DOS Kongressen 2014 ·
239
Early surgical stabilization of rib fractures using a
minimally invasive procedure: a pilot study
Kiran Anderson, Jesper Ravn, Henrik Eckardt
Ortopædkir. afd. , Rigshosptialet; Thoraxkir. afd. , Rigshosptialet; Ortopædkir.
afd., Rigshospitalet
Background:
In spite of considerable development in surgical fracture treat-
ment, most patients with rib fractures are still treated non-operatively, although
the respiratory consequences of rib fractures may have severe impact on the
prognosis after severe trauma. Recently, a number of studies have suggested
that a more active approach may decrease the number of days on ventilation as
well as reducing long-term pain in these patients.
Purpose / Aim of Study:
The purpose of the present study was to report our
initial experience with early surgical stabilization using a minimal invasive proce-
dure of open reduction and internal fixation of multiple rib fractures.
Materials and Methods:
12 consecutive patients received in our level 1-trau-
macenter with one of the following inclusion criterias were operated: flail chest
with at least two rib fractures on two adjacent ribs or four adjacent dislocated
rib fractures. The basic principles were: A. No osteosyntesis of costa # 1, 2 or 3.
B. Operative fixation of only dislocated ribs. In ribs with multiple fractures only
one fracture was stabilized. C. Small incisions with minimal dissection of muscle
tissue.
Findings / Results:
None of the patients had postoperative infections, seromas
or wound problems. Skin incisions were 10-15 cm. The average number of cos-
tae fixated was 3. Postoperation time in ICU averaged 2,8 days. Postoperative
number of days on assisted ventilation averaged 1,16 days. Total number of
admission days postoperatively averaged 9,6 days. Lung function at 3 month
was equal to background population.
Conclusions:
Rib fracture stabilization is a safe procedure that can be per-
formed with small incisions, without transection of muscles and with low mor-
bidity. The intraoperative impression is that operative fixation provide sufficient
stabilization for unstable chestwalls and provides a normal lung function.
186.
