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DOI: 10.1055/s-0039-1694192
Rib osteosynthesis in University medical center Ljubljana: 3-year experience
Publication History
Publication Date:
04 September 2019 (online)
Background:
Several randomized controlled trials have proved advantages of rib osteosynthesis in patients with flail chest such as: shorter duration of mechanical ventilation, shorter ICU stay and reduced incidence of pneumonia, especially in elderly patients. The advantages of rib osteosynthesis in non-flail rib fractures is still debatable. Rib osteosynthesis program was introduced into our institution in November 2015. We wish to present our initial experience with rib fracture stabilization using an established rib and sternum osteosynthesis system with pre-contoured locking titanium plates, locking screws and intramedullary splints.
Method and material:
Patients who underwent rib fracture fixation between November 2015 and April 2019 were retrospectively reviewed.
Result:
Rib osteosynthesis was performed in 18 patients (mean age 66 years): 14 with flail chest (5 from traumatic multiple rib fractures, one from CPR), 2 with rib nonunion, 2 after chest wall resection. In 9 patients the rib fixation was performed after thoracoscopic revision and 4 patients had a concurrent thoracotomy (including reconstruction cases).
There were 6 complications – two pneumonias, one superficial wound infection, bleeding, MOF and myopathy. Other than wound infection, all complications can be attributed to injury itself or associated medical conditions. No failed osteosynthesis were noticed.
Conclusion:
Our first experience with rib fixation is encouraging as results showed no failed osteosynthesis and a low rate of complications related to surgical procedure. Like in previous reports, most benefit is obvious in patients with flail chests and at older age. Rib plating system is highly adaptable and enables procedures with minimal damage to surrounding tissues. In combination with VATS, complete evacuation of hemothorax with hemostasis has been achieved, reducing the risk for retained hematomas. We have successfully used the system twice for chest reconstruction.