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

Abstract

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.

The beneficial application of preoperative 3D printing for surgical stabilization of rib fractures

“…Numerous studies examining the surgical repair of ribs promote this technique as superior to conservative treatment. [ 8 – 12 ] Therefore, in order to ensure a minimally invasive approach, Nickerson [ 13 ] mentioned that the surgical reach for rib fracture stabilization can be extended with the use of a 90° drill and screwdriver and that high fractures under the scapula where access is technically challenging can be stabilized without prolonged operative times. However, there is still much room for improvement of the surgical process, such as shortening the incision, reducing the time spent on searching for fracture sites, designing the length and curvature of the titanium plates, and measuring the length of the locking screws.…”

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

“…The fixation of the ribs in their anterior aspect had been performed through this approach employing minimal invasive plate osteosynthesis (MIPO) in trokar technique or with the 90 degree drill and screwdriver (10).…”

A new instrument for surgical stabilization of multiple rib fractures

“…For these plates, more dissociation of the muscles around the ribs is needed, which increases the damage to local tissue and extends the operation time. 5 , 6 , 17 – 20 Several kinds of claw-type titanium plates can be used. The number of claws ranges from 8 to 18.…”

“…These devices have been suggested to improve the prognosis of patients with multiple rib fractures. [5][6][7][8] Because the ribs are not all of the same shape, each fixation instrument has its restriction. Four-claw titanium plates were introduced in our hospital in 2012.…”