Rib fracture fixation: controversies and technical challenges.

Rib fractures are a common injury affecting more than 350,000 people each year in the United States and are associated with respiratory complications, prolonged hospitalization, prolonged pain, long-term disability, and mortality. The social and economic costs that rib fractures contribute to the health care burden of the United States are therefore significant. But despite this measurable impact on patients’ quality of life, current treatment of the majority of patients in the United States with rib fracture syndromes is supportive only. Even the most severe of chest wall injuries have historically been treated non-operatively. Recently, however, several reports from American centers support an increased application of operative fixation. With this resurgent interest of American surgeons in mind, we review the clinical presentations, potential indications, controversies, and technical challenges unique to rib fracture fixation.

[1]  T. Kossmann,et al.  Pilot study of operative fixation of fractured ribs in patients with flail chest , 2009, ANZ journal of surgery.

[2]  K. Martin,et al.  Surgical stabilization of rib fractures using Inion OTPS wraps--techniques and quality of life follow-up. , 2009, The Journal of trauma.

[3]  Y. Choi,et al.  Reoperative surgical stabilization of a painful nonunited rib fracture using bone grafting and a metal plate. , 2009, Journal of orthopaedic trauma.

[4]  P. Cole,et al.  Surgical Management of Multiple Painful Rib Nonunions in Patient With a History of Severe Shoulder Girdle Trauma: A Case Report and Literature Review , 2009, Journal of orthopaedic trauma.

[5]  D. Margulies,et al.  Treatment of chest wall implosion injuries without thoracotomy: technique and clinical outcomes. , 2009, The Journal of trauma.

[6]  D. Trunkey,et al.  Long-Term Morbidity, Vain, and Disability after Repair of Severe Chest Wall Injuries , 2009, The American surgeon.

[7]  R. Mullins,et al.  Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair. , 2009, The Journal of trauma.

[8]  D. Livingston,et al.  CHAPTER 36 – PULMONARY CONTUSION AND FLAIL CHEST , 2008 .

[9]  D. Waller,et al.  Surgical repair of post-traumatic lung hernia using a video-assisted open technique. , 2008, Interactive cardiovascular and thoracic surgery.

[10]  S. Winn,et al.  Reduction of rib fractures with a bioresorbable plating system: preliminary observations. , 2008, The Journal of trauma.

[11]  T. Ellis,et al.  Biomechanical testing of a novel, minimally invasive rib fracture plating system. , 2008, The Journal of trauma.

[12]  J. Richardson,et al.  Operative Fixation of Chest Wall Fractures: An Underused Procedure? , 2007, The American surgeon.

[13]  R. de Geest,et al.  Surgical stabilization of a rib fracture using an angle stable plate. , 2007, The Journal of trauma.

[14]  D. Frush,et al.  Nonoperative management of asymptomatic traumatic pulmonary hernia in a young child. , 2007, The Journal of trauma.

[15]  J. Kent,et al.  Resorbable plates for the fixation of mandibular fractures: a prospective study. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[16]  C. Cocanour,et al.  A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. , 2006, American journal of surgery.

[17]  J. Weigelt,et al.  Rib fractures: Relationship with pneumonia and mortality* , 2006, Critical care medicine.

[18]  Ronald I Gross,et al.  Transthoracic lung herniation due to blunt trauma , 2006 .

[19]  R. Nirula,et al.  Rib Fracture Stabilization in Patients Sustaining Blunt Chest Injury , 2006, The American surgeon.

[20]  G. Testerman Adverse Outcomes in Younger Rib Fracture Patients , 2006, Southern medical journal.

[21]  A. Granetzny,et al.  Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. , 2005, Interactive cardiovascular and thoracic surgery.

[22]  F. Luchette,et al.  Pain management guidelines for blunt thoracic trauma. , 2005, The Journal of trauma.

[23]  T. Hartman,et al.  Cough-induced rib fractures. , 2005, Mayo Clinic proceedings.

[24]  M. Oswanski,et al.  Prevalence of Delayed Hemothorax in Blunt Thoracic Trauma , 2005, The American surgeon.

[25]  W. Long,et al.  Operative chest wall fixation with osteosynthesis plates. , 2005, The Journal of trauma.

[26]  C. Kirker-Head,et al.  Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results. , 2010, Equine veterinary journal.

[27]  E. Bulger,et al.  Epidural analgesia improves outcome after multiple rib fractures. , 2004, Surgery.

[28]  Stanislaw P Stawicki,et al.  Rib Fractures in the Elderly: A Marker of Injury Severity , 2004, Journal of The American Geriatrics Society.

[29]  Gerald McGwin,et al.  The influence of side airbags on the risk of head and thoracic injury after motor vehicle collisions. , 2004, The Journal of trauma.

[30]  M. Eren,et al.  Open Fixation in Flail Chest: Review of 64 Patients , 2004, Asian cardiovascular & thoracic annals.

[31]  Wolfgang Lederer,et al.  Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray. , 2004, Resuscitation.

[32]  A. Iwasaki,et al.  Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy. , 2004, The Thoracic and cardiovascular surgeon.

[33]  Catherine G. Ambrose,et al.  Bioabsorbable Implants: Review of Clinical Experience in Orthopedic Surgery , 2004, Annals of Biomedical Engineering.

[34]  R. Mullins,et al.  Absorbable plates for rib fracture repair: preliminary experience. , 2003, The Journal of trauma.

[35]  R. Mullins,et al.  Rib fracture pain and disability: can we do better? , 2003, The Journal of trauma.

[36]  John B Holcomb,et al.  Morbidity from rib fractures increases after age 45. , 2003, Journal of the American College of Surgeons.

[37]  A. Ho,et al.  Acute pain management of patients with multiple fractured ribs. , 2003, Journal of Trauma.

[38]  Peter Cummings,et al.  Estimating seat belt effectiveness using matched-pair cohort methods. , 2003, Accident; analysis and prevention.

[39]  P. Bonnet,et al.  Traumatic extrathoracic lung herniation. , 2002, The Annals of thoracic surgery.

[40]  H. Matsuda,et al.  Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. , 2002, The Journal of trauma.

[41]  Y. Barnea,et al.  Isolated rib fractures in elderly patients: mortality and morbidity. , 2002, Canadian journal of surgery. Journal canadien de chirurgie.

[42]  P. Segers,et al.  Thoracic Trauma: an Analysis of 187 Patients , 2001, Acta chirurgica Belgica.

[43]  P. Giannoudis,et al.  Operative stabilisation of painful non-united multiple rib fractures. , 2001, Injury.

[44]  M. Gugger,et al.  Pulmonary function testing after operative stabilisation of the chest wall for flail chest. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[45]  D. Trunkey,et al.  Operative stabilization of a flail chest six years after injury. , 2001, The Annals of thoracic surgery.

[46]  P. Rokkanen,et al.  Comparison of absorbable poly-l-lactide and metallic intramedullary rods in the fixation of femoral shaft osteotomies: an experimental study in rabbits , 2001, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[47]  E. S. Jones,et al.  Intermittent positive pressure ventilation for the crushed chest: an epic in intensive care , 2001, Intensive Care Medicine.

[48]  D. Gaspard,et al.  Blunt Chest Trauma in the Elderly Patient: How Cardiopulmonary Disease Affects Outcome , 2000, The American surgeon.

[49]  C N Mock,et al.  Rib fractures in the elderly. , 2000, The Journal of trauma.

[50]  J. Richardson,et al.  Painful nonunion of multiple rib fractures managed by operative stabilization. , 2000, The Journal of trauma.

[51]  F. Puma,et al.  Chest wall stabilization with synthetic reabsorbable materials as originally published in 1992: Updated in 1999 by , 1999 .

[52]  T. Nakamura,et al.  Bioabsorbable poly-L-lactide costal coaptation pins and their clinical application in thoracotomy. , 1999, The Annals of thoracic surgery.

[53]  M. Aufmkolk,et al.  Operative chest wall stabilization in flail chest--outcomes of patients with or without pulmonary contusion. , 1998, Journal of the American College of Surgeons.

[54]  J. R. Oyarzun,et al.  Use of 3.5-mm acetabular reconstruction plates for internal fixation of flail chest injuries. , 1998, The Annals of thoracic surgery.

[55]  P. Vignon,et al.  Traumatic pulmonary hernia: surgical versus conservative management. , 1998, The Journal of trauma.

[56]  B. Regli,et al.  Long-Term Follow-up of Patients with Operative Stabilisation of a Flail Chest , 1997, The Thoracic and cardiovascular surgeon.

[57]  Z. Ahmed,et al.  Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. , 1995, The Journal of thoracic and cardiovascular surgery.

[58]  A. May,et al.  Anterior lung herniation: another aspect of the seatbelt syndrome. , 1995, The Journal of trauma.

[59]  D. Benetti,et al.  [Surgical stabilization of post-traumatic flail chest. Our experience with 116 cases treated]. , 1995, Minerva chirurgica.

[60]  D. Ziegler,et al.  The morbidity and mortality of rib fractures. , 1994, The Journal of trauma.

[61]  Y. Ikada,et al.  Bioabsorbable struts made from poly-L-lactide and their application for treatment of chest deformity. , 1994, The Journal of thoracic and cardiovascular surgery.

[62]  J. Sigurdsson,et al.  Major hemorrhage as a complication of cough fracture. , 1993, Chest.

[63]  A. Fiane,et al.  Intercostal pulmonary hernia after blunt thoracic injury. , 1993, The European journal of surgery = Acta chirurgica.

[64]  H. Ris,et al.  Osteosynthesis of the injured chest wall. Use of the AO (Arbeitsgemeinschaft für Osteosynthese) technique. , 1993, Scandinavian journal of thoracic and cardiovascular surgery.

[65]  D. Hoyt,et al.  Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. , 1991, The Journal of trauma.

[66]  V. Vécsei,et al.  [Surgical stabilization of thoracic wall fractures]. , 1991, Der Unfallchirurg.

[67]  R. Landreneau,et al.  Strut fixation of an extensive flail chest. , 1991, The Annals of thoracic surgery.

[68]  G. Quick A randomized clinical trial of rib belts for simple fractures. , 1990, The American journal of emergency medicine.

[69]  G. Haasler Open fixation of flail chest after blunt trauma. , 1990, The Annals of thoracic surgery.

[70]  E. Mackenzie,et al.  Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. , 1990, The Journal of trauma.

[71]  F. Wells,et al.  Traumatic intercostal pulmonary hernia. , 1990, The Annals of thoracic surgery.

[72]  M Gaillard,et al.  Mortality prognostic factors in chest injury. , 1990, The Journal of trauma.

[73]  J. Dougherty,et al.  Use of rib belts in acute rib fractures. , 1989, The American journal of emergency medicine.

[74]  M. Oreskovich,et al.  Long-term disability associated with flail chest injury. , 1985, American journal of surgery.

[75]  J. Landercasper,et al.  Long-term disability after flail chest injury. , 1983, The Journal of trauma.

[76]  J. Testart,et al.  Treatment of flail chest with Judet's struts. , 1983, The Journal of thoracic and cardiovascular surgery.

[77]  K. Tayton,et al.  How stiff should semi-rigid fixation of the human tibia be? A clue to the answer. , 1983, The Journal of bone and joint surgery. British volume.

[78]  K. Schmit-Neuerburg,et al.  Indication for thoracotomy and chest wall stabilization. , 1982, Injury.

[79]  W. Ruschewski,et al.  Stabilization of Flail Chest by Compression Osteosynthesis - Experimental and Clinical Results , 1981, The Thoracic and cardiovascular surgeon.

[80]  R. Labitzke [Early thoracotomy and chest wall stabilization with elastic rib clamps (author's transl)]. , 1981, Zentralblatt fur Chirurgie.

[81]  K. Norcross STRAPPING UP THE BROKEN RIB , 1980, The Lancet.

[82]  E. Croce,et al.  Intercostal pleuroperitoneal hernia. , 1979, The Journal of thoracic and cardiovascular surgery.

[83]  E. Brug,et al.  [Stabilization of the flail chest with tension band wires of ribs and sternum (author's transl)]. , 1979, Zentralblatt fur Chirurgie.

[84]  F. W. Blaisdell,et al.  Operative stabilization for flail chest after blunt trauma. , 1978, The Journal of thoracic and cardiovascular surgery.

[85]  P. Schüpbach,et al.  [Therapy of the unstable thorax in serial fractures of the ribs]. , 1978, Schweizerische medizinische Wochenschrift.

[86]  B. Moore,et al.  Operative stabilization of nonpenetrating chest injuries. , 1975, The Journal of thoracic and cardiovascular surgery.

[87]  J. Pastor,et al.  Surgical stabilization of traumatic flail chest. , 1975, Thorax.

[88]  A. Ledgerwood,et al.  Management of massive thoraco-abdominal wall defect from close-range shotgun blast. , 1971, The Journal of trauma.

[89]  S. Stephenson,et al.  New technic for stabilization of the flail chest. , 1966, American journal of surgery.

[90]  H. Hoffmeister,et al.  [STABILIZING SURGICAL INTERVENTIONS ON THE THORAX IN FUNNEL CHEST CORRECTIONS AND INJURIES OF THE BONY THORAX]. , 1964, Medizinische Klinik.

[91]  H. Polk,et al.  Abdominal Parietal Hernias at the Costal Margin , 1963, Annals of surgery.

[92]  J. Dykes,et al.  Early Reconstruction of the Crushed Chest , 1962 .

[93]  M. Virshup The anteriorly crushed chest or "steeringwheel injury". An improved method for sternal traction. , 1960, The Journal of thoracic and cardiovascular surgery.

[94]  E. A. Cohen Treatment of the flail chest by towel clip traction. , 1955, American journal of surgery.

[95]  R. T. McElvenny,et al.  Chest wall stabilization by soft tissue traction: a new method. , 1954, Journal of the American Medical Association.

[96]  D. Cameron,et al.  An analysis of the management of complications of multiple, three or more, rib fractures. , 1949, American journal of surgery.

[97]  I. A. Jaslow Skeletal traction in the treatment of multiple fractures of the thoracic cage. , 1946, American journal of surgery.

[98]  K. Hagen MULTIPLE RIB FRACTURES TREATED WITH A DRINKER RESPIRATOR , 1945 .

[99]  R. T. Findlay Fractures of the scapula and ribs , 1937 .

[100]  R. L. Waugh SAM BROWNE PLASTER-OF-PARIS BELT FOR IMMOBILIZATION OF THE CHEST , 1935 .