Surgical management of multiple rib fractures/flail chest

Abstract

Non-operative management Rib fractures can range from simple fractures to flail segments. Fail segments refers to multiple adjacent ribs with fractures of the same rib at multiple places. Simple fractures, even if multiple, are often tolerated well in the absence of underlying cardiopulmonary pathology. Analgesia, humidified oxygen, incentive spirometry and physiotherapy are the most important management components. Incentive spirometry and physiotherapy can be limited by pain therefore analgesia needs to be optimised

An unexpected fracture of a titanium rib plate in a patient with traumatic brain injury

“…Rib fractures are painful and potentially disabling. Up to 40% of patients with rib fractures require hospital admission [2,3]. Among them, the patient with the paradoxical chest wall movement accompanied by pulmonary contusion could have high morbidity and mortality [4].…”

“…Among them, the patient with the paradoxical chest wall movement accompanied by pulmonary contusion could have high morbidity and mortality [4]. In a patient with flail chest, an operative repair of severe chest wall injury could restore chest wall integrity therefore it is associated with lower rates of long-term morbidity [1,2]. As a result, the frequency of surgical stabilization of rib fractures has increased leading to reduction of ventilation need and fewer days in the intensive care unit for patients with flail chest.…”

“…Approximately 10% of patients who visit trauma centers have multiple rib fractures; among these, 3%–5% also have flail chest [[1], [2], [3]]. In a patient with flail chest, rib fixation is usually considered because it provides several advantages including reduction of intensive care unit (ICU) stay, lower risk of mechanical ventilator involvement, decrease of tracheostomy, and pain relief [[1], [2], [3], [4]]. However, several side effects such as infection, loosening, and delayed plate fracture are also reported [[5], [6], [7]].…”

Anaesthetic and surgical management of rib fractures

“…3 Rib fractures from blunt trauma are invariably associated with underlying lung contusion. 1,2 Damage to the alveolar capillary membrane complex leads to bleeding into the lung tissue and subsequent oedema. This often impairs gas exchange from intra-pulmonary shunting and reduced lung compliance.…”

“…Chest injuries contribute to 25% of deaths after trauma, and survivors can experience long-standing consequences, such as reduced functional capabilities and loss of work. 1 In the UK, rib fractures are most commonly the result of blunt chest wall trauma. Younger adults tend to sustain highimpact blows, such as in motor vehicle collisions, whilst the elderly usually suffer fragility fractures, for example after a fall from standing height.…”