An assessment of outcomes with intramedullary fixation of fractured ribs

Abstract

BackgroundSurgical management of fractured ribs with internal fixation is an increasingly accepted therapy. Concurrently, specific rib fixation prostheses are being developed which should improve results and minimise hardware and rib/splint construct failures. The Synthes titanium intramedullary splint lends itself to difficult to access areas such as posterior rib fractures and fractures under the scapula. We analyse a case series of patients in whom this rib fixation prosthesis has been used.MethodsFifteen patients received 35 intramedullary splints. Follow up at 3 and 6 months was performed with three dimensional computed tomography scanning to assess for bone alignment, callus formation and healing, residual deformity, hardware failure or cut through. Computerized finite element analysis (FEA) was used to model forces acting on a posterior fracture with and without an intramedullary fixation splint in situ.ResultsComplete healing (bony union) was noted in only 3 (9 %) of the fractures fixed with splints by 3 months. Partial healing (cartilaginous union) was noted in 28 of the 33 fractures (85 %), and non healing was noted in only 2 (6 %). In both those two patients, failure at the rib / splint interface was noted after both patients reported sneezing. No hardware failures were noted. By 6 months the fractures which had shown partial healing, had all completely healed. There were no late failures (between 3 and 6 months) of either hardware or rib/splint interfaces.FEA modelling identified sites of increased stress in the rib at the rib / splint interface and in a modelled intramedullary splint where it spans the fracture.ConclusionsFurther analysis of outcomes with intramedullary splints is warranted as well as further development of intramedullary rib fixation solutions.

Surgical Treatment of Flail Chest and Rib Fractures: A Systematic Review of the Literature

“…By 6 months, all rib fractures were completely healed. This small retrospective review demonstrated that while fracture healing may be delayed on CT-imaging, functional recovery is comparable to cortical plating [39] .…”

Posterior chest wall reconstruction: A novel approach

“…Extracortical plating provided superior fracture stabilization compared to intramedullary rib splinting as intramedullary splinting has been shown to fail in vitro and in vivo secondary to cortical bone perforation and fracture line instability. [7] Extracortical rib plating provides proximal and distal fixation not afforded by intramedullary splinting. OWT approach may serve as a viable option for external posterior rib fixation in future chest wall reconstruction.…”

Blunt chest trauma: is there a place for rib stabilization?

“…This feature is theoretically attractive when a minimally invasive approach is contemplated, or difficult to expose fracture sites (e.g., posterior, subscapular) are addressed. Preliminary data suggest adequate healing using splints, although much more research is needed (42). Concerns have been raised in the literature by some investigators that the single point of fixation may allow distraction (separation of the bone) at the fracture site (7).…”