This research evaluated the clinical efficacy of three-wings rib plate in the treatment of multiple rib fractures and flail chest with mechanical analysis and clinical verification. The model of rib and three-wings rib plate was reconstructed. The contact simulation with pretension stress was applied to the plate's fixation, and it was found that the bearable stress of the rib fractures after fixation increased from the result which indicated a good fixation efficacy of the plate. Clinical data of 53 cases of rib fractures and flail chest treated with three-wings rib plate in Shanghai Pudong Hospital of Fudan University were retrospectively analyzed. After the operation, the pain of the patients was relieved. Postoperative CT reconstruction of the chest showed good restoration of the rib fractures, which verified the clinical efficacy of three-wings rib plate. The three-wings rib plate showed a high value in clinical use for treatment of rib fractures.
China ; Flail Chest/surgery* ; Fracture Fixation, Internal ; Humans ; Retrospective Studies ; Rib Fractures/surgery* ; Ribs

Female ; Foreign-Body Migration ; complications ; diagnosis ; surgery ; Humans ; Lung ; Middle Aged ; Rib Fractures ; complications

Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.
China ; Consensus ; Flail Chest ; Fracture Fixation, Internal ; Humans ; Rib Fractures/surgery* ; Thoracic Injuries

Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.
Accidental Falls ; Female ; Hemothorax/*complications/surgery ; Humans ; Rib Fractures/complications/*diagnosis ; Thoracic Arteries/diagnostic imaging ; Time Factors ; Young Adult

PURPOSE: This study was conducted to analyze chest-trauma patients and the old-aged patients with a traumatic hemopneumothorax. METHODS: We reviewed the medical records of 101 chest-trauma patients admitted to the department of cardiovascular and thoracic surgery from June 1999 to November 2008. We evaluated the general characteristics of the chest-trauma patient, especially those of old-aged patients with a traumatic hemopneumothorax. RESULTS: Rib fracture was observed in 99 of the cases, the location distribution was right: left =261: 255, with right being dominant. Rib fractures commonly involved the 4th and the 7th rib. The average number of rib fractures was 5.1, and the average number of rib fractures in the old-aged patients was significantly higher than that in the non-old-aged patients (p=0.04). There were 17 cases of a hemopnuemothorax in old-aged patients, 52 cases in non-old-aged patients. The blood loss through the chest tube for old-aged patients was significantly more than that for the non-old-aged patients, and the initial hemoglobin level was lower in the old-aged patients. CONCLUSION: Elderly trauma patients are more likely to die after trauma than other age groups. Even with relatively stable vital signs, invasive hemodynamic monitoring and intensive treatment are recommended.
Aged ; Chest Tubes ; Hemodynamics ; Hemoglobins ; Hemopneumothorax ; Hemothorax ; Humans ; Medical Records ; Pneumothorax ; Rib Fractures ; Ribs ; Thoracic Surgery ; Thorax ; Vital Signs

OBJECTIVETo introduce the methods of dacron flap application and its indications in treating fracture of multiple ribs, in order to reduce the incidence of the complications of fracture displacement.

METHODSFrom September 2006 to March 2008, 12 patients with fracture of multiple ribs were treated with absorbable rib fixed nail and dacron flap. Included 8 males and 4 females,the age was from 22 to 51 years with an average of 38.2 years,the operative time was 2 hours to 3 days after injured. All the patients were closed injury and simultaneously accompanied with significant chest pain and chest tightness. 4 cases with dyspnea, blood in sputum and blood oxygen saturation decreased. The X-ray showed 3 cases of unilateral fracture and 9 cases of bilateral rib fractures and all cases accompanied with hemopneumothorax.

RESULTSAll patients were followed up from 2 to 26 months with an average of 8 months. All the fractures healed. According to clinical criteria, pain, breathing, ribs alignment etc. to observe the effect, 10 cases got excellent result, 1 case good, 1 case poor.

CONCLUSIONIt is safe and effective to use absorbable rib fixed nails and dacron flap for treating fracture of multiple ribs and especially for the patients of osteoporosis, comminuted fracture or oblique fracture.

Adult ; Bone Nails ; Female ; Fracture Fixation, Intramedullary ; Humans ; Male ; Middle Aged ; Rib Fractures ; surgery ; Surgical Flaps ; Treatment Outcome ; Young Adult

Migrations of orthopedic wires to cardiovascular system are uncommon and rarely reported. We report a case of right ventricle embolization with the Kirschner wire that was used for right 2nd rib osteosynthesis 2 years and 8 months previously in a 50-year-old man. The patient was asymptomatic and migration of the Kirschner wire was discovered by routine chest X-ray. An 8 cm-long Kirschner wire was successfully retrieved from the right ventricle. The treatment strategy for Kirschner wire removal from right ventricle is discussed.
Bone Wires ; adverse effects ; Embolism ; etiology ; Foreign-Body Migration ; Heart Ventricles ; Humans ; Male ; Middle Aged ; Rib Fractures ; surgery ; Ribs

OBJECTIVETo study the indications, methods and experience of absorbable rib-connecting-pins fixation in the treatment of multiple rib fractures.

METHOD52 cases with multiple rib fractures were performed internal fixation with absorbable rib-connecting-pins under epidural anesthesia.

RESULTSAll cases were followed up for 1 to 12 months, with an average of 5 months. All fractures were achieved healing in 3 to 6 months after the operation and were not found chest wall deformity.

CONCLUSIONSAbsorbable rib-connecting-pins fixation is a simple and effective method and worthies recommending to perform operation for the appropriate cases with multiple rib fractures.

Absorbable Implants ; Adult ; Aged ; Anesthesia, Epidural ; Bone Nails ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Rib Fractures ; surgery

OBJECTIVETo compare screw's inserting angle through the 11th and 12th rib in treating L1 burst fracture, explore effects on inserting screw and postoperative angle.

METHODSFrom October 2007 to October 2010, 108 patients with L1 brust fracture treated through anterior approach were analyzed,including 68 males and 40 females, aged from 21 to 64 years (mean 38.22 years). All patients were divided into the 11th (A, 51 cases) and 12th (B, 57 cases) approach. The data of operation time,blood loss, duration of incision pain, JOA score, Oswestry score, VAS score, quality of life (SF-36), recovery of nervous function, coronal Cobb angle, included angle between screw and plate were observed.

RESULTSAll patients were followed up for 9 to 37 months, mean 23 months. The operation time, blood loss, duration of incision pain, in group A were lower than group B (P<0.05), JOA score, Oswestry score, VAS score, SF-36, recovery of nervous function had no significant differences (P>0.05). There were no differences in Cobb angle before operation, but had significance after operation (P=0.000). There were statistically significance between two group in angle between screw and plate (P=0.000, P=0.003).

CONCLUSIONThe 11th rib approach for the treatment of L1 burst fracture has less effects on screw, less trauma and less angle between screw and plate.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Recovery of Function ; Rib Fractures ; diagnostic imaging ; physiopathology ; surgery ; Ribs ; surgery ; Spinal Cord ; physiopathology ; Tomography, X-Ray Computed ; Young Adult