Biomechanical Testing of Two Devices for Internal Fixation of Fractured Ribs

Campbell, Nicole; Richardson, Martin; Antippa, Phillip

doi:10.1097/ta.0b013e3181ae555e

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…Operated patients had also a significantly larger range of motion in the thorax. Campbell et al [15] have undertaken a follow-up one to five years after stabilizing surgery, and 60 % of their patients reported chest wall stiffness. We did not specifically ask for stiffness in the thoracic cage but, according to the results of the measurement of thorax excursion, most patients were within reference values.…”

Section: Discussionmentioning

confidence: 99%

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Physical function and pain after surgical or conservative management of multiple rib fractures – a follow-up study

Olsén

Slobo

Klarin

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundThere is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients.MethodsA consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia. For comparison, 30 patients who were treated conservatively were evaluated with the same outcome measures.ResultsThe results concerning pain, lung function, shoulder function and level of physical activity were similar in the two groups. The patients who had undergone surgery had a significantly larger range of motion in the thorax (p < 0.01) and less deterioration in two items in Disability Rating Index (sitting and standing bent over a sink) (p < 0.05).DiscussionIt is questionable whether the control group is representative since the majority of patients were invited but refused to participate in the follow-up. In addition, this study is too small to make a definitive conclusion if surgery is better than conservative treatment. But we see some indications, such as a tendency for decreased pain, better thoracic range of motion and physical function which would indicate that surgery is preferable. If operation technique could improve in the future with a less invasive approach, it would presumably decrease post-operative pain and the benefit of surgery would be greater than the morbidity of surgery.ConclusionsPatients undergoing surgery have a similar long-term recovery to those who are treated conservatively except for a better range of motion in the thorax and fewer limitations in physical function. Surgery seems to be beneficial for some patients, the question remains which patients.Trial registrationFoU i Sverige (R&D in Sweden), No 106121

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Section: Discussionmentioning

confidence: 99%

“…This system applies the concept of angular locked plates and intramedullary nailing and has been tested previously [14, 15]. A traditional thoracotomy was performed and the pleura cleaned, removing haematoma and debris when an injury to pleura, lung parenchyma or blood-vessels was suspected.…”

Section: Methodsmentioning

confidence: 99%

Physical function and pain after surgical or conservative management of multiple rib fractures – a follow-up study

Olsén

Slobo

Klarin

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Compared to other intramedullary fixation devices including the rib splint , shorter metal screw (Campbell et al 2010) and Kirschner wires , the bioresorbable intramedullary screw has some important advantages. One advantage in rotational stability is that the screw/bone contact on both sides of the fixated rib is very tight, and hence inhibits rotational motion on either side of the fracture.…”

Section: Discussionmentioning

confidence: 99%

“…The testing of metal intramedullary screw fixation (which was not screwed right through the bone) was less effective in terms of median force at failure and stiffness compared to the bioresorbable Inion (Inion Resorbables, Tampere, Finland) mesh for internal fixation of fractured ribs (Campbell et al 2010). However, these experimental bending tests do not accurately reproduce the directional loadings on ribs and rib fixation devices that result from muscle exertion during breathing and coughing.…”

Section: Introductionmentioning

confidence: 98%

“…Experimental studies on assessing intramedullary rib fixation devices have included two-point bending tests of metal wires and splints in human cadaver ribs ) and four-point bending tests of metal intramedullary screw fixation in porcine ribs (Campbell et al 2010). The testing of metal intramedullary screw fixation (which was not screwed right through the bone) was less effective in terms of median force at failure and stiffness compared to the bioresorbable Inion (Inion Resorbables, Tampere, Finland) mesh for internal fixation of fractured ribs (Campbell et al 2010).…”

Section: Introductionmentioning

confidence: 99%

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Stress analysis of a centrally fractured rib fixated by an intramedullary screw

Liovic

Šutalo

Marasco

2012

Computer Methods in Biomechanics and Biomedical Engineering

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The stress on an intramedullary screw rib fixation device holding together a centrally fractured human rib under in vivo force loadings was studied using finite element analysis (FEA). Validation of the FEA modelling using pullout from porcine ribs proved FEA to be suitable for assessing the structural integrity of screw/bone systems such as rib fixated by a screw. In the human rib fixation investigation, it was found that intramedullary bioresorbable Bioretec screws can fixate centrally fractured human ribs under normal breathing conditions. However, under coughing conditions, simulation showed Bioretec fixating screws to bend substantially. High stresses in the screw are mainly the result of flexion induced by the force loading, and are restricted to thin regions on the outside of the screw shaft. Stiffer screws result in less locally intense stress concentrations in bone, indicating that bone failure in the bone/screw contact regions can be averted with improvements in screw stiffness.

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Biomechanics of Rib Fracture Fixation

Bottlang

Long

2015

Injuries to the Chest Wall

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Biomechanical Testing of Two Devices for Internal Fixation of Fractured Ribs

Cited by 12 publications

References 27 publications

Physical function and pain after surgical or conservative management of multiple rib fractures – a follow-up study

Physical function and pain after surgical or conservative management of multiple rib fractures – a follow-up study

Stress analysis of a centrally fractured rib fixated by an intramedullary screw

Biomechanics of Rib Fracture Fixation

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