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World Journal of Surgery Jul 2023Surgical stabilization of rib fractures (SSRF) is associated with improved respiratory symptoms and shorter intensive care admission in patients with flail chest. For...
BACKGROUND
Surgical stabilization of rib fractures (SSRF) is associated with improved respiratory symptoms and shorter intensive care admission in patients with flail chest. For multiple rib fractures, the benefit of SSRF remains a topic of debate. This study investigated barriers and facilitators of healthcare professionals to SSRF as treatment for multiple traumatic rib fractures.
METHODS
Dutch healthcare professionals were asked to complete an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators of SSRF. If ≥ 20% of participants responded negatively, the item was considered a barrier, and if ≥ 80% responded positively, the item was considered a facilitator.
RESULTS
Sixty-one healthcare professionals participated; 32 surgeons, 19 non-surgical physicians, and 10 residents. The median experience was 10 years (P-P 4-12). Sixteen barriers and two facilitators for SSRF in multiple rib fractures were identified. Barriers included lack of knowledge, experience, evidence on (cost-)effectiveness, and the implication of more operations and higher medical costs. Facilitators were the assumption that SSRF alleviates respiratory problems and the feeling that surgeons are supported by colleagues for SSRF. Non-surgeons and residents reported more and several different barriers than surgeons (surgeons: 14; non-surgical physicians: 20; residents: 21; p < 0.001).
CONCLUSION
For adequate implementation of SSRF in patients with multiple rib fractures, implementation strategies should address the identified barriers. Especially, improved clinical experience and scientific knowledge of healthcare professionals, and high-level evidence on the (cost-) effectiveness of SSRF potentially increase its use and acceptance.
Topics: Humans; Rib Fractures; Flail Chest; Fracture Fixation; Length of Stay; Ribs; Delivery of Health Care; Retrospective Studies
PubMed: 37014429
DOI: 10.1007/s00268-023-06973-y -
Plastic and Reconstructive Surgery.... Dec 2023Rib remodeling is a surgical technique for waist shaping in women and men. However, one of the main patient complaints is the scar. We aimed to describe a scarless,...
BACKGROUND
Rib remodeling is a surgical technique for waist shaping in women and men. However, one of the main patient complaints is the scar. We aimed to describe a scarless, ultrasound-guided rib remodeling (RibXcar) technique that assessed the degree of angular variation of the fracture by ultrasound and the variation in waist measurement and patient satisfaction through a survey.
METHODS
The RibXcar technique was performed in 30 women aged 18-35 years in Peru, Colombia, and Mexico between October and December 2022 by three board-certified plastic surgeons trained in ultrasound and in this technique. The plastic surgeons measured costal angles before and immediately, 1 month, and 3 months after the surgery by ultrasound, as well as the waist in the same site and at these time points. Similarly, patient satisfaction was surveyed 3 months after the surgery, in which questions were asked about body aesthetics and the puncture site.
RESULTS
Ultrasound angular measurements before and immediately, 1 month, and 3 months after the surgical procedure were 168.00, 158.00, 160.00, and 160.43 degrees in the 10th rib, 170.50, 160.50, 152.50, and 163.50 degrees in the 11th rib, and 172.00, 162.00, 154.00, and 165.00 degrees in the 12th rib, respectively. The satisfaction survey showed that patients were satisfied with the aesthetic results of both the shape of the waist and the puncture site.
CONCLUSIONS
RibXcar surgery maintains the angular variation over time. Similarly, waist measurements show a sustained reduction. Three months postoperatively, the patients were satisfied with the aesthetic results of the waist and the puncture site.
PubMed: 38115833
DOI: 10.1097/GOX.0000000000005499 -
Injury Jul 2024Rib fracture non-union is an uncommon complication of traumatic rib fractures. Our objective was to perform a scoping review of the literature for the management of rib... (Review)
Review
OBJECTIVE
Rib fracture non-union is an uncommon complication of traumatic rib fractures. Our objective was to perform a scoping review of the literature for the management of rib fracture non-union. This included analysis of the variations in surgical technique, complications experienced, and reported outcomes.
METHODS
We conducted a scoping review and searched databases (MEDLINE, CINAHL, and Embase). We performed abstract and full-text screening, and abstracted data related to pre-operative assessment, surgical technique, complications, and reported outcome measures.
RESULTS
We included 29 articles of which 19 were case reports and 10 were case series. The data quality was generally heterogeneous. The studies included 229 patients and the commonest symptoms of rib fracture non-union included chest pain, clicking, dyspnea and deformities. The patients underwent surgical management of rib fracture non-union (excluding first rib fractures) using various techniques. The majority used surgical stabilization of rib fracture with or without a graft. The reported outcomes were inconsistent between studies, but showed high rates of union (>94 %), reduction in reported VAS scores, and improved return to work when included. Implant failure occurred in 10 % of the 229 total patients reported in our studies, the re-operation rate was 13 %, and the overall complication rate was 27 %.
CONCLUSION
Surgical management of rib fracture non-union often involving locking plates and screws with or without a graft has been shown in several case reports and series as an effective treatment with acceptable implant failure and complication rates. Surgical management is therefore a viable option for symptomatic patients. Further research is required to determine optimal management strategies that further reduce surgical complications for these patients.
Topics: Humans; Rib Fractures; Fractures, Ununited; Fracture Fixation, Internal; Fracture Healing; Treatment Outcome; Reoperation
PubMed: 38762403
DOI: 10.1016/j.injury.2024.111553 -
Annals of Biomedical Engineering Jul 2023The use of ovine animal models in the study of injury biomechanics and modeling is increasing, due to their favorable size and other physiological characteristics. Along...
The use of ovine animal models in the study of injury biomechanics and modeling is increasing, due to their favorable size and other physiological characteristics. Along with this increase, there has also been increased interest in the development of in silico ovine models for computational studies to compliment physical experiments. However, there remains a gap in the literature characterizing the morphological and mechanical characteristics of ovine ribs. The objective of this study therefore is to report anatomical and mechanical properties of the ovine ribs using microtomography (micro-CT) and two types of mechanical testing (quasi-static bending and dynamic tension). Using microtomography, young ovine rib samples obtained from a local abattoir were cut into approximately fourteen 38 mm sections and scanned. From these scans, the cortical bone thickness and cross-sectional area were measured, and the moment of inertia was calculated to enhance the mechanical testing data. Based on a standard least squares statistical model, the cortical bone thickness varied depending on the region of the cross-section and the position along the length of the rib (p < 0.05), whereas the cross-sectional area remained consistent (p > 0.05). Quasi-static three-point bend testing was completed on ovine rib samples, and the resulting force-displacement data was analyzed to obtain the stiffness (44.67 ± 17.65 N/mm), maximum load (170.54 ± 48.28 N) and displacement at maximum load (7.19 ± 2.75 mm), yield load (167.81 ± 48.12 N) and displacement at yield (6.10 ± 2.25 mm), and the failure load (110.90 ± 39.30 N) and displacement at failure (18.43 ± 2.10 mm). The resulting properties were not significantly affected by the rib (p > 0.05), but by the animal they originated from (p < 0.05). For the dynamic testing, samples were cut into coupons and tested in tension with an average strain rate of 18.9 strain/sec. The resulting dynamic testing properties of elastic modulus (5.16 ± 2.03 GPa), failure stress (63.29 ± 14.02 MPa), and failure strain (0.0201 ± 0.0052) did not vary based on loading rate (p > 0.05).
Topics: Sheep; Animals; X-Ray Microtomography; Ribs; Mechanical Phenomena; Cortical Bone; Biomechanical Phenomena; Stress, Mechanical
PubMed: 36841890
DOI: 10.1007/s10439-023-03156-7 -
Ugeskrift For Laeger Jun 2024Slipping rib syndrome (SRS) is a possibly lesser known but not rare condition associated with severe pain in the lower part of the thorax and/or upper abdomen. SRS is... (Review)
Review
Slipping rib syndrome (SRS) is a possibly lesser known but not rare condition associated with severe pain in the lower part of the thorax and/or upper abdomen. SRS is caused by an anatomical variant where typical costa 9 collides with costa 8 resulting in neuralgic pain. Surgery with reconstruction of the rib curvature has few recurrences. The diagnosis and treatment of SRS patients are presented, but our primary aim is to raise awareness about a painful and largely overlooked condition as a differential diagnosis in patients with unexplained chronic pain in the lower thorax.
Topics: Humans; Ribs; Syndrome; Chest Pain; Diagnosis, Differential; Tomography, X-Ray Computed
PubMed: 38903030
DOI: 10.61409/V09230577 -
Journal of Clinical Medicine Apr 2024In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in... (Review)
Review
In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics of AIS, and the interesting and novel field investigating the sleep impact at nighttime on AIS in relation to the sequence of the scoliogenetic changes in scoliotics. The expressed opinions are mainly based on the published peer-reviewed research of the author and his team of co-authors. Based on the analysis noted above, it can be postulated that the vertebral growth changes in the spine during initial idiopathic scoliosis (IS) development are not primary-intrinsic but secondary changes. The primary cause starting the deformity is not located within the vertebral bodies. Instead, the deformations seen in the vertebral bodies are the secondary effects of asymmetrical loads exerted upon them, due to muscular loads, growth, and gravity.
PubMed: 38673436
DOI: 10.3390/jcm13082163 -
Current Pain and Headache Reports Nov 2023Rib fractures are a common traumatic injury that has been traditionally treated with systemic opioids and non-opioid analgesics. Due to the adverse effects of opioid... (Review)
Review
PURPOSE OF REVIEW
Rib fractures are a common traumatic injury that has been traditionally treated with systemic opioids and non-opioid analgesics. Due to the adverse effects of opioid analgesics, regional anesthesia techniques have become an increasingly promising alternative. This review article aims to explore the efficacy, safety, and constraints of medical management and regional anesthesia techniques in alleviating pain related to rib fractures.
RECENT FINDINGS
Recently, opioid analgesia, thoracic epidural analgesia (TEA), and paravertebral block (PVB) have been favored options in the pain management of rib fractures. TEA has positive analgesic effects, and many studies vouch for its efficacy; however, it is contraindicated for many patients. PVB is a viable alternative to those with contraindications to TEA and exhibits promising outcomes compared to other regional anesthesia techniques; however, a failure rate of up to 10% and adverse complications challenge its administration in trauma settings. Serratus anterior plane blocks (SAPB) and erector spinae blocks (ESPB) serve as practical alternatives to TEA or PVB with lower incidences of adverse effects while exhibiting similar levels of analgesia. ESPB can be performed by trained emergency physicians, making it a feasible procedure to perform that is low-risk and efficient in pain management. Compared to the other techniques, intercostal nerve block (ICNB) had less analgesic impact and required concurrent intravenous medication to achieve comparable outcomes to the other blocks. The regional anesthesia techniques showed great success in improving pain scores and expediting recovery in many patients. However, choosing the optimal technique may not be so clear and will depend on the patient's case and the team's preferences. The peripheral nerve blocks have impressive potential in the future and may very well surpass neuraxial techniques; however, further research is needed to prove their efficacy and weaknesses.
Topics: Humans; Rib Fractures; Analgesics; Pain Management; Nerve Block; Pain; Analgesics, Opioid; Pain, Postoperative
PubMed: 37747621
DOI: 10.1007/s11916-023-01172-9 -
Clinical Anatomy (New York, N.Y.) Apr 2024Cerebro-costo-mandibular syndrome (CCMS) is a congenital condition with skeletal and orofacial abnormalities that often results in respiratory distress in neonates. The... (Review)
Review
Cerebro-costo-mandibular syndrome (CCMS) is a congenital condition with skeletal and orofacial abnormalities that often results in respiratory distress in neonates. The three main phenotypes in the thorax are posterior rib gaps, abnormal costovertebral articulation and absent ribs. Although the condition can be lethal, accurate diagnosis, and subsequent management help improve the survival rate. Mutations in the causative gene SNRPB have been identified, however, the mechanism whereby the skeletal phenotypes affect respiratory function is not well-studied due to the multiple skeletal phenotypes, lack of anatomy-based studies into the condition and rarity of CCMS cases. This review aims to clarify the extent to which the three main skeletal phenotypes in the thorax contribute to respiratory distress in neonates with CCMS. Despite the posterior rib gaps being unique to this condition and visually striking on radiographic images, anatomical consideration, and meta-analyses suggested that they might not be the significant factor in causing respiratory distress in neonates. Rather, the increase in chest wall compliance due to the rib gaps and the decrease in compliance at the costovertebral complex was considered to result in an equilibrium, minimizing the impact of these abnormalities. The absence of floating ribs is likely insignificant as seen in the general population; however, a further absence of ribs or vestigial rib formation is associated with respiratory distress and increased lethality. Based on these, we propose to evaluate the number of absent or vestigial ribs as a priority indicator to develop a personalized treatment plan based on the phenotypes exhibited.
Topics: Infant, Newborn; Humans; Intellectual Disability; Ribs; Micrognathism; Respiratory Distress Syndrome
PubMed: 37265362
DOI: 10.1002/ca.24054 -
Otolaryngology--head and Neck Surgery :... Aug 2023Microtia is a congenital condition known to be associated with vertebral anomalies and congenital syndromes, most prominently hemifacial microsomia. There is... (Review)
Review
OBJECTIVE
Microtia is a congenital condition known to be associated with vertebral anomalies and congenital syndromes, most prominently hemifacial microsomia. There is controversy, however, on whether to screen with spinal imaging. Additionally, microtia ear reconstruction utilizes rib harvesting that could potentially worsen pre-existing vertebral and rib anomalies, specifically scoliosis. We report on the prevalence and characteristics of vertebral anomalies among microtia patients at a tertiary pediatric center.
STUDY DESIGN
Retrospective case review with literature review.
SETTING
Tertiary pediatric referral center.
METHODS
A review of 425 children with microtia was conducted, characterized as either syndromic or nonsyndromic. Data included demographics, spinal imaging performed, indications, anomalies detected, and microtia repair.
RESULTS
Among 425 microtia patients, 24.5% were syndromic with an average age of 9.7 years. Only 18.4% of all patients had spinal imaging performed (50% syndromic vs 8.1% nonsyndromic). Overall, 10.6% had a vertebral anomaly with a 57.7% detection rate (67.3% syndromic vs 38.5% nonsyndromic). The most common anomaly was scoliosis, with a prevalence of 7.8%. Fusion defects and rib deformities were the next most prominent. Microtia repair, most commonly with an autologous rib graft, was performed in 21.6% of the cohort. However, only 19.2% had spinal imaging and 16.7% with a vertebral anomaly.
CONCLUSION
Children with microtia are at a greater risk of vertebral abnormalities. Scoliosis prevalence in isolated microtia is comparable to the general population (2%-3%) but greatly increased with genetic syndromes. Screening for vertebral anomalies should be considered when planning microtia reconstructions, especially in the syndromic population.
Topics: Child; Humans; Congenital Microtia; Scoliosis; Retrospective Studies; Spine
PubMed: 36805618
DOI: 10.1002/ohn.289