Treatment of open chest rib fractures with the matrix rib internal fixation system

Abstract

Rationale: Rib fractures are common among patients with blunt chest wall trauma and often represent life-altering injuries. Patient concerns: A 31-year-old woman presented with right chest trauma, with pain and bleeding as a result of a traffic accident 1 hour previously. Diagnoses: Chest computed tomography showed open chest trauma, multiple rib fractures, flail chest, hemopneumothorax, and lung contusion on the right side. Interventions: We decided to perform debridement via emergency, thoracoscopic exploration to remove blood and contaminants from the chest cavity. Thereafter, the third to seventh fractured ribs were fixed and reconstructed using the matrix rib internal fixation system, followed by suturing of the incision according to the original anatomical level. Outcomes: The patient was discharged 15 days after surgery, and recovered well with satisfactory results. Lessons: We believe that initial chest reconstruction with internal fixation in the first stage following thorough debridement may be suitable for treating flail chest, and could save the patient's life in the early stages. However, the decision to perform the first-stage operation for the open contaminated wound should be carefully considered.

In vitro and in vivo investigation of osteogenic properties of self-contained phosphate-releasing injectable purine-crosslinked chitosan-hydroxyapatite constructs

“…The reparative stage can occur via two mechanisms: direct healing, which occurs without a cartilaginous intermediate and indirect bone healing where there is formation of a cartilaginous callus 50 . Indirect fracture healing is the most common form of repair and consists of both endochondral and intramembranous ossifications 51,52 . Therefore, in the current study, we used an intramedullary nailing procedure to introduce tibial fracture as this procedure results in indirect fracture healing involving endochondral ossification as the predominant process for bone regeneration.…”

Anatomofunctional comparison between the ribs of man and domestic animals

“…In the investigated species, reports of deformities were observed, some due to congenital anomalies (Farias et al, 2020), closed and exposed fractures in traumatized patients or those with mineral deficiencies (Pereira & Cardoso, 2011;Feng et al, 2019;Choi et al, 2021), in addition to benign and malignant neoplasms (Brondino et al, 2017;Aires et al, 2020;Goldback et al, 2020;Santos et al, 2021) in the ribs.…”

Surgical fixation of rib fractures: how I do it

“…After primary and secondary surveys, the patient's condition should be further optimized by efficient pain control and aggressive pulmonary hygiene (1). Furthermore, early prophylactic antibiotics administration-especially in case of open fractures -aids in infection prevention (10).…”

“…Already many years ago, surgeons have started to carry out rib fixation, but these procedures were done rather infrequently, and had to be performed using nonspecific materials such as wires, sutures or common reconstruction plates (8). Recently, new material and technologies have been developed and enriched this field and more recent studies support surgical stabilization over conservative treatment, showing that the surgical option has a beneficial influence in terms of reduction of pain, duration of mechanical ventilation, hospital stay, ICU time, tracheostomy rate, and pulmonary infection rate (5,6,(9)(10)(11).…”