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Archives of Orthopaedic and Trauma... May 2024Rib fractures commonly occur in trauma patients with varying presentations. Though the literature in recent years has moved toward favoring more early intervention of... (Review)
Review
INTRODUCTION
Rib fractures commonly occur in trauma patients with varying presentations. Though the literature in recent years has moved toward favoring more early intervention of acute rib fractures, little has been reported on the matter of surgical fixation for symptomatic rib fracture nonunions.
MATERIALS AND METHODS
We performed a review of PubMed and Cochrane databases for articles published since 2000. Inclusion criteria were studies with greater than six months of follow-up, while case studies were excluded. A thorough analysis was performed on patient outcomes, complications reported, operative techniques utilized, and fixation systems used, among other parameters reported by the articles.
RESULTS
One hundred and thirty-nine studies resulted from our review, and a total of nine studies met our inclusion criteria with a combined total of 182 patients who underwent open reduction and internal fixation for symptomatic rib fracture nonunions. All studies reported a significant reduction of pain with increased satisfaction in the majority of patients. There were a total of 71 postoperative complications, the most common of which included surgical site infections, hardware failure, and hematoma. The most serious complications were insulting injury to the lung parenchyma or pleura; however, these were extremely rare based off the current literature. The use of bone grafting was common with eight of the nine studies mentioning the benefits of grafting.
CONCLUSION
Surgical stabilization of rib fracture nonunions appears to be an appropriate treatment alternative, and various techniques and approaches may be used with similar success. Further studies with higher level of evidence are recommended on the subject.
Topics: Humans; Rib Fractures; Fractures, Ununited; Fracture Fixation, Internal; Postoperative Complications; Bone Transplantation
PubMed: 38492065
DOI: 10.1007/s00402-024-05264-y -
Annals of Medicine and Surgery (2012) Feb 2024Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if... (Review)
Review
INTRODUCTION
Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if herniation of globe content occurs. Various studies have demonstrated the use of autologous cartilage grafts in the reconstruction of orbital fractures.
METHODS
A systematic review protocol was registered with PROSPERO, and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers.
RESULTS
Seven thousand one hundred seventy-one articles were identified following a comprehensive literature search. These articles were filtered for relevance and duplication, which reduced the number of articles to 16. A total of 259 patients underwent orbital reconstruction with the use of autologous cartilage. Conchal cartilage was harvested in 148 patients, auricular cartilage in 22 patients, nasoseptal cartilage in 72 patients, and costal cartilage in 17 patients. Thirty, seven, twelve, and four complications were observed in patients where cartilage was harvested from the concha, auricle, nasoseptum and rib, respectively. Most common complications included diplopia (=23), infra-orbital para/anaesthesia (=27), and enophthalmos (=7). No failure of graft or donor site morbidity were observed in the studies.
CONCLUSION
Autogenous materials such as cartilage can be used as an alternative for orbital reconstruction. Cartilage was considered by the authors to provide adequate structural support to the orbital contents, and that it was easy to harvest, shape, and position.
PubMed: 38333240
DOI: 10.1097/MS9.0000000000001598 -
Frontiers in Bioengineering and... 2022The vast majority of previous experimental studies on the thoracic spine were performed without the entire rib cage, while significant contributive aspects regarding...
The vast majority of previous experimental studies on the thoracic spine were performed without the entire rib cage, while significant contributive aspects regarding stability and motion behavior were shown in several other studies. The aim of this literature review was to pool and increase evidence on the effect of the rib cage on human thoracic spinal biomechanical characteristics by collating and interrelating previous experimental findings in order to support interpretations of and studies disregarding the rib cage to create comparability and reproducibility for all studies including the rib cage and provide combined comparative data for future biomechanical studies on the thoracic spine. After a systematic literature search corresponding to PRISMA guidelines, eleven studies were included and quantitatively evaluated in this review. The combined data exhibited that the rib cage increases the thoracic spinal stability in all motion planes, primarily in axial rotation and predominantly in the upper thorax half, reducing thoracic spinal range of motion, neutral zone, and intradiscal pressure, while increasing thoracic spinal neutral and elastic zone stiffness, compression resistance, and, in a neutral position, the intradiscal pressure. In particular, the costosternal connection was found to be the primary stabilizer and an essential determinant for the kinematics of the overall thoracic spine, while the costotransverse and costovertebral joints predominantly reinforce the stability of the single thoracic spinal segments but do not alter thoracic spinal kinematics. Neutral zone and neutral zone stiffness were more affected by rib cage removal than the range of motion and elastic zone stiffness, thus also representing the essential parameters for destabilization of the thoracic spine. As a result, the rib cage and thoracic spine form a biomechanical entity that should not be separated. Therefore, usage of entire human non-degenerated thoracic spine and rib cage specimens together with pure moment application and sagittal curvature determination is recommended for future testing in order to ensure comparability, reproducibility, and quasi-physiological validity.
PubMed: 35782518
DOI: 10.3389/fbioe.2022.904539 -
Annals of Emergency Medicine Jun 2022Chest ultrasonography has been reported as an accurate imaging modality and potentially superior to chest radiographs in diagnosing traumatic rib fractures. However, few... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
Chest ultrasonography has been reported as an accurate imaging modality and potentially superior to chest radiographs in diagnosing traumatic rib fractures. However, few studies have compared ultrasonography to the reference standard of computed tomography (CT), with no systematic reviews published on the topic to date. Our objective was to summarize the evidence comparing the test characteristics of chest ultrasonography to CT in diagnosing rib fractures.
METHODS
This study was performed and reported in adherence to PRISMA guidelines. We searched 5 databases plus gray literature from inception to October 2021. Two independent reviewers completed study selection, data extraction, and a QUADAS-2 risk of bias assessment. Summary measures were obtained from the Hierarchical Summary Receiver Operating Characteristic model.
RESULTS
From 1,660 citations, we identified 7 studies for inclusion, of which 6 had available 2×2 data for meta-analysis (n = 663). Of the 6 studies, 3 involved emergency department-performed ultrasonography and 3 radiology-performed ultrasonography. Chest ultrasonography had a pooled sensitivity of 89.3% (95% confidence interval [CI], 81.1 to 94.3) and specificity of 98.4% (95% CI, 90.2 to 99.8) compared with CT imaging for the diagnosis of any rib fracture. The finding of a fracture on ultrasonography, defined as an underlying cortical irregularity, was associated with a +likelihood ratio (LR) of 55.7 (95% CI, 8.5 to 363.4) for CT diagnosed rib fracture, while the absence of ultrasonography fracture held a -LR of 0.11 (95% CI, 0.06 to 0.20). We were unable to detect a difference in test characteristics between emergency department- and radiology-performed ultrasonography (P=.11). The overall risk of bias of included studies was high, with patient selection identified as the highest risk domain.
CONCLUSION
Chest ultrasonography is both sensitive and highly specific in diagnosing rib fractures following blunt trauma.
Topics: Humans; Radiography; Rib Fractures; Thoracic Injuries; Ultrasonography; Wounds, Nonpenetrating
PubMed: 35461720
DOI: 10.1016/j.annemergmed.2022.02.006 -
Child Abuse & Neglect Jul 2006There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse.... (Review)
Review
BACKGROUND
There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in children? (ii) If so, what are the frequency and characteristics of these fractures that may help to distinguish them from rib fractures caused by physical abuse?
METHODS
We performed a literature search of original articles, references, textbooks, and conference abstracts, published in any language from 1950 to 1 October 2005. Articles were identified from ASSIA, Caredata, Medline, Ovid Medline in Process, ChildData, CINAHL, Embase, ISI Proceedings, SIGLE, Science Citation Index, Social Science Citation Index, and TRIP databases. We included all studies that addressed rib fractures and CPR in children less than 18 years, and excluded review articles, expert opinion, consensus guidelines, and studies that were significantly methodologically flawed on critical appraisal. Each study underwent two independent reviews (with a third review if there was disagreement). Each reviewer used standardized criteria for study definition, data extraction, and critical appraisal, to determine the quality of the study and to establish if it met the inclusion criteria of this systematic review.
FINDINGS
Of the 427 studies reviewed, 6 were included: 1 case control, 4 cross-sectional, and 1 case series. These represent data on 923 children who underwent CPR. Three children sustained rib fractures as a result of resuscitation; all three of these had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature who had a posterior rib fracture due to CPR. Resuscitation was performed variably by both medical and non-medical personnel.
CONCLUSION
Rib fractures after cardiopulmonary resuscitation are rare. When they do occur, they are anterior and may be multiple. As the studies performed to date did not use the most sensitive techniques for detecting rib fractures, further prospective studies of children would be valuable to provide additional clarification on this question.
Topics: Adolescent; Cardiopulmonary Resuscitation; Causality; Child; Child Abuse; Child, Preschool; Clavicle; Cross-Sectional Studies; Diagnosis, Differential; Humans; Infant; Rib Fractures; Risk Factors; Sternocostal Joints
PubMed: 16857258
DOI: 10.1016/j.chiabu.2005.12.007 -
Emergency (Tehran, Iran) 2016The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet;... (Review)
Review
INTRODUCTION
The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet; therefore, the present study aimed to conduct a thorough meta-analytic systematic review on this subject.
METHODS
Two reviewers independently carried out a comprehensive systematic search in Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest databases. Data were summarized as true positive, false positive, true negative and false negative and were analyzed via STATA 11.0 software using a mixed-effects binary regression model. Sources of heterogeneity were further assessed through subgroup analysis.
RESULTS
Data on 1667 patients (807 subjects with and 860 cases without thoracic fractures), whose age ranged from 0 to 92 years, were extracted from 17 surveys. Pooled sensitivity and specificity of ultrasonography in detection of thoracic bone fractures were 0.97 (95% CI: 0.90-0.99; I2= 88.88, p<0.001) and 0.94 (95% CI: 0.86-0.97; I2= 71.97, p<0.001), respectively. The same measures for chest radiography were found to be 0.77 (95% CI: 0.56-0.90; I2= 97.76, p<0.001) and 1.0 (95% CI: 0.91-1.00; I2= 97.24, p<0.001), respectively. The sensitivity of ultrasonography was higher in detection of rib fractures, compared to fractures of sternum or clavicle (97% vs. 91%). Moreover, the sensitivity was found to be higher when the procedure was carried out by a radiologist in comparison to an emergency medicine specialist (96% vs. 90%).
CONCLUSION
Base on the findings of the present meta-analysis, screening performance characteristic of ultrasonography in detection of thoracic bone fractures was found to be higher than radiography. However, these characteristics were more prominent in detection of rib fractures and in cases where was performed by a radiologist.
PubMed: 27274514
DOI: No ID Found -
Journal of Surgical Oncology Sep 2019Pedicled and free composite flaps derived from the thoracodorsal artery system, including the latissimus dorsi-rib (LD-R) and the serratus anterior-rib (SA-R)...
Pedicled and free composite flaps derived from the thoracodorsal artery system, including the latissimus dorsi-rib (LD-R) and the serratus anterior-rib (SA-R) osteo-muscular or osteo-myocutaneous flaps, are potential options to address head and neck, thorax, upper and lower extremity bone, and soft tissue defects' reconstruction. We aimed to report our series of LD/SA-R composite pedicled and free flaps, evaluating outcomes and complications, and to systematically identify all literature reporting results following LD/SA-rib reconstructions.
Topics: Bone Neoplasms; Humans; Male; Middle Aged; Retrospective Studies; Soft Tissue Neoplasms; Surgical Flaps
PubMed: 31197840
DOI: 10.1002/jso.25579 -
Sports Health 2024A nationally ranked Division One female collegiate tennis player presented with pain in the chest and right posterior rib region after feeling a popping sensation during...
A nationally ranked Division One female collegiate tennis player presented with pain in the chest and right posterior rib region after feeling a popping sensation during a routine overhead movement. The patient was eventually diagnosed with 2 lower rib stress fractures. After unsuccessful conservative management, the player underwent an open reduction and internal fixation and autologous bone grafting of the sixth and seventh ribs with a muscle-sparing approach and was able to return to full competition. We present this case along with a systematic review of the literature regarding rib stress fractures, which included 6 separate online data sources (PubMed, EMBASE, Cochrane, CINAHL, SportDiscus, and Medline). The successful surgical intervention demonstrates a significant option for elite athletes who wish to return to competition but have been unable to with standard of care conservative management of rib stress fractures.
Topics: Humans; Fractures, Stress; Female; Rib Fractures; Tennis; Fracture Fixation, Internal; Bone Plates; Bone Transplantation; Young Adult; Return to Sport
PubMed: 37688535
DOI: 10.1177/19417381231195271 -
Journal of Clinical Anesthesia Feb 2024Rib fractures (RF) are common injuries. Multiple analgesia strategies are available for treatment of pain associated with RF. However, the optimal multimodal technique... (Review)
Review
STUDY OBJECTIVE
Rib fractures (RF) are common injuries. Multiple analgesia strategies are available for treatment of pain associated with RF. However, the optimal multimodal technique for pain management is not known. The primary aim of this review was to evaluate the status of evidence derived from randomized clinical trials (RCTs) on the effectiveness of pain management modalities for rib fracture pain. Other patient-centered outcomes were secondary objectives.
METHODS
Searches were conducted in MEDLINE, Embase, Scopus, and Cochrane Library. The screening process involved two phases, two researchers independently screened the title and abstract and subsequently screened full text. RCT data were extracted independently by two research team members. Consensus was achieved by comparison and discussion when needed. Risk of bias assessment was performed using the Cochrane Risk of Bias 2 tool.
RESULTS
A total of 1344 citations were identified. Title and abstract screening excluded 1128 citations, and full text review excluded 177 articles. A total of 32 RCTs were included in the full review. Multiple analgesia techniques and medications were identified and their effect on pain score and need for rescue opioid analgesia. None of the included studies were judged to have a high risk of bias, while only 10 studies were assessed as having a low risk of bias.
CONCLUSIONS
This systematic review found that studies are of low quality with diverse methodologies and outcomes. A reduction in pain scores was found for epidural analgesia when compared with other modalities. However, the low quality of the evidence necessitates cautious interpretation of this finding. PROSPERO registration: CRD42022376298 (Nov, 16, 2022).
Topics: Humans; Pain Management; Rib Fractures; Randomized Controlled Trials as Topic; Analgesia, Epidural; Pain
PubMed: 37883901
DOI: 10.1016/j.jclinane.2023.111276 -
International Journal of Oral and... Mar 2018The purpose of this study was to compare the efficacy of alveolar bone reconstruction for alveolar cleft patients performed with the traditional iliac graft or... (Review)
Review
The purpose of this study was to compare the efficacy of alveolar bone reconstruction for alveolar cleft patients performed with the traditional iliac graft or alternative/supplementary bone grafting materials. Electronic databases, relevant journals, and reference lists of the included studies were searched to the end of June 2016. A best-evidence synthesis was performed to draw conclusions. A total of 38 studies were included, which provided 25 pieces of evidence: seven of moderate evidence and 18 of insufficient evidence. The seven pieces of moderate evidence indicated that (1) bone morphogenetic protein 2 bound to absorbable collagen sponge shares similar cleft repair efficacy to the iliac graft; (2) covering the iliac graft with an acellular dermis matrix membrane may increase bone retention for unilateral cleft patients; (3) mixing iliac graft with platelet-rich plasma may increase bone retention for skeletally mature patients, but (4) does not achieve the same result for younger patients; and compared with the iliac graft, (5) the mandible graft is more effective, whereas (6) the cranium graft and (7) rib graft are less effective for alveolar cleft reconstruction. The efficacy of the remaining grafting materials was supported by insufficient evidence. More well-designed controlled studies are needed to ascertain the long-term clinical results of alveolar cleft reconstruction.
Topics: Absorbable Implants; Acellular Dermis; Alveolar Process; Bone Morphogenetic Protein 2; Bone Transplantation; Cleft Palate; Collagen; Humans; Ilium; Mandible; Platelet-Rich Plasma; Plastic Surgery Procedures; Ribs; Skull
PubMed: 28863859
DOI: 10.1016/j.ijom.2017.08.003