Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting With “Major” Vertebral Fracture Affect Care and Acute Outcomes?

Alvi, Mohammed Ali; Kapurch, Joseph; Ivanov, David; Kerezoudis, Panagiotis; Bydon, Mohamad; Freedman, Brett A.

doi:10.1097/bot.0000000000001316

Cited by 6 publications

(8 citation statements)

References 29 publications

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“…In our case, the patient declined and became hemodynamically unstable once placed in the prone position before the surgical incision was made. Although flail chest physiology may be relatively rare, accounting for less than 5% of the patients in the cohort of Alvi et al, 18 its consequences are severe and can be rapidly fatal. Our patient’s decline is suspected to be secondary to increased intrathoracic pressure, right ventricular compression, and subsequent decreased venous return, which only improved upon return to the supine position.…”

Section: Discussionmentioning

confidence: 96%

“…Additionally, bracing in the prone position for prolonged periods of time intraoperatively predispose to pressure ulcers. In a series of 57 patients with unstable spinal fractures and concomitant segmental rib fractures, Alvi et al 18 retrospectively evaluated outcomes of patients who underwent spinal fixation. In their study, 4 patients decompensated while being placed in the prone position for surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Pennington et al 19 described utilizing the ventral aspect of a thoracolumbar sacral orthosis (TLSO) to place the patient prone and successfully complete spinal fixation in the setting of flail chest physiology. Separately, Alvi et al 18 published the sole article assessing rib fixation in the setting of unstable spinal fractures. Here, we present a case of flail chest physiology associated with unstable cervical and thoracic fractures that tolerated prone positioning only after rib fixation.…”

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confidence: 99%

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Rib fixation for flail chest physiology and the facilitation of safe prone spinal surgery: illustrative case

Wessell¹,

Pereira²,

Eriksson

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Spine fractures are frequently associated with additional injuries in the trauma setting, with chest wall trauma being particularly common. Limited literature exists on the management of flail chest physiology with concurrent unstable spinal injury. The authors present a case in which flail chest physiology precluded safe prone surgery and after rib fixation the patient tolerated spinal fixation without further issue. OBSERVATIONS Flail chest physiology can cause cardiovascular decompensation in the prone position. Stabilization of the chest wall addresses this instability allowing for safe prone spinal surgery. LESSONS Chest wall fixation should be considered in select cases of flail chest physiology prior to stabilization of the spinal column in the prone position. Further research is necessary to identify patients that are at highest risk to not tolerate prone surgery.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Rib fixation for flail chest physiology and the facilitation of safe prone spinal surgery: illustrative case

Wessell¹,

Pereira²,

Eriksson

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…11 Rib fractures are among the most common thoracic injury in patients following highenergy trauma. 12 The more rib fractures a patient sustains, the higher the mortality rate, usually due to additional underlying organ damage. 13 Various studies on trauma patients with thoracic injuries have indicated considerable differences in their morbidity and mortality, though there is limited research on comparison between trauma patients with and without thoracic injuries.…”

Section: Introductionmentioning

confidence: 99%

Thoracic injuries in trauma patients Epidemiology and its influence on mortality

Lundin

Akram

Berg

et al. 2022

Preprint

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BackgroundThoracic injuries are common among trauma patients. Studies on trauma patients with thoracic injuries have reported considerable differences in morbidity and mortality, and there is limited research on comparison between trauma patients with and without thoracic injuries, particularly in the Scandinavian population. Thoracic injuries in trauma patients should be identi ed early and need special attention since the differences in injury patterns among patient population are important as they entail different treatment regimens and in uence patient outcomes.The aim of the study was to describe the epidemiology of trauma patients with and without thoracic injuries and its in uence on 30-day mortality. MethodsPatients were identi ed through the Karolinska Trauma Register. The Abbreviated Injury Scale (AIS) system was used to nd patients with thoracic injuries. Logistic regression analysis was performed to evaluate factors (age, gender, ASA class, GCS (Glasgow Coma Scale), NISS (New Injury Severity Score) and thoracic injury) associated with 30-day mortality. ResultsA total of 2397 patients were included. Of those, 768 patients (32%) had a thoracic injury. The mean (± SD, range) age of all patients (n=2397) was 46 (20, 18-98) years, and the majority (n=1709, 71%) of the patients were males. There was a greater proportion of patients with rib fractures among older (≥ 60 years) patients, whereas younger patients had a higher proportion of injuries to the internal thoracic organs. The 30-day mortality was 11% (n=87) in patients with thoracic injury and 4.3% (n=71) in patients without. After multivariable adjustment, a thoracic injury was found to be associated with an increased risk of 30-day mortality (OR 1.9, 95% CI 1.3-3.0); as was age ≥ 60 years (OR 3.7, 95% CI 2.3-6.0), ASA class 3-4 (OR 2.3, 95% CI 1.4-3.6), GCS 1-8 (OR 21, 95% CI 13-33) and NISS >15 (OR 4.2, 2.4-7.3). ConclusionThoracic injury was an independent predictor of 30-day mortality after adjustment for relevant key variables. We also found a difference in injury patterns with older patients having a higher proportion of rib fractures, whilst younger patients suffered more internal thoracic organ injuries.

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“…The fourth article is a novel report of the additional challenges that a polytrauma patient presents. 14…”

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confidence: 99%

The Role of Surgical Stabilization of Rib Fractures in Polytrauma

Mayberry¹

2019

Journal of Orthopaedic Trauma

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T he modern resurgence of surgical stabilization of rib fractures (SSRFs) began in the early 1980s in Portland, Oregon, with William Long. Long had completed a trauma and surgical critical care fellowship at the University of Maryland Shock Trauma Center in Baltimore, followed by cardiothoracic surgery training at the University of California, San Diego, without ever seeing or hearing of SSRF. But after encountering a handful of patients with severe chest wall injury at Legacy Emanuel Medical Center in Portland, Long concluded that surgical stabilization was in select cases warranted. In 1985, Long presented his experience with SSRF in a poster display at the American College of Surgeons Clinical Congress, receiving interest but mostly disapproval.George Haasler at the Medical College of Wisconsin reported dramatic improvement of respiratory function in a patient with multiple, severely displaced rib fractures after SSRF in 1990. 1 Haasler became a strong advocate for early operative stabilization along with his colleagues, Mario Gasparri and William Tisol. 2 In 1992, Donald Trunkey performed the first flail chest SSRF at Oregon Health & Science University (OHSU) in Portland after having observed SSRF earlier in San Francisco. 3 Trunkey, along with Richard Mullins, the Trauma Section Chief, encouraged John Mayberry, Trauma Fellow, to investigate SSRF as a research endeavor. Their goals were to investigate the technical challenges, the indications, and the long-term outcomes of SSRF. 4 The high rate of long-term disability of patients with flail chest treated nonoperatively reported by Landercasper and colleagues 5 greatly influenced their research. Concurrently, Long from across the Willamette River in Portland and Mouton et al 6 from Switzerland theorized that flail chest SSRF could provide not only acute benefits but also prevent longterm pain and disability.Several seminal investigative reports quickly followed. In 1995, Ahmed and Mohyuddin 7 from the United Arab Emirates repaired 26 patients with flail chest equivalents with intramedullary wires. Compared with contemporary controls, these patients required less ventilator time, less tracheostomies, less pneumonia, and had lower mortality. In 1996, Tanaka et al 8 from Japan presented a prospective randomized trial of "severe flail chest patients" treated with either early SSRF or "internal pneumatic stabilization" at the American Association for the Surgery of Trauma's annual meeting with the same positive results and a dramatic return to work advantage for the stabilized patients. In 1998, Voggenreiter et al 9 from Germany presented their similar series and outcomes. From their groupings of patients come the admonition that patients with pulmonary contusion may not benefit from SSRF, which Fokin et al 10 currently dispute.In the first decade of this century, SSRF was progressively accepted by the mainstream trauma surgeon community. The number of case series, cohort comparisons, and randomized trials of SSRF steadily increased, culminating in 2010 with the re...

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Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting With “Major” Vertebral Fracture Affect Care and Acute Outcomes?

Cited by 6 publications

References 29 publications

Rib fixation for flail chest physiology and the facilitation of safe prone spinal surgery: illustrative case

Rib fixation for flail chest physiology and the facilitation of safe prone spinal surgery: illustrative case

Thoracic injuries in trauma patients Epidemiology and its influence on mortality

The Role of Surgical Stabilization of Rib Fractures in Polytrauma

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