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The Journal of Surgical Research Aug 2022Multiple rib fractures and flail chest are common in trauma patients and may result in significant morbidity and mortality. While rib fractures have historically been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multiple rib fractures and flail chest are common in trauma patients and may result in significant morbidity and mortality. While rib fractures have historically been treated conservatively, there is increasing interest in the benefits of surgical fixation. However, strong evidence that supports surgical rib fixation and identifies the most appropriate patients for its application is currently sparse.
METHODS
A systematic review and meta-analysis following PRISMA guidelines was performed to identify all peer-reviewed papers that examined surgical compared to conservative management of rib fractures. We undertook a subgroup analysis to determine the specific effects of rib fracture type, age, the timing of fixation and study design on outcomes. The primary outcomes were the length of hospital and ICU stay, and secondary outcomes included mechanical ventilation time, rates of pneumonia, and mortality.
RESULTS
Our search identified 45 papers in the systematic review, and 40 were included in the meta-analysis. There was a statistical benefit of surgical fixation compared to conservative management of rib fractures for length of ICU stay, mechanical ventilation, mortality, pneumonia, and tracheostomy. The subgroup analysis identified surgical fixation was most favorable for patients with flail chest and those who underwent surgical fixation within 72 h. Patients over 60 y had a statistical benefit of conservative management on length of hospital stay and mechanical ventilation.
CONCLUSIONS
Surgical fixation of flail and multiple rib fractures is associated with a reduction in morbidity and mortality outcomes compared to conservative management. However, careful selection of patients is required for the appropriate application of surgical rib fixation.
Topics: Flail Chest; Fracture Fixation, Internal; Humans; Length of Stay; Pneumonia; Retrospective Studies; Rib Fractures; Ribs; Spinal Fractures
PubMed: 35390577
DOI: 10.1016/j.jss.2022.02.055 -
The Surgical Clinics of North America Apr 2024Common mechanisms of blunt thoracic injury include motor vehicle collisions and falls. Chest wall injuries include rib fractures and sternal fractures; treatment... (Review)
Review
Common mechanisms of blunt thoracic injury include motor vehicle collisions and falls. Chest wall injuries include rib fractures and sternal fractures; treatment involves supportive care, multimodal analgesia, and pulmonary toilet. Pneumothorax, hemothorax, and pulmonary contusions are also common and may be managed expectantly or with tube thoracostomy as indicated. Surgical treatment may be considered in select cases. Less common injury patterns include blunt trauma to the tracheobronchial tree, esophagus, diaphragm, heart, or aorta. Operative intervention is more often required to address these injuries.
Topics: Humans; Thoracic Injuries; Wounds, Nonpenetrating; Rib Fractures; Pneumothorax; Thoracotomy
PubMed: 38453306
DOI: 10.1016/j.suc.2023.09.007 -
Kyobu Geka. the Japanese Journal of... Sep 2022A traumatic chest wall injury is a condition that is often encountered in medical practice, but the underlying pathophysiology varies widely depending on the...
A traumatic chest wall injury is a condition that is often encountered in medical practice, but the underlying pathophysiology varies widely depending on the circumstances of the injury and the patient's background. The chest wall, which protects vital organs and provides respiratory movement, can be a life-threatening emergency when injured, thus it is important to respond promptly and appropriately. Because a penetrating chest wall trauma is often associated with intra-thoracic organ damage, it is important to consider an emergency thoracotomy in cases involving massive hemorrhage or air leakage. The ribs and sternum are primarily injured in patients with blunt wall trauma. Flail chest, which is defined as multiple bifocal fractures of the ribs or multiple rib fractures with a sternal fracture, causes respiratory failure secondary to paradoxical respiration. The main treatment for flail chest is ventilatory care and surgical treatment, although early rib fixation has been reported to improve prognosis in recent years. There are several types of devices to fix the ribs and sternum, but selection criteria have yet to be established.
Topics: Flail Chest; Fracture Fixation, Internal; Humans; Rib Fractures; Thoracic Injuries; Thoracic Wall; Wounds, Nonpenetrating
PubMed: 36155586
DOI: No ID Found -
Advances in Surgery Sep 2022Rib fractures are a morbid consequence of blunt trauma and are associated with a highly variable clinical presentation ranging from nondisplaced rib fractures causing... (Review)
Review
Rib fractures are a morbid consequence of blunt trauma and are associated with a highly variable clinical presentation ranging from nondisplaced rib fractures causing limited, manageable pain to severely displaced rib fractures with concomitant thoracic injuries leading to respiratory failure. Due to an evolution of techniques, hardware technology, and general acceptance, rib plating has increased substantially at trauma centers all throughout the United States over the past decade. This article aims to review the most recent and current reports for rib plating with respect to indications, preoperative evaluation and imaging, approaches, timing for intervention, outcomes in patients with flail chest and nonflail injuries, and the management of complications. From these data, it becomes clear that the surgical stabilization of rib fractures (SSRF) has a firm place in the management of thoracic trauma.
Topics: Humans; Rib Fractures; Ribs; Thoracic Injuries
PubMed: 36096575
DOI: 10.1016/j.yasu.2022.02.009 -
Current Opinion in Otolaryngology &... Aug 2022In revision or posttraumatic rhinoplasty, the quantity and quality of septal cartilage available for grafting is often deficient and auricular cartilage often provides... (Review)
Review
PURPOSE OF REVIEW
In revision or posttraumatic rhinoplasty, the quantity and quality of septal cartilage available for grafting is often deficient and auricular cartilage often provides insufficient strength for structural nasal reconstruction. Accordingly, rib cartilage serves as a reliable, abundant source of cartilage for grafting. However, the various sources of rib cartilage carry respective benefits and weaknesses. This review examines recent studies, novel applications and a comparison of the primary sources of rib cartilage, including autologous cartilage, irradiated cadaveric rib and fresh frozen cadaveric cartilage.
RECENT FINDINGS
Options for rib cartilage include autologous, irradiated cadaveric rib, and more recently, reports on fresh frozen cadaveric cartilage. Studies continue to conclude that autologous and irradiated donor cartilage carry equivalent results, have similar rates of complication and have a comparable cost profile.
SUMMARY
Regardless of the source, rib cartilage plays an important role in structural rhinoplasty, especially in revision cases. Although the risks, benefits and long-term results of autologous and radiated homologous cartilage have been evaluated in observational studies, fresh frozen rib cartilage will need further follow up before widespread use, although preliminary literature shows promise.
Topics: Cadaver; Costal Cartilage; Humans; Nose; Rhinoplasty; Ribs; Transplantation, Autologous
PubMed: 35906971
DOI: 10.1097/MOO.0000000000000807 -
British Journal of Hospital Medicine... Oct 2019Rib fractures are a common reason for hospital admission and are associated with significant morbidity and mortality. This article discusses the management of simple rib...
Rib fractures are a common reason for hospital admission and are associated with significant morbidity and mortality. This article discusses the management of simple rib fractures and provides practical guidance for junior doctors involved in the care of these patients. Careful assessment to identify patients at high risk of complications is essential and calculation of a rib fracture score can aid management decisions. Pain from rib fractures can be severe and requires multimodal analgesia started promptly and proactively on hospital admission. This may include the use of regional anaesthetic techniques such as thoracic epidurals and erector spinae blocks for patients with significant chest trauma or those at high risk of pulmonary complications.
Topics: Age Factors; Analgesia, Epidural; Analgesics; Analgesics, Opioid; Humans; Oxygen; Pain Management; Retrospective Studies; Rib Fractures; Risk Factors; Trauma Severity Indices
PubMed: 31589510
DOI: 10.12968/hmed.2019.80.10.C146 -
Surgical Technology International Nov 2023Rib fractures are a common injury in blunt trauma and are associated with high morbidity and mortality. Recent advances in surgical stabilization of rib fractures (SSRF)...
Rib fractures are a common injury in blunt trauma and are associated with high morbidity and mortality. Recent advances in surgical stabilization of rib fractures (SSRF) have led to better patient outcomes for those with highly unstable complex rib fractures, as well as those with less severe injuries. This result has been due in part to the expansion of indications for repair, as well as the development of new hardware systems to address a variety of fracture patterns and injuries. This joint advancement of operator techniques, outcomes research, and industry development has brought SSRF to the forefront of rib fracture management and challenged non-operative paradigms. The future of repair is now shifting focus, as surgeons develop minimally invasive approaches and challenge manufacturers to develop new systems, instruments, and materials to address increasingly complex fracture patterns. These expansions promise to make SSRF an increasingly effective form of management for traumatic rib fractures.
PubMed: 38038173
DOI: 10.52198/23.STI.43.OS1726