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Abstract: Case Reports |

Surgical Management of Multiple Rib Fractures FREE TO VIEW

Mario G. Gasparri, MD; G. Hossein Almassi, MD; George B. Haasler, MD
Author and Funding Information

Medical College of Wisconsin, Milwaukee, WI


Chest


Chest. 2003;124(4_MeetingAbstracts):295S-a-296S. doi:10.1378/chest.124.4_MeetingAbstracts.295S-a
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Published online

INTRODUCTION:  Multiple rib fractures remain life-threatening injuries with considerable morbidity in survivors. There has been renewed enthusiasm for surgical fixation of rib fractures as reports suggest improved short and long-term outcomes. This case report illustrates the Medical College of Wisconsin approach to these injuries using plates to internally fixate the fractures.CASE PRESENTATIONS: 49 year-old white male involved in motorcycle accident. Seen at outside institution, found to have multiple rib fractures, and discharged with Oxycontin. Represented within 24 hours with pain and shortness of breath.Taken to operating room for rib stabilization. Via left thoracotomy, left ribs 3-9 were stabilized using plates.Patient discharged home post-operative day (POD) 4, back to work POD 10, and off all pain medications POD 14.DISCUSSION: The current standard treatment for multiple rib fractures consists of aggressive pulmonary toilet, vigorous pain control, cautious fluid administration, and selective intubation. Despite this approach, these injuries remain lethal with in-hospital mortalities of roughly 15%12 and pulmonary morbidities (pneumonia, empyema, ARDS) of roughly 25%34. Additionally, in survivors, long-term morbidity is significant with 30-50% complaining of chronic pain and dyspnea and 25-35% remaining permanently disabled56. Studies have suggested that surgical fixation of rib fractures rapidly restores normal chest wall dynamics and decreases pain resulting in decreased mortality, decreased need for mechanical ventilation, acceleration of in-hospital recovery, and decreased long term morbidity78. Also, current surgical techniques and innavative hardware have allowed this procedure to be performed safely with minimal surgical morbidity9. This case illustrates these points as fixation of the patient’s rib fractures allowed rapid recovery with early normalization of pulmonary function tests and resumption of normal activity.CONCLUSIONS: Multiple rib fractures carry with them high morbidity and mortality rates and in survivors, long-term morbidity is significant. Operative rib stabilization has a role in treatment and studies suggest improved short and long-term outcomes. Further studies are required to better delineate treatment effects and allow optimal patient selection.

Pulmonary Function Tests

PFTsPreoperativePostop Day 11Postop Day 30FVC57%94%96%FEV163%87%90%DLCO58%55%98%

DISCLOSURE:  M.G. Gasparri, None.

Tuesday, October 28, 2003

4:15 PM - 5:45 PM

References

Ziegler DW, Agarwal NN, The morbidity and mortality of rib fractures.J Trauma.1994;37:975–979
 
Ciraulo DL, Elliott D, Mitchell KA, Rodriguez A, Flail chest as a marker for significant injuries.J Am Coll Surg.1994;178:466–470
 
Albaugh G, Kann B, Puc MM, et al. Age-adjusted outcomes in traumatic flail chest injuries in the elderly.Am Surg.2000;66:978–981
 
Bulger EM, Arneson MA, Mock CN, Jurkovich GJ, Rib fractures in the elderly.J Trauma.2000;48:1040–1047
 
Landercasper J, Cogbill TH, Lindesmith LA, Long-Term Disability After Flail Chest Injury.J Trauma.1984;5:410–414
 
Beal SL, Oreskovich MR, Long-Term Disability Associated With Flail Chest Injury.Am J Surg.1985;150:324–326
 
Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.J Trauma.2002;52:727–732
 
Ahmed Z, Mohyuddin Z, Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation.J Thorac Cardiovasc Surg.1995;110:1676–1680
 
Oyarzun JR, Bush AP, McCormick JR, Bolanowski PJ, Use of 3.5-mm Acetabular Reconstruction Plates for Internal Fixation of Flail Chest Injuries.Ann Thorac Surg.1998;65:1471–1474
 

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References

Ziegler DW, Agarwal NN, The morbidity and mortality of rib fractures.J Trauma.1994;37:975–979
 
Ciraulo DL, Elliott D, Mitchell KA, Rodriguez A, Flail chest as a marker for significant injuries.J Am Coll Surg.1994;178:466–470
 
Albaugh G, Kann B, Puc MM, et al. Age-adjusted outcomes in traumatic flail chest injuries in the elderly.Am Surg.2000;66:978–981
 
Bulger EM, Arneson MA, Mock CN, Jurkovich GJ, Rib fractures in the elderly.J Trauma.2000;48:1040–1047
 
Landercasper J, Cogbill TH, Lindesmith LA, Long-Term Disability After Flail Chest Injury.J Trauma.1984;5:410–414
 
Beal SL, Oreskovich MR, Long-Term Disability Associated With Flail Chest Injury.Am J Surg.1985;150:324–326
 
Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.J Trauma.2002;52:727–732
 
Ahmed Z, Mohyuddin Z, Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation.J Thorac Cardiovasc Surg.1995;110:1676–1680
 
Oyarzun JR, Bush AP, McCormick JR, Bolanowski PJ, Use of 3.5-mm Acetabular Reconstruction Plates for Internal Fixation of Flail Chest Injuries.Ann Thorac Surg.1998;65:1471–1474
 
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