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1.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116991

RESUMO

The gold standard for rib fracture nonunion management remains a matter of debate. Operative treatment of rib fracture nonunion has become increasingly popular. A 69-year-old man was operatively treated with intercostal neurectomy of the left eighth rib to resolve chronic thoracic pain following a rib fracture nonunion. After the intervention, the patient developed a flank bulge which was most likely due to the intercostal neurectomy, causing partial denervation of the abdominal musculature. Although the pain at the nonunion site decreased after the operative intervention, the patient still experienced severe pain during daily activities and reported poor quality of life due to the flank bulge. Physiotherapy and an abdominal belt did not improve this flank bulge. When considering operative neurectomy of the intercostal nerves of ribs 7-12 to resolve chronic pain due to rib fracture nonunion, the treating surgeon should be aware of this debilitating complication.


Assuntos
Fraturas não Consolidadas , Fraturas das Costelas , Músculos Abdominais , Idoso , Denervação , Fraturas não Consolidadas/cirurgia , Humanos , Nervos Intercostais/cirurgia , Masculino , Qualidade de Vida , Fraturas das Costelas/complicações , Fraturas das Costelas/cirurgia
2.
Kyobu Geka ; 74(5): 397-400, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-33980804

RESUMO

An 82-year old man was admitted for a left fifth rib fracture with traumatic pneumothorax. Computed tomography showed a sharp rib fragment protruding into the thoracic cavity. Thoracic drainage was not performed before surgery to avoid lung injury by the rib fragment. At surgery, fifth rib fragment protruding into the thoracic cavity was found, but lung injury was not present. The bone fragment was removed, and the patient's postoperative course was uneventful.


Assuntos
Lesão Pulmonar , Pneumotórax , Fraturas das Costelas , Traumatismos Torácicos , Idoso de 80 Anos ou mais , Humanos , Lesão Pulmonar/diagnóstico por imagem , Lesão Pulmonar/prevenção & controle , Masculino , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/cirurgia , Costelas , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia
3.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653849

RESUMO

A 73-year-old male patient underwent operative treatment for dislocation of multiple costochondral junctions alongside multiple bony rib fractures and a flail chest following high-energy trauma. During the operative fixation of the flail chest, the costochondral lesions were surgically stabilised with plates and screws, which were fixated on the osseous anterior rib, sternum or the rib cartilage. The patient experienced no pulmonary complications during the primary admission. At 7 months after the trauma, the chest CT scan showed full consolidation of all fixated rib fractures, including the costochondral lesions, without hardware dislocation or complications. The patient did not require any pain medication and had no pain during daily activities, at rest or at night. Although being a biomechanically demanding region, which is often not defined in current rib fracture classification, operative treatment of costochondral lesions is feasible with outcome similar to the treatment of bony rib fractures.


Assuntos
Tórax Fundido , Fraturas Múltiplas , Fraturas das Costelas , Traumatismos Torácicos , Idoso , Tórax Fundido/diagnóstico por imagem , Tórax Fundido/etiologia , Tórax Fundido/cirurgia , Fixação Interna de Fraturas , Humanos , Masculino , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/cirurgia
4.
J Cardiothorac Surg ; 16(1): 5, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33583412

RESUMO

OBJECTIVE: To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures. METHODS: Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). RESULTS: The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to 10 months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape. CONCLUSION: The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Impressão Tridimensional , Fraturas das Costelas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fraturas das Costelas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Unfallchirurg ; 124(5): 358-361, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33616681

RESUMO

The coronavirus disease 2019 (COVID-19) has spread rapidly worldwide and leads to high morbidity and mortality. Clinical experience regarding the surgical management in COVID-19 patients is limited. We report the interdisciplinary approach in a COVID-19 patient with severe thoracic trauma and pulmonary symptoms, who was admitted to the emergency unit after blunt chest trauma with dislocated serial rib fractures and concomitant hemothorax.


Assuntos
COVID-19 , Fraturas das Costelas , Traumatismos Torácicos , Ferimentos não Penetrantes , Idoso , Humanos , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/cirurgia , SARS-CoV-2 , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia
6.
J Trauma Acute Care Surg ; 90(3): 451-458, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33559982

RESUMO

BACKGROUND: Surgical stabilization of rib fracture (SSRF) is increasingly used to manage patients with rib fractures. Benefits of performing SSRF appear variable, and the procedure is costly, necessitating cost-effectiveness analysis for distinct subgroups. We aimed to assess the cost-effectiveness of SSRF versus nonoperative management among patients with rib fractures younger than 65 years versus 65 years or older, with versus without flail chest. We hypothesized that, compared with nonoperative management, SSRF is cost-effective only for patients with flail chest. METHODS: This economic evaluation used a decision-analytic Markov model with a lifetime time horizon incorporating US population-representative inputs to simulate benefits and risks of SSRF compared with nonoperative management. We report quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. Deterministic and probabilistic sensitivity analyses accounted for most plausible clinical scenarios. RESULTS: Compared with nonoperative management, SSRF was cost-effective for patients with flail chest at willingness-to-pay threshold of US $150,000/QALY gained. Surgical stabilization of rib fracture costs US $25,338 and US $123,377/QALY gained for those with flail chest younger than 65 years and 65 years or older, respectively. Surgical stabilization of rib fracture was not cost-effective for patients without flail chest, costing US $172,704 and US $243,758/QALY gained for those younger than 65 years and 65 years or older, respectively. One-way sensitivity analyses showed that, under most plausible scenarios, SSRF remained cost-effective for subgroups with flail chest, and nonoperative management remained cost-effective for patients older than 65 years without flail chest. Probability that SSRF is cost-effective ranged from 98% among patients younger than 65 years with flail chest to 35% among patients 65 years or older without flail chest. CONCLUSIONS: Surgical stabilization of rib fracture is cost-effective for patients with flail chest. Surgical stabilization of rib fracture may be cost-effective in some patients without flail chest, but delineating these patients requires further study. LEVEL OF EVIDENCE: Economic/decision, level II.


Assuntos
Tórax Fundido/complicações , Tórax Fundido/cirurgia , Fixação de Fratura/economia , Fraturas das Costelas/complicações , Fraturas das Costelas/cirurgia , Fatores Etários , Idoso , Análise Custo-Benefício , Feminino , Tórax Fundido/economia , Humanos , Tempo de Internação , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Fraturas das Costelas/economia , Sensibilidade e Especificidade , Resultado do Tratamento
7.
Am Surg ; 87(2): 181-182, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33342262

RESUMO

This review is submitted for inclusion in the literary festschrift in honor of J. David Richardson, MD.


Assuntos
Fraturas das Costelas/história , História do Século XX , Humanos , Kentucky , Fraturas das Costelas/cirurgia , Texas , Traumatologia/história
8.
Acta Chir Orthop Traumatol Cech ; 87(5): 360-362, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-33146606

RESUMO

The authors present a case of 74-year-old female patient who suffered a flail chest in motor vehicle accident. First day after injury a descending thoracic aorta was injured, most likely during manipulation with the patient. This injury was verified by operation, which was indicated 26 hours after the hospital admission, because of a sudden decrease of blood pressure with blood loss over 600 ml through the chest tube. The female patient died during surgery despite all efforts. Due to our experience with this rare case and after literature studying, we would recommend to consider early surgical revision. Based on the close contact of severely displaced sharp edges of ribs to the descending aorta, which was visible on the CT scan. Even through the absence of clear leak of contrast in the CT examination. We could resect these parts of ribs. Key words: flail chest, descending thoracic aortic injury.


Assuntos
Tórax Fundido , Fraturas das Costelas , Traumatismos Torácicos , Idoso , Feminino , Humanos , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/cirurgia , Costelas , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Tomografia Computadorizada por Raios X
10.
PLoS One ; 15(9): e0239896, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986770

RESUMO

INTRODUCTION: Pain management is the pillar of caring for patients with traumatic rib fractures. Intravenous lidocaine (IVL) is a well-established non-opioid analgesic for post-operative pain, yet its efficacy has yet to be investigated in trauma patients. We hypothesized that IVL is associated with decreased inpatient opioid requirements among patients with rib fractures. METHODS: We retrospectively evaluated adult patients presenting to our Level 1 trauma center with isolated chest wall injuries. After 1:1 propensity score matching patients who received vs did not receive IVL, we compared the two groups' average daily opioid use, opioid use in the last 24 hours of admission, and pain scores during admissions hours 24-48. We performed multivariable linear regression for these outcomes (with sensitivity analysis for the opioid use outcomes), adjusting for age as a moderating factor and controlling for hospital length of stay and injury severity. RESULTS: We identified 534 patients, among whom 226 received IVL. Those who received IVL were older and had more serious injury. Compared to propensity-score matched patients who did not receive IVL, patients who received IVL had similar average daily opioid use and pain scores, but 40% lower opioid use during the last 24 hours of admission (p = 0.002). Multivariable regression-with and without sensitivity analysis-did not show an effect of IVL on any outcomes. CONCLUSION: IVL was crudely associated with decreased opioid requirements in the last 24 hours of admission, the time period associated with opioid use at 90 days post-discharge. However, we did not observe beneficial effects of IVL on multivariable adjusted analyses; we are conducting a randomized control trial to further evaluate IVL's opioid-sparing effects for patients with rib fractures.


Assuntos
Administração Intravenosa , Assistência ao Convalescente/métodos , Analgésicos não Narcóticos/uso terapêutico , Lidocaína/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Fraturas das Costelas/cirurgia , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Narcóticos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Escala de Gravidade do Ferimento , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/uso terapêutico , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
11.
Acta Chir Orthop Traumatol Cech ; 87(3): 155-161, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32773015

RESUMO

PURPOSE OF THE STUDY Rib fractures represent one of the most common fractures sustained by 10-40% of all patients with blunt chest trauma, their incidence increases with age. In the current literature, however, new indication criteria continue to emerge. The purpose of this study is to assess the indication criteria, the timing of surgery and the use of individual plates in dependence on fracture location in our patients after the chest wall stabilisation in a retrospective analysis. MATERIAL AND METHODS Our group of patients (n = 349) included the patients who were hospitalised in the Trauma Centre of the University Hospital Olomouc from 1 January 2015 to 31 January 2019, of whom 16 patients were indicated for a surgery. In case of polytrauma, spiral CT was performed, while all patients with a more serious wall chest trauma underwent 3D CT chest wall reconstruction. The surgical approach was chosen based on the fracture location, most frequently posterolateral thoracotomy was opted for. The type of plates was chosen based on the location and type of the fracture. The most common was the lateral type of fracture. RESULTS The most common indication for surgery was multiple rib fractures with major chest wall disfiguration with the risk of injury to intrathoracic organs, present hemothorax or pneumothorax. The age of patients ranged from 44 to 92 years. 8 patients sustained a thoracic monotrauma, the remaining patients suffered multiple injuries, mostly craniocerebral trauma, pelvic or long bone fractures or parenchymal organ injury. The patients were indicated for surgery between 1 hour and 7 days after the hospital admission, on average 3 plates per patient were used and the most commonly used type of plate was the newly modified Judet plate made by Medin. All the patients underwent a surgical revision of pleural cavity, in 3 patients diaphragmatic rupture was found despite a negative preoperative CT scan. The duration of mechanical ventilation in polytrauma patients was 16 days, in thoracic monotrauma patients it was 2 days. CONCLUSIONS Prevailing majority of patients with a blunt chest trauma with rib fractures is still treated non-operatively, which is confirmed also by our group of patients. Nonetheless, correctly and early indicated stabilisation of the chest wall based on accurate indication criteria is of a great benefit to the patients. The aim of each and every trauma centre should be to develop a standardised protocol for the management of blunt chest trauma (the so-called "rib fracture protocol"), which comprises precisely defined criteria for patient admission, multimodal analgesia, indications for surgery, comprehensive perioperative and postoperative care and a subsequent rehabilitation of patients. Key words: rib fracture protocol, chest wall stabilisation, flail chest.


Assuntos
Tórax Fundido , Fraturas das Costelas , Traumatismos Torácicos , Parede Torácica , Ferimentos não Penetrantes , Tórax Fundido/diagnóstico por imagem , Tórax Fundido/etiologia , Tórax Fundido/cirurgia , Humanos , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/cirurgia , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
12.
J Cardiothorac Surg ; 15(1): 167, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646474

RESUMO

BACKGROUND: Chest blunt trauma (CBT) and the resultant rib fractures often lead to thoracic collapse. The purpose of this study was to explore the effect of displacement of the rib fracture and thoracic collapse on the thoracic volume by using normal chest CT data. METHODS: In this retrospective study, seven consecutive normal participants were selected from our hospital between June and July 2018. Normal thoracic models were reconstructed, followed by simulation of lateral fractures through the 4th to 9th ribs under three collapse modes with 1-5 cm of collapse. The thoracic collapse models (n = 630) were reconstructed using 3Dmax 2014. We calculated the thoracic volume and reduction percentage for each thoracic collapse model. Linear regression-based comparisons of thoracic volume reductions were performed. RESULTS: In all three collapse modes, the degree of the collapse was linearly correlated with the mean thoracic volume reduction. The reduction percentage in the posterior collapse mode was higher than that in the anterior collapse mode (P < 0.001). The largest volume reductions in the anterior, posterior, and simultaneous collapse models were in the 6th rib fracture model (P < 0.001), 8th rib fracture model (P < 0.001), and 7th rib fracture model (P < 0.001), respectively. CONCLUSIONS: The influences of rib fracture displacement and collapse on the thoracic volume in the 6th through 8th ribs are critical in lateral rib fractures. For patients with 6th to 8th rib fractures and posterior rib collapse, surgical intervention to restore thoracic volume may be more essential.


Assuntos
Fraturas das Costelas/diagnóstico por imagem , Cavidade Torácica/diagnóstico por imagem , Cavidade Torácica/patologia , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Simulação por Computador , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/complicações
13.
J Card Surg ; 35(8): 2064-2066, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652795

RESUMO

A flail chest can occur when cardiopulmonary resuscitation causes extensive rib fractures. Despite successful cardiopulmonary resuscitation, if the flail chest is not treated, the patient may not survive regardless of the correction of the primary condition that caused the cardiac arrest. Therefore, if flail chest persists despite the appropriate conservative management to correct the flail chest, active surgical management is essential. We present a successful surgical treatment with a pectus bar for a patient with flail chest, caused by extensive segmental rib fractures sustained during cardiopulmonary resuscitation for a massive pulmonary thromboembolism.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Tórax Fundido/etiologia , Tórax Fundido/cirurgia , Fixação Interna de Fraturas/métodos , Fixadores Internos , Procedimentos Cirúrgicos Torácicos/métodos , Idoso , Feminino , Tórax Fundido/diagnóstico por imagem , Parada Cardíaca/terapia , Humanos , Radiografia Torácica , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Costelas/cirurgia , Tomografia Computadorizada por Raios X
15.
Ann Thorac Surg ; 110(3): 993-997, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32353437

RESUMO

BACKGROUND: Although open reduction and internal fixation (ORIF) is an accepted treatment for a proportion of acute rib fractures, The literature on its potential to treat chronic, nonunion fractures is scarce. This study evaluates the outcomes and quality of life of patients who underwent ORIF for chronic, symptomatic, nonunion rib fractures. METHODS: Thirty-two patients were explored for possible ORIF of nonunion rib fractures (≥6 months after injury). After excluding non-English-speaking patients (n = 1), those where no instability was noted at surgery (n = 3), and those deceased at the time of study (n = 4), 24 patients were eligible. Telephone interviews were conducted using a previously published rib fracture pain questionnaire. RESULTS: Seventy percent of eligible patients (19/24) consented and completed the questionnaire at a median of 55 months (interquartile range, 24-62) from surgery. Injuries were classified as multisystem trauma (n = 4) or isolated rib fractures (n = 15). The median pain severity (on a scale of 1 [none/mild] to 10 [severe]) significantly decreased from preoperatively (9; interquartile range, 7-10) to postoperatively (1; interquartile range, 0-2; P < .001). Most patients returned to daily activities, were able to work at their preinjury level, were satisfied with their surgery, and would undergo operative management again. CONCLUSIONS: Patients who underwent ORIF reported a significant decrease in fracture-associated symptoms and pain severity postoperatively. Most returned to daily activities, could work at preinjury levels, and were satisfied with surgery. ORIF should be considered as an option to help patients with symptomatic nonunion rib fractures.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Fraturas das Costelas/cirurgia , Doença Crônica , Feminino , Seguimentos , Fraturas não Consolidadas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
BMC Surg ; 20(1): 103, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404137

RESUMO

BACKGROUND: Development of multiple rib fractures leading to bilateral flail chest in Cronkhite-Canada Syndrome (CCS) has not been reported. CASE PRESENTATION: A 59-year-old man presented with complaints of fatigue, chest pain, respiratory distress and orthopnea requiring ventilatory support to maintain oxygenation. CCS with bilateral anterior and posterior flail chest due to multiple rib fractures (2nd-10th on the right side and 2nd-11th on the left side). He underwent open reduction and anterior and posterior internal fixation using a titanium alloy fixator and a nickel-titanium memory alloy embracing fixator for chest wall reconstruction. He recovered gradually from the ventilator and showed improvement in his symptoms. He gained about 20 kg of weight in the follow up period (6 months after discharge from the hospital). CONCLUSION: CCS is a rare, complex disease that increases the risk of developing multiple rib fractures, which can be successfully treated with open reduction and internal fixation.


Assuntos
Tórax Fundido/cirurgia , Polipose Intestinal/cirurgia , Fraturas das Costelas/cirurgia , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Níquel/química , Redução Aberta , Parede Torácica , Titânio/química
17.
Ann Thorac Surg ; 110(3): 988-992, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360874

RESUMO

BACKGROUND: The appropriate timing of rib fixation remains unclear. We investigated the efficacy of early rib fixation compared with late rib fixation, using data from a Japanese nationwide inpatient database. METHODS: We identified patients who underwent rib fixation and received mechanical ventilation from July 1, 2010, to March 31, 2018, using data from the Diagnosis Procedure Combination database in Japan. The primary outcome was the duration of mechanical ventilation after rib fixation. Secondary outcomes were the length of hospital stay after rib fixation, total hospitalization costs, tracheostomy, pneumonia after admission, and all-cause 28-day in-hospital mortality. We performed propensity score-adjusted analyses to compare outcomes between patients undergoing rib fixation less than or equal to 6 days after admission and those undergoing rib fixation greater than 6 days after admission. RESULTS: We identified 211 patients, including 113 patients undergoing early rib fixation and 98 patients undergoing late rib fixation. In the propensity score-adjusted analyses, early rib fixation was associated with shorter duration of mechanical ventilation (difference, -26.7%; 95% confidence interval [CI], -39.4% to -11.4%), shorter length of hospital stay (difference, -33.3%; 95% CI, -52.8% to -5.6%), and lower total hospitalization costs (difference, -28.7%; 95% CI, -38.4% to -17.5%). There were no significant differences between the groups regarding the proportions of patients receiving tracheostomy (odds ratio [OR], 0.67; 95% CI, 0.31-1.48), pneumonia after admission (OR, 0.74, 95% CI, 0.33-1.65), or all-cause 28-day in-hospital mortality (OR, 0.90, 95% CI, 0.06-12.5). CONCLUSIONS: Early rib fixation was associated with better in-hospital outcomes.


Assuntos
Fixação Interna de Fraturas/métodos , Pacientes Internados/estatística & dados numéricos , Sistema de Registros , Fraturas das Costelas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico , Fraturas das Costelas/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
18.
J Trauma Acute Care Surg ; 89(2): 411-418, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32282759

RESUMO

BACKGROUND: In recent years, there has been a growing interest in operative treatment for multiple rib fractures and flail chest. However, to date, there is no comprehensive study that extensively focused on the incidence of complications associated with rib fracture fixation. Furthermore, there is insufficient knowledge about the short- and long-term outcomes after rib fracture fixation. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The MEDLINE, EMBASE, and Cochrane databases were searched to identify studies reporting on complications and/or outcome of surgical treatment after rib fractures. Complications were subdivided into (1) surgery- and implant-related complications, (2) bone-healing complications, (3) pulmonary complications, and (4) mortality. RESULTS: Forty-eight studies were included, with information about 1,952 patients who received rib fracture fixation because of flail chest or multiple rib fractures. The overall risk of surgery- and implant-related complications was 10.3%, with wound infection in 2.2% and fracture-related infection in 1.3% of patients. Symptomatic nonunion was a relatively uncommon complication after rib fixation (1.3%). Pulmonary complications were found in 30.9% of patients, and the overall mortality was 2.9%, of which one third appeared to be the result of the thoracic injuries and none directly related to the surgical procedure. The most frequently used questionnaire to assess patient quality of life was the EuroQol-5D (EQ-5D) (n = 4). Four studies reporting on the EQ-5D had a weighted mean EQ-5D index of 0.80 indicating good quality of life after rib fracture fixation. CONCLUSION: Surgical fixation can be considered as a safe procedure with a considerably low complication risk and satisfactory long-term outcomes, with surgery- and implant-related complications in approximately 10% of the patients. However, the clinically most relevant complications such as infections occur infrequently, and the number of complications requiring immediate (surgical) treatment is low. LEVEL OF EVIDENCE: Systematic Review, level III.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias , Fraturas das Costelas/cirurgia , Tórax Fundido/cirurgia , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Fraturas Múltiplas/cirurgia , Fraturas não Consolidadas , Humanos , Fixadores Internos , Qualidade de Vida , Transtornos Respiratórios/etiologia , Doenças Respiratórias/etiologia , Infecção da Ferida Cirúrgica
19.
J Trauma Acute Care Surg ; 89(1): 103-110, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32176172

RESUMO

BACKGROUND: Rib fractures in the geriatric trauma population are associated with significant morbidity and mortality. The outcomes of surgical stabilization of rib fractures (SSRF) have not been well defined in this population. METHODS: Data from the 2016 to 2017 Trauma Quality Improvement Program database were analyzed. Patients older than 65 years admitted with isolated chest wall injury and multiple rib fractures were abstracted from the database. Multivariate propensity score matching was utilized to stratify patients that underwent rib fixation versus nonoperative management. In the matched cohort, we assessed outcomes including mortality, intensive care unit (ICU) and hospital lengths of stay (LOS), tracheostomy rates, and ventilator-associated pneumonia (VAP) rates. We performed a secondary analysis of patients receiving early (<72 hours) versus late SSRF. RESULTS: Of the 44,450 patients included in the study analysis, 758 (1.7%) underwent SSRF. Patients undergoing SSRF were younger, had a higher prevalence of flail chest, higher rates of emergency room intubation, higher Injury Severity Score, and increased ICU admission rates. The 1:1 propensity score match resulted in 758 patients in each group. The in-hospital mortality rate was significantly lower in patients that underwent SSRF (4.2% vs. 7.3%, p = 0.01). However, the fixation group also had higher rates of tracheostomy during admission (11.2% vs. 4.6%, p < 0.001) and VAP (3.0% vs. 1.6%, p = 0.007). In a secondary matched analysis of 326 pairs of patients undergoing SSRF, we found that early fixation was associated with decreased rates of VAP (1.5% vs. 4.6%, p = 0.01), fewer ventilator days (4 days vs. 7 days, p = 0.003), shorter ICU LOS (6 days vs. 9 days, p = 0.001), and shorter hospital LOS (10 days vs. 15 days, p < 0.001). CONCLUSION: This study demonstrates a mortality benefit in geriatric trauma patients undergoing SSRF. Early SSRF was observed to be associated with decreased rates of VAP, decreased ICU LOS, and decreased hospital LOS. Early SSRF may be associated with improved outcomes in the geriatric trauma population with multiple rib fractures. LEVEL OF EVIDENCE: Therapeutic/Care management, level III.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas das Costelas/cirurgia , Idoso , Feminino , Tórax Fundido/epidemiologia , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Prevalência , Pontuação de Propensão , Fraturas das Costelas/mortalidade , Traqueostomia/estatística & dados numéricos
20.
Thorac Cardiovasc Surg ; 68(4): 357-360, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32005045

RESUMO

INTRODUCTION: There is no data regarding the incidence and treatment of deep infection affecting the surgical implants after rib fixation. The aim of this study is to share our experience in the management of infected material after surgical rib fixation. METHODS: The medical records of operated patients from January 2012 to December 2018 were retrospectively analyzed. RESULTS: Three patients out of 87 (3.44%) developed an infection. One patient was treated conservatively and two patients were operated for hardware removal. CONCLUSIONS: The lack of evidence prompts for the design of surgical databases to share experience and enhance available data.


Assuntos
Tratamento Conservador , Remoção de Dispositivo , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixadores Internos/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fraturas das Costelas/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia , Idoso , Humanos , Pessoa de Meia-Idade , Paris , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagem
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