Rib fractures are common in blunt chest wall trauma. More severe chest wall trauma is a major cause of morbidity and mortality, especially in the presence of a flail chest where paradoxical inward movement of the flail segment in inspiration is found. Patients with flail chest often require aggressive pain control, ventilation, and prolonged ICU stay.1
The need to improve rib fracture treatment has been recognized for many years and some surgeons have been using operative approaches including plates, intramedullary devices, vertical bridging, wire, sutures, and struts to repair the chest wall. 2 3 4 5 6 7 8 9 10
These attempts indicate a trend in better rib fracture treatment to improve pain control, reduce duration of mechanical ventilation, reduce ICU stays, reduce the risk for chest wall deformities and ultimately improve patient care.
1) Tanaka A, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002 Apr;52(4):727-32; discussion 732.
2) Schüpbach P, Meier P. A new rib plate for the stabilization of multiple rib fractures and thoracic wall fracture with paradoxical respiration [Article in German]. Helv Chir Acta. 1976 Dec;43(5-6):497-502.
3) Balci AE, Eren S, Cakir O, Eren MN. Open fixation in flail chest: review of 64 patients. Asian Cardiovasc Thorac Ann. 2004 Mar;12(1):11-5.
4) Mohr M, Abrams E, Engel C, et al. Geometry of human ribs pertinent to orthopedic chestwall reconstruction. J Biomech 2007;40:1310-1317.
5) Ciraulo DL, Elliott D, Mitchell KA, Rodriguez A. Flail chest as a marker for significant injuries. J Am Coll Surg. 1994 May;178(5):466-70.
6) Meier, P., et al., Zur Therapie des instabilen Thorax bei Rippenserienfrakturen, Schweiz. Med. Wschr., 108:606-613 (1978).
7) Moore, B.P., Operative stabilization of non-penetrating chest injuries, J. Thorac. Cardiovasc. Surg., 70, 619-639 (1975).
8) Samarrai AR. Costosynthetic stabilization of massive chest wall instability. Int Surg. 1990 Oct-Dec;75(4):231-3.
9) Paris, F., et al., Surgical stabilization of traumatic flail chest, Thorax, 30, 521-527 (1975)
10) Mayberry JC, Trunkey DD. The fractured rib in chest wall trauma. Chest surgery clinics of North America. 1997 May;7(2):239-61.