Comparison of surgical fixation and nonsurgical management of flail chest and pulmonary contusion

Yuan, Zhe; Tang, Xue; Xie, Hui; Wang, Rui Lan

doi:10.1016/j.ajem.2015.04.005

Cited by 30 publications

(14 citation statements)

References 16 publications

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“…With internal fixation, patients in study group had free movement and sputum, which is conducive to the maintenance of a clear airway to reduce the incidence of postoperative pulmonary infection and atelectasis (23); while in the control group, patients might suffer from respiratory muscle atrophy with the use of the ventilator, and were incapable of timely sputum excretion due to severe pain or inconvenient movement, prone to atelectasis and repeated pulmonary infection (24), which contributed to longer hospitalization time and more cases of pulmonary infection and atelectasis in control group than study group. Study by Zhang et al (25) proved that patients who underwent surgical treatment of flail chest and pulmonary contusion enjoyed a shorter hospitalization time than non-surgical patients, which agrees with the results of this study.…”

Section: Discussionsupporting

confidence: 92%

Efficacy of nickel‑titanium memory alloy in the treatment of multiple rib fracture combined with sternal fracture

Xiong¹,

Hu²,

Li³

et al. 2019

Exp Ther Med

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Clinical efficacy and complications of nickel-titanium memory alloy in the treatment of multiple rib fractures combined with sternal fractures was investigated. A retrospective analysis of 123 patients with multiple rib fractures combined with sternal fractures admitted to First People's Hospital of Fuzhou from January 2013 to December 2015 was performed, including study group (treated with internal fixation by the nickel-titanium memory alloy, n=68) and control group (treated with internal fixation by partial pressure bandage, n=55). Μean arterial pressure (MAP), heart rate (HR), and visual analogue pain score (VAS) of the two groups before and after treatment were compared and analyzed. No significant difference in MAP, HR and VAS scores between groups was detected before treatment (P>0.05). After treatment, MAP score of study group was significantly higher, and HR and VAS scores were significantly lower (P<0.05). Μethod of internal fixation by the nickel-titanium memory alloy, with better efficacy than the traditional method of internal fixation by partial pressure bandage and less postoperative complications in the treatment of flail chest caused by multiple rib fractures combined with sternal fractures, is worthy of clinical application and promotion.

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Section: Discussionsupporting

confidence: 92%

Efficacy of nickel‑titanium memory alloy in the treatment of multiple rib fracture combined with sternal fracture

Xiong¹,

Hu²,

Li³

et al. 2019

Exp Ther Med

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“…Twenty-five studies ( n = 4826) reported on mortality (Online Appendix 4) [18, 19, 22, 23, 25, 27, 28, 30, 32–34, 36–50]. Rib fixation resulted in a significant reduction of mortality compared to nonoperative treatment with a risk ratio (RR) of 0.41 (95% CI 0.27, 0.61, p < 0.001, I 2 = 0%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one studies ( n = 4770) reported on length of hospital stay (Online Appendix 4) [16, 17, 23, 25, 26, 31–35, 37–45, 47, 50, 51]. Rib fixation did not result in a significant reduction of HLOS compared to nonoperative treatment with a mean difference of −1.46 days (95% CI −4.31, 1.39, p = 0.32, I 2 = 96%) (Online Appendix 6).…”

Section: Resultsmentioning

confidence: 99%

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Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis

Beks

Peek

Jong

et al. 2018

Eur J Trauma Emerg Surg

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Purpose The aim of this systematic review and meta-analysis was to present current evidence on rib fixation and to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies. Methods MEDLINE, Embase, CENTRAL, and CINAHL were searched on June 16th 2017 for both RCTs and observational studies comparing rib fixation versus nonoperative treatment. The MINORS criteria were used to assess study quality. Where possible, data were pooled using random effects meta-analysis. The primary outcome measure was mortality. Secondary outcome measures were hospital length of stay (HLOS), intensive care unit length of stay (ILOS), duration of mechanical ventilation (DMV), pneumonia, and tracheostomy. Results Thirty-three studies were included resulting in 5874 patients with flail chest or multiple rib fractures: 1255 received rib fixation and 4619 nonoperative treatment. Rib fixation for flail chest reduced mortality compared to nonoperative treatment with a risk ratio of 0.41 (95% CI 0.27, 0.61, p < 0.001, I 2 = 0%). Furthermore, rib fixation resulted in a shorter ILOS, DMV, lower pneumonia rate, and need for tracheostomy. Results from recent studies showed lower mortality and shorter DMV after rib fixation, but there were no significant differences for the other outcome measures. There was insufficient data to perform meta-analyses on rib fixation for multiple rib fractures. Pooled results from RCTs and observational studies were similar for all outcome measures, although results from RCTs showed a larger treatment effect for HLOS, ILOS, and DMV compared to observational studies. Conclusions Rib fixation for flail chest improves short-term outcome, although the indication and patient subgroup who would benefit most remain unclear. There is insufficient data regarding treatment for multiple rib fractures. Observational studies show similar results compared with RCTs. Electronic supplementary material The online version of this article (10.1007/s00068-018-1020-x) contains supplementary material, which is available to authorized users.

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“…193615:425:11> 3CoJayle.C.P [5]10104:14:13 in ≥2 placesCoNirula.R [6]. 3030NRNRNRCoTanka [7]18192:114:5> 6RCTTeng [8]3228NRNR≥4CoWang [9]697241:2843:29≥2RCTWei [10]505430:2037:17≥3CoXu.J [11]171512:512:3≥4CoYang [12]303020:1021:9≥3CoZhang.Z.T [13]565637:1931:252~6.CoZhang Y [14]241519:514:17~16CoSM surgical management group that patients who are managed operatively,NSM non-surgical management group that patients who are managed nonoperativelyNR not reported, RCT random control trail, Co cohort study…”

Section: Resultsmentioning

confidence: 99%

Surgical management versus non-surgical management of rib fractures in chest trauma:a systematic review and meta-analysis

Liu

Xiong

2019

J Cardiothorac Surg

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Objective Rib fractures are common injuries sustained by patients who experience high-impact chest trauma, and they result in severe respiratory compromise because of the altered mechanics of respiration. Several studies have shown that the ventilation requirements and incidence of pulmonary complications may be decreased with operative intervention. The purpose of this study was to evaluate the effect of surgical fixation treatments for rib fractures through systematic review and meta-analysis. Methods A literature search was performed in the PubMed, EMBASE, Web of Science and Cochrane Library databases for information from February 1958 to April 2018. Studies comparing the benefits of surgical management with that of non-surgical management of rib fractures were included. Statistical heterogeneity was evaluated by the X 2 test with the significance set to P < 0.10 or I 2 > 50%. Results Fourteen studies consisting of 839 patients were included (407 patients in the surgical management group; 432 patients in the non-surgical management group). The results showed that the surgical management group experienced a significant decrease in hospitalization time, intensive care time, mechanical ventilation time, mortality rate, pulmonary infection rate and tracheotomy rate compared with the non-surgical management group. However, the surgical management group incurred extra costs, and there was no significant difference in the duration of antibiotic use between the two groups. Conclusions Compared with non-surgical management, surgical management methods are of great value in the treatment of rib fractures despite the added expense.

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Comparison of surgical fixation and nonsurgical management of flail chest and pulmonary contusion

Cited by 30 publications

References 16 publications

Efficacy of nickel‑titanium memory alloy in the treatment of multiple rib fracture combined with sternal fracture

Efficacy of nickel‑titanium memory alloy in the treatment of multiple rib fracture combined with sternal fracture

Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis

Surgical management versus non-surgical management of rib fractures in chest trauma:a systematic review and meta-analysis

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