- Two-stage osteosynthesis of bilateral multiple multifragmental fractured ribs in patients with severe respiratory failure
Two-stage osteosynthesis of bilateral multiple multifragmental fractured ribs in patients with severe respiratory failure
PAEDIATRIC SURGERY.UKRAINE.2018.3(60):34-37; doi 10.15574/PS.2018.60.34
Bilov O. V.
SI «Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine», Dnipro
Patients with bilateral multiple multifragmental fractured ribs with the formation of flotating chest wall accounted for 0.4% of all patients with thoracic injury being treated.
Objective: to evaluate the efficiency of the step-wise metallic osteosynthesis in bilateral multiple multifragmental rib fractures.
Materials and methods. A retrospective analysis of the treatment of six patients was carried out. For the stabilization of the chest were carried out two-stage osteosynthesis of the ribs, pneumatic stabilization and traction of the flotating flap. Osteosynthesis of the ribs was conducted by using Ilizarov's needles in two stages to reduce surgical injury and stabilization of the patient between the staged surgical interventions.
Results. In patients who underwent osteosynthesis of the ribs, there was a decrease in the artificial lung ventilation duration (6.75±3.4 days) and the stay time in the intensive care unit (12.0±2.4 days) observed as compared to the unoperated patients. Also in the group of operated patients, it was observed a quantity reduction of respiratory complications, length of hospital stay and mortality.
Conclusions. Carrying out the two-stage osteosynthesis of the ribs in patients with a flotating chest wall allows reducing the surgical injury and operation length and achieving stabilization of the thoracic framework, reducing mortality, shortening the terms of artificial ventilation, staying in the intensive care unit, the length of hospital stay and the number of respiratory complications. Conservative methods of chest wall stabilization can be used to prepare the patient for surgical treatment.
Key words: multiple multifragmentary fractured ribs, two-stage osteosynthesis, respiratory failure.
1. Benyan AS. (2017). Blunt chest trauma: possibilities to stabilize multiple and floating ribs fractures. Hirurgia. 8; 69–74. https://doi.org/10.17116/hirurgia2017869-74
2. Getman VG. (1998). Surgical treatment of chest wall injuries and of their sequelae. Kiev: 32.
3. Davydova NS, Shen´ NP, Skorokhodova LA, Boltaeva PG, Lukin SYu, Besedina EA, Nikol´sky AV. (2017). Clinical and economic significance of respiratory biomechanics advanced control when performing prolonged artificial pulmonary ventilation in patient with severe blunt chest trauma after metal structures interstitial rib stabilization. Anesteziologiya i reanimatologiya. 6: 412–418.
4. Korymasov EA, Benyan AS. Pushkin SYu. (2016). Philosophy of surgery of the multiple and floating fractures of ribs. Vestnik khirurgii imeni II Grekova: 175 (3); 106-110.
5. Magomedov AYu, Vinokurov SA, Nepomnyashchy VG, Magomedov YuA, Vladzimirsky AV. (2010). Diagnostics and treatment of the combined injuries of a thorax and extremities. 11(3). http://www.mif-ua.com/archive/article/19991
6. Pronskikh AlA, Kravtsov SA, Pronskikh AA. (2014). Surgical restoration of chest structure in a patient with polytrauma. A case report. Polytrauma. 2: 65–70.
7. Granetrny A, El-Aal MA, Emam E et al. (2006). Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Int Cardiovasc Thorac Surg. 4: 583–587. https://doi.org/10.1510/icvts.2005.111807; PMid:17670487
8. Tanaka H, Yukioka T, Yamaguti Y et al. (2002). Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J. Trauma. 52: 727-732. https://doi.org/10.1097/00005373-200204000-00020; PMid:11956391
Article received: Mar 23, 2018. Accepted for publication: Sep 14, 2018.