applied to manage a flail chest. However, rare and life‐threatening organ injury occurs due to an insufficient claw bend. We report an ingenuity of surgical fixation using KANI® plates (USCI Japan, Tokyo, Japan) in a flail chest. A 60‐year‐old man with a severe flail chest underwent a surgical rib fixation. He had multiple rib fractures accompanied by dislocation and protruding crossed rib edges; we assumed a possibility of lung injury during a standard procedure in which the KANI® plates would be placed from outside the chest wall. Therefore, we placed KANI® plates inside the chest wall to ensure sufficient claw bend and to cover crossed rib edges to prevent organ injuries. We propose that our new ingenuity provides a safe and tight rib fixation in rib fractures with protruding crossed rib edges which the standard method cannot flatten.

When to proceed to surgical rib fixation?—A single-institution clinical experience

“…The future evolution would probably be in the use of minimally-invasive surgery (38)(39)(40) and in the development of 3D printed or resorbable devices. As we described a technique using plates and intramedullary splints, we should be aware of the risk of rare and life-threatening organ injury (41) and consider other types of fixtures (42). Even though, Marasco et al highlighted the risk of failure of SSRF of the posterior portion of the rib with one resorbable device (43) but should be used carefully (44).…”

“…On admission to the ICU, median ISS and SAPS II were 32 [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and 24 [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] respectively. After total body-CTscan; the median number of rib fractures was 7 [6][7][8][9][10].…”