Simple rib fractures are the most common injury sustained following blunt chest trauma, accounting for more than half of chest injuries from non-penetrating trauma. Approximately 10% of all patients admitted after blunt chest trauma have one or more rib fractures.
Many physicians, as well as patients, are not aware of the treatment options for rib fractures.
Treatment of rib fractures has conventionally been conservative, using pain killers and physical adjuncts like analgesic ointments, gels and warm compresses.
The problem with this approach is that patients often experience pain and difficulty breathing for long periods of time after their injury and during recovery, with little to no relief from medications. Recovery from rib fractures can range from 8 -16 weeks depending on age and health of patient. Some patients experience chronic problems related to their injury.Rib fractures therefore result in prolonged morbidity and unsatisfactory outcomes.
A more serious form of rib fracture is called flail chest. Here three or more ribs located next to each other are fractured in two or more places.
This causes the chest wall to become unstable, interfering with breathing. Many patients may need to be put on ventilators, may need a tracheostomy (an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) resulting in prolonged hospitalization, ICU care and major morbidity.
A further complex problem is the development of a stove in chest. The stove-in chest is a rare form of flail chest in which there is collapse of a segment of the chest wall, which is driven inside the chest, associated with a high immediate mortality.
Injury to underlying lung or heart or other vital structures can occur
Surgical fixation of ribs has emerged as an attractive technique to overcome these problems mentioned above. Surgical stabilization of rib fractures is a safe and effective method to treat displaced rib fractures. The procedure provides definitive stabilization of fractures, improves pulmonary function, lessens pain medication requirements, prevents deformity formation, and results in reduced morbidity and mortality with early return to work.
It uses prefabricated plates with which the ribs can be stabilized using appropriate muscle sparing incisions.
Our unit has a large experience of surgical fixation of ribs and sternum. We use the Depuy surgical system for fixation. It is affordable, high quality and gives excellent results. The plates can also be used to fix fractures of the sternum or breastbone.
RBS is a 40 year old paramilitary forces officer was shifted tour hospital from another city after a road traffic accident. He was intubated on admission in our casualty because of severe respiratory distress.
On evaluation he had multiple fractures of his ribs with severe flail chest.
He was operated the next morning. His ribs were stabilized with prosthesis and the posterior end of the flail was fixed with wires.
He was stable and was extubated on the second postop day and discharged on day 7, in a fully mobile state. He continues to do well 5 weeks later with minimal pain and deformity.