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Micromachines Jan 2022This article presents a novel cross-rib micro-channel (MC-CR) heat sink to make fluid self-rotate. For a thermal test chip (TTC) with 100 w/cm, the cross-ribs...
This article presents a novel cross-rib micro-channel (MC-CR) heat sink to make fluid self-rotate. For a thermal test chip (TTC) with 100 w/cm, the cross-ribs micro-channel were compared with the rectangular (MC-R) and horizontal rib micro-channel (MC-HR) heat sinks. The results show that, with the cross-rib micro-channel, the junction temperature of the thermal test chip was 336.49 K, and the pressure drop was 22 kPa. Compared with the rectangular and horizontal ribs heat sink, the cross-rib micro-channel had improvements of 28.6% and 14.3% in cooling capability, but the pressure drop increased by 10.7-fold and 5.5-fold, respectively. Then, the effects of the aspect ratio (λ) of micro-channel in different flow rates were studied. It was found that the aspect ratio and cooling performance were non-linear. To reduce the pressure drop, the inclination (α) and spacing (S) of the cross-ribs were optimized. When α = 30°, S = 0.1 mm, and λ = 4, the pressure drop was reduced from 22 kPa to 4.5 kPa. In addition, the heat dissipation performance of the rectangular, staggered fin (MC-SF), staggered rib (MC-SR) and cross-rib micro-channels were analyzed in the condition of the same pressure drop, MC-CR still has superior heat dissipation performance.
PubMed: 35056296
DOI: 10.3390/mi13010132 -
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 -
Journal of the American College of... Aug 2020Rib fractures are associated with significant morbidity and mortality. Despite the publication of management guidelines and national outcomes benchmarking, there is... (Clinical Trial)
Clinical Trial
BACKGROUND
Rib fractures are associated with significant morbidity and mortality. Despite the publication of management guidelines and national outcomes benchmarking, there is significant variation in evidence-based (EB) adherence and outcomes. Systems for clinical decision support intervention (CDSI) allow rapid ordering of bundled disease-specific EB treatments. We developed an EB rib fracture protocol and CDSI at our institution. The purpose of the current study was to evaluate implementation and clinical outcomes using this CDSI.
STUDY DESIGN
A rib fracture care CDSI was developed, disseminated, and implemented in July 2018. Implementation outcomes were evaluated using the Proctor framework. Adherence was tracked monthly via run charts and acceptance was evaluated on a 7-point Likert scale using the Unified Theory of Acceptance and Use of Technology questionnaire. Propensity score matching was used to compare in-hospital morbidity and mortality in pre-implementation (January 1, 2016 through December 31, 2016) vs post-implementation (September 1, 2018 through April 30, 2019) cohorts.
RESULTS
A total of 197 patients were eligible for the intervention. Provider CDSI adherence was 83% at 1 month and reached 100% after 7 months. Acceptance of CDSI using the Unified Theory of Acceptance and Use of Technology had a mean Likert score higher than 6 (range 6.1 to 6.8, SD 0.5 to 1.5), indicating high acceptance. A significant reduction in hospital length of stay was found post implementation (incident rate ratio 0.80; 95% CI, 0.66 to 0.98; p = 0.03) comparing propensity-matched subjects.
CONCLUSIONS
The development and use of a CDSI resulted in improved provider delivery of EB practice and was associated with reduced hospital length of stay.
Topics: Adult; Aged; Aged, 80 and over; Clinical Protocols; Decision Support Systems, Clinical; Electronic Health Records; Female; Guideline Adherence; Hospital Mortality; Humans; Length of Stay; Logistic Models; Male; Middle Aged; Practice Guidelines as Topic; Practice Patterns, Physicians'; Propensity Score; Quality Improvement; Rib Fractures; Treatment Outcome
PubMed: 32360959
DOI: 10.1016/j.jamcollsurg.2020.04.023 -
European Journal of Trauma and... Aug 2019Rib fixation for flail chest has been shown to improve in-hospital outcome, but little is known about treatment for multiple rib fractures and long-term outcome is...
PURPOSE
Rib fixation for flail chest has been shown to improve in-hospital outcome, but little is known about treatment for multiple rib fractures and long-term outcome is scarce. The aim of this study was to describe the safety, long-term quality of life, and implant-related irritation after rib fixation for flail chest and multiple rib fractures.
METHODS
All adult patients with blunt thoracic trauma who underwent rib fixation for flail chest or multiple rib fractures between January 2010 and December 2016 in our level 1 trauma facility were retrospectively included. In-hospital characteristics and implant removal were obtained via medical records and long-term quality of life was assessed over the telephone.
RESULTS
Of the 864 patients admitted with ≥ 3 rib fractures, 166 (19%) underwent rib fixation; 66 flail chest patients and 99 multiple rib fracture patients with an ISS of 24 (IQR 18-34) and 21 (IQR 16-29), respectively. Overall, the most common complication was pneumonia (n = 58, 35%). Six (9%) patients with a flail chest and three (3%) with multiple rib fractures died, only one because of injuries related to the thorax. On average at 3.9 years, follow-up was obtained from 103 patients (62%); 40 with flail chest and 63 with multiple rib fractures reported an EQ-5D index of 0.85 (IQR 0.62-1) and 0.79 (0.62-0.91), respectively. Forty-eight (48%) patients had implant-related irritation and nine (9%) had implant removal.
CONCLUSIONS
We show that rib fixation is a safe procedure and that patients reported a relative good quality of life. Patients should be counseled that after rib fixation approximately half of the patients will experience implant-related irritation and about one in ten patients requires implant material removal.
Topics: Aged; Conservative Treatment; Female; Flail Chest; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Multiple; Hospitalization; Humans; Male; Middle Aged; Netherlands; Retrospective Studies; Rib Fractures
PubMed: 30229337
DOI: 10.1007/s00068-018-1009-5 -
African Journal of Thoracic and... 2022Hydatid disease is a zoonosis caused by larval stages of cestodes belonging to the genus Echinococcus. The rib location is exceptional. It presents a real diagnostic and...
BACKGROUND
Hydatid disease is a zoonosis caused by larval stages of cestodes belonging to the genus Echinococcus. The rib location is exceptional. It presents a real diagnostic and therapeutic challenge.
OBJECTIVES
To describe the clinical, serological and radiological features and surgical management of rib hydatidosis.
METHODS
This is a retrospective study conducted over 4 years, on five cases of rib hydatidosis. We analysed the clinical and radiological presentations and the adopted therapeutic procedure.
RESULTS
The average age of our patients was 44 years, without gender predominance. The clinical signs were dominated by the presence of an immobile swelling of fluid consistency without inflammatory sign, accompanied by moderate and intermittent localised pain. The laboratory assessment was nonspecific. The radiological assessment, including chest X-ray and thoracic computed tomography, with and without contrast, was essential in order to assess the extent of the lesion. Thoracic magnetic resonance imaging was requested in one case because of suspicions of a spinal extension. All of our patients underwent a rib excision accompanied by medical treatment of albendazole 24 hours after the surgery. The follow-up ranged from 1 year to 4 years and did not show any recurrence.
CONCLUSION
Hydatidosis of the ribs is an exceptional location of hydatid disease. The diagnosis was based on radiology and intraoperative exploration. The treatment remained essentially surgical by rib excision with anthelmintic drugs to prevent recurrence.
PubMed: 36339109
DOI: 10.7196/AJTCCM.2022.v28i3.193 -
Journal of Clinical Medicine Apr 2022Introduction: The fast and accurate diagnosis of rib fractures in polytrauma patients is important to reduce the mortality rate and relieve long-term pain and...
Introduction: The fast and accurate diagnosis of rib fractures in polytrauma patients is important to reduce the mortality rate and relieve long-term pain and complications. Aim: To evaluate the diagnostic accuracy and potential time savings using automatic rib segmentation and a curved, unfolded view for the detection of rib fractures in trauma patients. Methods: The multidetector computed tomography raw data of 101 consecutive polytrauma patients (72 men; mean age 45 years, age range 17 to 84 years) admitted to a university hospital were retrospectively post-processed to generate a curved, unfolded view of the rib cage. No manual corrections were performed. Patients with reconstruction errors and movement artifacts were excluded from further analysis. All fractures were identified and classified by the study coordinator using the original data set. Two readers (reader 1 and reader 2) evaluated the original axial sections and the unfolded view, separately. The fracture locations, fracture type, and reading times were recorded. Sensitivity and specificity were calculated on a per-rib basis using a ratio estimator. Cohen’s Kappa was calculated as an index of inter-rater agreement. Results: 26 of 101 patients (25.7%) were excluded from further analysis owing to breathing artifacts (6.9%) or incorrect centerline computation in the unfolded view (18.8%). In total, 107 (5.9%) of 1800 ribs were fractured in 25 (33%) of 75 patients. The unfolded view had a sensitivity/specificity of 81%/100% (reader 1) and 71%/100% (reader 2) compared to 94%/100% (reader 1; p = 0.002/p = 0.754) and 63%/99% (reader 2; p < 0.001/p = 0.002). The sensitivity (reader 1; reader 2) was poor for buckled fractures (31%; 38%), moderate for undislocated fractures (78%; 62%), and good for dislocated fractures (94%; 90%). The assessment of the unfolded view was performed significantly faster than that of the original layers (19.5 ± 9.4 s vs. 68.6 ± 32.4 s by reader 1 (p < 0.001); 24.1 ± 9.5 s vs. 40.2 ± 12.7 s by reader 2 (p < 0.001)). Both readers demonstrated a very high interobserver agreement for the unfolded view (κ = 0.839) but only a moderate agreement for the original view (κ = 0.529). Conclusion: Apart from a relatively high number of incorrect centerline reconstructions, the unfolded view of the rib cage allows a faster diagnosis of dislocated rib fractures.
PubMed: 35566629
DOI: 10.3390/jcm11092502 -
The Journal of International Medical... May 2023Osteosarcoma and Ewing sarcoma of the rib, sternum, and clavicle are rare tumor entities, and their clinical features and treatment outcomes have been rarely reported....
OBJECTIVE
Osteosarcoma and Ewing sarcoma of the rib, sternum, and clavicle are rare tumor entities, and their clinical features and treatment outcomes have been rarely reported. The present study was performed to evaluate their survival and confirm independent survival predictors.
METHODS
Data on patients with osteosarcoma or Ewing sarcoma of the rib, sternum, and clavicle from 1973 to 2016 were retrospectively extracted from the database. Univariate and multivariate Cox regression analyses were used to determine the independent risk factors. Kaplan-Meier survival curves were applied to examine the prognostic difference between the groups.
RESULTS
In total, 475 patients with osteosarcoma or Ewing sarcoma of the rib, sternum, and clavicle were eligible for this study, including 173 (36.4%) with osteosarcoma and 302 (63.6%) with Ewing sarcoma. The 5-year overall survival and cancer-specific survival rates of all patients were 53.6% and 60.8%, respectively. Six independent variables were identified, including age at diagnosis, sex, histological grade, metastatic status, tumor type, and surgery.
CONCLUSIONS
Surgical resection is a reliable treatment for osteosarcoma and Ewing sarcoma of the rib, sternum, and clavicle. Further research is needed to reconfirm the role of chemotherapy and radiotherapy in survival of these patients.
Topics: Humans; Sarcoma, Ewing; Prognosis; Clavicle; Retrospective Studies; Osteosarcoma; Sternum; Bone Neoplasms; Ribs
PubMed: 37219447
DOI: 10.1177/03000605231175763 -
International Journal of Surgery Case... May 2022Osteoid osteoma (OO) is a type of benign bone tumor that usually affects long bones of the lower extremities. In this case report, we describe a successful surgical...
INTRODUCTION
Osteoid osteoma (OO) is a type of benign bone tumor that usually affects long bones of the lower extremities. In this case report, we describe a successful surgical resection of an OO located in the rib which is an extremely rare location.
CASE PRESENTATION
This is a 23-year-old man, referred to our thoracic surgery department for a very intense nocturnal right chest pain for over two months, the physical examination was normal without clinically palpable chest mass. The CT scan showed an osteocondensing lesion at the junction of the middle and posterior arches of the right 6th rib suggesting Ewing's sarcoma, a PET CT was then requested showed an appearance of a regular non-hypermetabolic inhomogeneous condensation at the junction of the middle and posterior arcs of the 6th right rib. After multidisciplinary concertation, a CT-guided biopsy of the lesion was performed, the histological examination of which revealed an osteoid osteoma, then a complete resection of the lesion was performed under posterolateral thoracotomy which histology confirmed a costal osteoid osteoma. The patient is currently in good health condition with complete disappearance of chest pain after one month of the operation and does not present any complications for the long-term follow-up.
DISCUSSION
Osteoid osteoma (OO) is a benign primary bone tumor with unknown pathogenesis. That occurs in patients during the first two decades of life in about 60 to 75% of cases with a strong predilection for long bones, in 60 to 70% of cases. Flat bones, such as the skull, jawbones, innominate bones, and ribs are rarely described (McDermott et al., 1996 [1]). The standard treatment for OO is complete surgical excision, which is offered to the patient when the pain is chronic and not relieved by medical treatment (Osteoid osteoma: the results of surgical treatment [Internet] [2]).
CONCLUSION
The osteoid osteoma of the rib is a very rare entity of bone neoplasms, this is the first case in our department that demonstrates that the OO of the rib must be suspected affront any painful rib and that complete surgical excision when it's possible, is a safe and effective treatment.
PubMed: 35658306
DOI: 10.1016/j.ijscr.2022.107139 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Apr 2022The aim of this study was to determine the effect of the presence of rib fracture on mortality and morbidity in blunt thoracic trauma (BTT).
BACKGROUND
The aim of this study was to determine the effect of the presence of rib fracture on mortality and morbidity in blunt thoracic trauma (BTT).
METHODS
Records of patients aged over 18 and admitted with BTT between January 2017 and October 2019 dates were ret-rospectively evaluated. Only patients with both BTT and rib fracture were included in the study. Age, gender, trauma mechanism, additional organ injuries, and need for intensive care unit of patients were identified. The total length of hospital stay, length of stay in the intensive care unit, treatment modalities, need for mechanical ventilator; blood and blood products, complications, and mortality rates for patients were recorded.
RESULTS
One hundred eighty-six (73.8%) and 66 (26.2%) of 252 included patients were male and female, respectively. The most commonly seen trauma mechanism was motor vehicle accidents (51.4%). The mean age of patients was 52±12 (18-91). We identified that there was a significant association between hemothorax and non-thoracic additional organ injuries (p=0.024). There was no significant association between pneumothorax and additional organ injuries (p=0.067). The number of fractured ribs was significantly different between cases with and without hemothorax (p<0.001). There was also a significant difference between cases with and without pneumothorax in terms of the number of broken ribs (p<0.039). There was a significant difference between cases undergone thoracotomy and cases who did not undergo thoracotomy in terms of mean length of stay in the hospital (p<0.001). There was a positive correlation between the number of broken ribs and length of stay in the hospital (r=320, p<0.001).
CONCLUSION
Increased number of rib fracture in BTTs increases morbidity and length of stay in the hospital.
Topics: Aged; Female; Hemothorax; Humans; Male; Morbidity; Pneumothorax; Rib Fractures; Wounds, Nonpenetrating
PubMed: 35485510
DOI: 10.14744/tjtes.2020.55710 -
European Journal of Radiology Sep 2022The purpose of this study was to evaluate the performance of a deep learning system for the automatic diagnosis and classification of rib fractures.
PURPOSE
The purpose of this study was to evaluate the performance of a deep learning system for the automatic diagnosis and classification of rib fractures.
METHODS
This retrospective study analyzed computed tomography (CT) data of patients diagnosed with a rib fracture between 1 January 2019 and 23 July 2020 in two hospitals, including 591 patients from Suzhou TCM hospital and 75 patients from Jintan TCM hospital. A deep learning system (Dr.Wise@ChestFracture v1.0) based on a convolutional neural network framework was used as a diagnostic tool, and a human-model comparison experiment was designed to compare the diagnostic efficiencies of the deep learning system and radiologists. Furthermore, a secondary classification model was established to distinguish the different types of fracture. First, a classification model to differentiate between fresh and old fractures was developed. Second, a submodel to determine any misalignment in fresh fractures was established.
RESULTS
For all fracture types, the detection efficiency (recall) of the system was statistically significantly better than that of radiologists with different levels of experience (all p < 0.0167 except for senior radiologists). The F1-score of the system for diagnosing rib fractures was similar to that of the radiologists. The system was much faster than the radiologists in assessing rib fractures (all p < 0.0167). The two classification models can distinguish between fresh and old fractures (accuracy = 87.63%) and determine whether there is any misalignment in fresh fractures (accuracy = 95.22%) or not.
CONCLUSION
The use of a deep learning system can accurately, automatically, and rapidly diagnose and classify rib fractures, helping doctors improve the diagnostic efficiency and reducing their workload. The classification models can distinguish different types of rib fracture well.
Topics: Deep Learning; Humans; Neural Networks, Computer; Retrospective Studies; Rib Fractures; Tomography, X-Ray Computed
PubMed: 35797792
DOI: 10.1016/j.ejrad.2022.110434