5 Dec 2014

Analysis of bone healing in flail chest injury: do we need to fix both fractures per rib?

CCS researchers Dr Silvana Marasco, Assoc Prof Susan Liew and Prof Dinesh Varma have co-written a study which looks at bone healing in flail chest injury.

According to the article, surgical rib fixation for severe rib fracture injuries is generating increasing interest in the medical literature. It is well documented that poorly healed fractured ribs can lead to chronic pain, disability, and deformity.

An unanswered question in surgical rib fixation for flail chest injury is whether it is sufficient to fix one fracture per rib, on successive ribs, thus converting a flail chest injury into simple fractured ribs, or whether both ends of the floating segment of the chest wall should be fixed. The study aimed to analyse surgical rib fixation in flail chest injury, assessing 3-month outcomes for nonfixed fractured rib ends in the flail segment.

The study is a retrospective review (2005-2013) of 60 consecutive patients who underwent surgical rib fixation for flail chest injury admitted to the Alfred Hospital, Melbourne, Australia. Imaging by three-dimensional computed tomography (3D CT) of the chest at admission was compared with follow-up 3D CT at 3 months after injury. The 3-month CT scans were assessed for degree of healing and presence of residual deformity at the fracture fixation site. Follow-up CT was performed in 52 of the 60 patients.

At 3 months after surgery, 86.5% of the patients had at least partial healing with good alignment and adequate fracture stabilization. Hardware failure was noted in five patients (9.6%) and occurred with the absorbable prostheses only. Six patients who had preoperative overlapping or displacement showed no improvement in deformity despite fixing the lateral fractures. Callus formation and bony bridging between adjacent ribs was often noted in the rib fractures not fixed (28 of 52 patients, 54%)

The researchers found that the retrospective review of 3D CT chest at 3 months after rib fixation indicates that a philosophy of fixing only one fracture per rib in a flail segment does not avoid deformity and displacement, particularly in posterior rib fractures.

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