Is fixation of a single end of flail segment rib fractures enough?
Anthony Perugini1, James Iandoli1, Nicholas Pelz1
1Department of Orthopedics, OhioHealth Doctor's Hospital, Columbus, Ohio, USA.
Background:
Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures in a flail chest. This study aimed to analyze surgical rib fixation and assess outcomes for non-fixed fractured rib ends in segmental rib fractures.
Methods:
This is a retrospective review of 125 patients who underwent open reduction internal fixation of flail segmental rib fractures at our urban Level 1 trauma center. Initial plain films and CT were compared with follow-up plain film imaging at 3 months to assess radiographic outcomes, fracture healing, fixation failure, or residual deformity. Clinical outcomes such as length of intensive care unit (ICU) stay, length of ventilatory support, associated pneumonia, duration until chest tube removal, and need for additional rib surgery were analyzed.
Results:
Fixation of a single end of segmental rib fractures and flail segments was associated with decreased incidence of fracture union at 3 months postoperatively (43/55 vs 65/70, respectively; p=0.018) but failed to show any difference in fracture collapse (50/55 vs 67/70, respectively; p=0.223). There were no differences between postoperative ICU length of stay (4.18±5.54 vs 4.62±4.48 days, respectively; p=0.690), postoperative ventilatory status (29/55 vs 38/70, respectively; p=0.840), duration of ventilatory support (3.52±4.69 vs 4.34±5.87, respectively; p=0.430), or associated pneumonia (7/55 vs 8/70, respectively; p=0.770).
Conclusions:
These data support that fixation of both sides of flail segment rib fractures results in improved rib fracture union at 3 months postoperatively. However, fixation of both sides of flail segments does not appear to result in any difference in fracture collapse or clinical perioperative outcomes.
Level Of Evidence:
Therapeutic Level III.
More Related Videos
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
07:35Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
Related Concept Videos
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:24Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:03Fixation and Sectioning
The simplest type of preparation is the wet mount, in which the specimen is placed in a drop of liquid on the slide. A liquid specimen can be directly deposited on the slide using a dropper. Solid specimens, such as skin scraping, can be placed on the slide before adding a drop of liquid to prepare the wet mount. Sometimes the liquid is simply water, but stains are often added...