Tunnel-type open reduction and internal fixation of rib fractures with titanium locking plate_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Qianping , SANG Hongyang , WU Song ,  CHENG Shaofei

Department of Cardiothoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital East, Shanghai, 201306, P.R.China;

Corresponding author：

CHENG Shaofei, Email: shaofeicheng@126.com

Keywords：

Tunnel-type; locking plate; rib fractures; open reduction and internal fixation

DOI：

10.7507/1007-4848.201702005

Video：

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Objective To investigate the tunnel-type open reduction and internal fixation of rib fractures (ORIF) with titanium locking plate in traumatic rib fractures. Methods Clinical data of 10 patients with multiple rib fractures from June 2016 to January 2017 in the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were analyzed. There were 6 males and 4 males with an average age of 38.5±9.0 years (range, 30–63 years). All patients underwent emergency treatment, chest CT and ultrasound examination before they admitted to the hospital. According to rib fractures and injuries, patients were given the tunnel-type ORIF of rib fractures with titanium locking plates, the chest tube and negative suction drainage. The patients were followed up over three months. Results All patients were cured. There was no complication during follow-up. No wound infection and death occurred. Postoperative three-month follow-up showed that chest pain was significantly relieved without pulmonary atelectasis and pleural effusion or other complications. Conclusion Tunnel-type internal fixation of rib fractures with titanium locking plates is effective, which can quickly restore the stability and integrity of the thorax. Surgical procedure is simple and can get fast postoperative recovery to improve the patient's quality of life.

Citation： LI Qianping, SANG Hongyang, WU Song, CHENG Shaofei. Tunnel-type open reduction and internal fixation of rib fractures with titanium locking plate. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 974-978. doi: 10.7507/1007-4848.201702005 Copy

1.	Brasel KJ, Moore EE, Albrecht RA, et al. Western Trauma Association Critical Decisions in Trauma: Management of rib fractures. J Trauma Acute Care Surg, 2017, 82(1): 200-203.
2.	Pieracci FM, Majercik S, Ali-Osman F, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury, 2016, 48(2017): 307-321.
3.	Marasco S, Lee G, Summerhayes R, et al. Quality of life after major trauma with multiple rib fractures. Injury, 2015, 46(1): 61-65.
4.	Gordy S, Fabricant L, Ham B, et al. The contribution of rib fractures to chronic pain and disability. Am J Surg, 2014, 207(5): 659-662, 662-663.
5.	Shulzhenko NO, Zens TJ, Beems MV, et al. Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma. Surgery, 2017, 161(4): 1083-1089.
6.	Dehghan N, de Mestral C, McKee MD, et al. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg, 2014, 76(2): 462-468.
7.	Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732, 732.
8.	Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit?. J Am Coll Surg, 2012, 215(2): 201-205.
9.	Pieracci FM, Rodil M, Stovall RT, et al. Surgical stabilization of severe rib fractures. J Trauma Acute Care Surg, 2015, 78(4): 883-887.
10.	Leinicke JA, Elmore L, Freeman BD, et al. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg, 2013, 258(6): 914-921.
11.	Nishiumi N, Fujimori S, Katoh N, et al. Treatment with internal pneumatic stabilization for anterior flail chest. Tokai J Exp Clin Med, 2007, 32(4): 126-130.
12.	Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732, 732.
13.	Granetzny A, Abd EM, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg, 2005, 4(6): 583-587.
14.	Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924-932.
15.	Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs nonoperative management of flail chest: a meta-analysis. J Am Coll Surg, 2013, 216(2): 302-311.
16.	Wada T, Yasunaga H, Inokuchi R, et al. Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: A propensity score-matched analysis. J Crit Care, 2015, 30(6): 1227-1231.
17.	de Moya M, Bramos T, Agarwal S, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma, 2011, 71(6): 1750-1754.
18.	Doben AR, Eriksson EA, Denlinger CE, et al. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care, 2014, 29(1): 139-143.
19.	Fowler TT, Taylor BC, Bellino MJ, et al. Surgical treatment of flail chest and rib fractures. J Am Acad Orthop Surg, 2014, 22(12): 751-760.
20.	Caragounis EC, Fagevik OM, Pazooki D, et al. Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study. World J Emerg Surg, 2016, 11(27): 1-7.
21.	Liu J, Li K, Ju Z, et al. Internal fixation treatment of multiple rib fractures with absorbable rib-connecting-pins under epidural anesthesia. Zhongguo Yi Liao Qi Xie Za Zhi, 2011, 35(2): 147-148, 151.
22.	Moreno DLSB, Polo OM, Delgado SC, et al. Surgical fixation of rib fractures with clips and titanium bars (STRATOS System). Preliminary experience. Cir Esp, 2010, 88(3): 180-186.
23.	Bottlang M, Helzel I, Long WB, et al. Anatomically contoured plates for fixation of rib fractures. J Trauma, 2010, 68(3): 611-615.
24.	Chai X, Lin Q, Ruan Z, et al. The clinical application of absorbable intramedullary nail and claw plate on treating multiple rib fractures. Minerva Chir, 2013, 68(4): 415-420.
25.	王洪斌, 张明, 刘海林, 等. 微创小切口肋骨内固定术治疗多根多处肋骨骨折及连枷胸. 中国胸心血管外科临床杂志, 2012, 19(4): 449-450.
26.	罗玉龙, 苏鹏霄, 李超峰. 多发肋骨骨折内固定临床应用比较. 吉林医学, 2009, 30(7): 589-591.
27.	Benian AS, Pushkin S, Syzrantsev I, et al. Osteosyntesis of ribs using the technology "matrix rib" in treatment of victims with multiple float rib fractures. Vestn Khir Im Ⅱ Grek, 2013, 172(6): 78-79.

1. Brasel KJ, Moore EE, Albrecht RA, et al. Western Trauma Association Critical Decisions in Trauma: Management of rib fractures. J Trauma Acute Care Surg, 2017, 82(1): 200-203.
2. Pieracci FM, Majercik S, Ali-Osman F, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury, 2016, 48(2017): 307-321.
3. Marasco S, Lee G, Summerhayes R, et al. Quality of life after major trauma with multiple rib fractures. Injury, 2015, 46(1): 61-65.
4. Gordy S, Fabricant L, Ham B, et al. The contribution of rib fractures to chronic pain and disability. Am J Surg, 2014, 207(5): 659-662, 662-663.
5. Shulzhenko NO, Zens TJ, Beems MV, et al. Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma. Surgery, 2017, 161(4): 1083-1089.
6. Dehghan N, de Mestral C, McKee MD, et al. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg, 2014, 76(2): 462-468.
7. Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732, 732.
8. Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit?. J Am Coll Surg, 2012, 215(2): 201-205.
9. Pieracci FM, Rodil M, Stovall RT, et al. Surgical stabilization of severe rib fractures. J Trauma Acute Care Surg, 2015, 78(4): 883-887.
10. Leinicke JA, Elmore L, Freeman BD, et al. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg, 2013, 258(6): 914-921.
11. Nishiumi N, Fujimori S, Katoh N, et al. Treatment with internal pneumatic stabilization for anterior flail chest. Tokai J Exp Clin Med, 2007, 32(4): 126-130.
12. Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732, 732.
13. Granetzny A, Abd EM, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg, 2005, 4(6): 583-587.
14. Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924-932.
15. Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs nonoperative management of flail chest: a meta-analysis. J Am Coll Surg, 2013, 216(2): 302-311.
16. Wada T, Yasunaga H, Inokuchi R, et al. Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: A propensity score-matched analysis. J Crit Care, 2015, 30(6): 1227-1231.
17. de Moya M, Bramos T, Agarwal S, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma, 2011, 71(6): 1750-1754.
18. Doben AR, Eriksson EA, Denlinger CE, et al. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care, 2014, 29(1): 139-143.
19. Fowler TT, Taylor BC, Bellino MJ, et al. Surgical treatment of flail chest and rib fractures. J Am Acad Orthop Surg, 2014, 22(12): 751-760.
20. Caragounis EC, Fagevik OM, Pazooki D, et al. Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study. World J Emerg Surg, 2016, 11(27): 1-7.
21. Liu J, Li K, Ju Z, et al. Internal fixation treatment of multiple rib fractures with absorbable rib-connecting-pins under epidural anesthesia. Zhongguo Yi Liao Qi Xie Za Zhi, 2011, 35(2): 147-148, 151.
22. Moreno DLSB, Polo OM, Delgado SC, et al. Surgical fixation of rib fractures with clips and titanium bars (STRATOS System). Preliminary experience. Cir Esp, 2010, 88(3): 180-186.
23. Bottlang M, Helzel I, Long WB, et al. Anatomically contoured plates for fixation of rib fractures. J Trauma, 2010, 68(3): 611-615.
24. Chai X, Lin Q, Ruan Z, et al. The clinical application of absorbable intramedullary nail and claw plate on treating multiple rib fractures. Minerva Chir, 2013, 68(4): 415-420.
25. 王洪斌, 张明, 刘海林, 等. 微创小切口肋骨内固定术治疗多根多处肋骨骨折及连枷胸. 中国胸心血管外科临床杂志, 2012, 19(4): 449-450.
26. 罗玉龙, 苏鹏霄, 李超峰. 多发肋骨骨折内固定临床应用比较. 吉林医学, 2009, 30(7): 589-591.
27. Benian AS, Pushkin S, Syzrantsev I, et al. Osteosyntesis of ribs using the technology "matrix rib" in treatment of victims with multiple float rib fractures. Vestn Khir Im Ⅱ Grek, 2013, 172(6): 78-79.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Tunnel-type open reduction and internal fixation of rib fractures with titanium locking plate

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