Modern Algorithms of Thoracic Cage Stabilization in Patients with Multiple Rib Fractures and Flail Chest

Аннотация

Objectives– to improve the treatment results in patients with multiple rib fractures and flail chest via the development and implementation of modern therapeutic and tactical algorithms.

Material and methods.A non-randomized prospective study has been carried out to evaluate the results of treatment in 198 patients withmultiple rib fractures and flail chestin the period of 2011-2017. Three clinical types were identified: 1) patients with multiple rib fractures with disordered thoracic cage structure – 77 (38.9%); 2) patients with flail chest – 71 (35.9%); 3) patients with multiple rib fractures without disordered thoracic cage structure – 50 (25.2%).

There were developed and applied the diagnostic and treatment algorithms depending on the severity of injures of sternocostal frame and intrapleural organs, the presence and severity of associated injuries and background diseases, the conditions of medical aid. 

Results.The treatment tactics of all patients was based on the differentiated, staged and combined use of various methods of stabilizing the thoracic cage including the advanced types of medical care. Surgical stabilization methods were used in 162 patients, in 26 of them a combination of surgical techniques was applied, in 20 – the internal pneumatic stabilization, in 42 – the conservative treatment was performed.

The retrospective analysis and the obtained results compared to the results of the equivalent historical group allowed us to state the decrease of mechanical ventilation time from 11.0 ± 3.9 to 5.1 ± 3.2 days (t = 1.17; p> 0.05), the length of stay in the ICU from 11.5 ± 5.4 to 6.8 ± 3.7 days (t = 0.72; p> 0.05), the complications frequency from 36.5% to 15.9% and mortality rate from 22.3% to 8.7%. 

Conclusion.Modern diagnostic and treatment algorithms in patients with multiple rib fractures and flail chest are based on stage-by-stage application, succession and combination of various methods of the thoracic cage stabilization throughout the medical assistance process. The algorithms, allowing to stabilize the thorax and to improve the condition of the patients in general, make it possible to realize the full potential of modern thoracic surgery.

Conflict of Interest:nothing to disclose.

Список литературы

1. Schuurmans J, Goslings JC, Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg. 2017;43(2):163-168.

doi: 10.1007/s00068-016-0721-2

PMID: 27572897

2. Haines KL, Zens T, Warner-Hillard C, DeSouza E, Jung HS, Agarwal S. Rib fracture location should be evaluated when predicting morbidity and mortality in trauma patients.Am Surg. 2018;84(9):1462-1465.

PMID: 30268176

3. Majercik S, Pieracci FM. Chest Wall Trauma. Thorac Surg Clin.2017;27(2): 113-121.

doi: 10.1016/j.thorsurg.2017.01.004

PMID: 28363365

4. Schulz-Drost S, Ekkernkamp A, Stengel D. Epidemiology, injury entitles and treatment practice for chest wall injuries: current scientific knowledge and treatment recommendations. Unfallchirurg. 2018;121(8):605-614.

doi: 10.1007/s00113-018-0532-5

PMID: 30073550

5. Udekwu P, Roy S, McIntyre S, Farrell M. Flail chest: influence on length of stay and mortality in blunt chest injury. AmSurg. 2018;84(9):1406-1409.

PMID: 30268166

6. Satyvaldaev MN, Akselrov AM. The review of problems in the management of flail chest. Medicinskaya nauka i obrazovanie Urala. 2018;19:1(93):186-191. (In Russ.).

7. McLean MM, Bunn J, Wasserman A, Tilney P. A 62-year-old man with aortic dissection and flail chest. AirMedJ. 2018;37(5):272-276.

doi: 10.1016/j.amj.2018.05.003

PMID: 30322625

8. Tseimakh ЕА, Bondarenko AV, Men`shikov AA, Bombizo VA. The modern technologies in the complex treatment of patients with dominant thoracic injuries at polytrauma. Politravma. 2016;3:14-23. (In Russ.).

9. Swart E, Laratta J, Slobogean G, Mehta S. Operative treatment of rib fractures in flail chest injuries: a meta-analysis and cost-effectiveness analysis. J Orthop Trauma. 2017;31(2):64-70.

doi: 10.1097/BOT.0000000000000750

PMID: 27984449

10. Golic DA, Svraka D, Keleman N, Petrovic S. Epidural analgesia with surgical stabilization of flail chest following blunt thoracic trauma in patients with multiple trauma. Front Med. 2018;5:280.

doi: 10.3389/fmed.2018.00280

PMID: 30338260

11. Merchant NN, Onugha O. Novel extra-thoracic VATS minimally invasive technique for management of multiple rib fractures. J Vis Surg. 2018;4:103.

doi: 10.21037/jovs.2018.05.08

PMID: 29963392

12. Apaydin T, Arapi B, Basaran C. Surgical reconstruction of traumatic flail chest with titanium plaques. IntJSurgCaseRep. 2018;50:72-74.

doi: 10.1016/j.ijscr.2018.07.033

PMID: 30086476

13. Benyan AS. Blunt chest trauma: possibilities to stabilize multiple and floating ribs fractures. Khirurgiia. 2017;8:69-74. (In Russ.).

doi: 10.17116/hirurgia2017869-74

PMID: 28805782

Для цитирования

Benyan AS, Korymasov EA, Borkovskiy AYu. Modern Algorithms of Thoracic Cage Stabilization in Patients with Multiple Rib Fractures and Flail Chest.Science & Innovations in Medicine. 2018;4(12):1319.

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