Functional results after chest wall stabilization with a new screwless fixation device

Wiese, Mark; Kawel‐Boehm, Nadine; Santa, Pablo Moreno de la; Al-Shahrabani, F; Toffel, Melanie; Rosenthal, Rachel; Schäfer, Juliane; Tamm, Michael; Bremerich, Jens; Lardinois, Didier

doi:10.1093/ejcts/ezu318

Cited by 22 publications

(22 citation statements)

References 21 publications

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“…In our study, 2 patients did not undergo complete hardware removal. Wiese et al (6) also demonstrated suitable outcomes in 2 patients who underwent partial removal. We advocate that if hardware must be removed early, then partial hardware removal may be a suitable option.…”

Section: Discussionmentioning

confidence: 91%

“…Rib fractures are rarely open fractures, but they do often communicate with the airways (via pulmonary lacerations) or with the environment (via TT), and therefore patients with SSRF may be at increased risk for infection. Wiese et al (6) reported on 2 patients with hardware infection after SSRF; both had diabetes mellitus and had sustained severe trauma with extensive soft-tissue contusions. Bacterial translocation from TTs placed before SSRF has been suggested as a mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, more institutions have started performing SSRF and are expanding the indications in selected patients (5). Although SSRF appears to be a safe procedure (6), the risks remain poorly described. As the use of SSRF increases, surgeons will need to be aware of associated complications and management options.…”

Section: Introductionmentioning

confidence: 99%

“…The reported risk of hardware infection after SSRF is low, but considerable variation exists (0%–10%) since most of the available data have been derived from case series (6–8). Hardware infection, defined as a deep wound-space infection in the setting of implanted hardware, is well researched in the orthopedics literature (9), which suggests that infected hardware cannot be cured with the hardware in place (10).…”

Section: Introductionmentioning

confidence: 99%

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Infected hardware after surgical stabilization of rib fractures

Thiels

Aho

Naik

et al. 2016

Journal of Trauma and Acute Care Surgery

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Background Surgical stabilization of rib fracture (SSRF) is increasingly used for treatment of rib fractures. There are few data on the incidence, risk factors, outcomes, and optimal management strategy for hardware infection in these patients. We aimed to develop and propose a management algorithm to help others treat this potentially morbid complication. Methods We retrospectively searched a prospectively collected rib fracture database for the records of all patients who underwent SSRF from August 2009 through March 2014 at our institution. We then analyzed for the subsequent development of hardware infection among these patients. Standard descriptive analyses were performed. Results Among 122 patients who underwent SSRF, most (73%) were men; the mean (SD) age was 59.5 (16.4) years, and median (interquartile range [IQR]) Injury Severity Score was 17 (13–22). The median number of rib fractures was 7 (5–9), and 48% of patients had flail chest. Mortality at 30 days was 0.8%. Five patients (4.1%) had a hardware infection on mean postoperative day 12.0 (6.6). Median Injury Severity Score (17 [13–42]) and hospital length of stay (9 [6–37] days) in these patients were similar to the values for those without infection (17 [13–22] and 9 [6–12] days, respectively). Patients with infection underwent a median (IQR) of 2 (2–3) additional operations, which included wound débridement (n=5), negative-pressure wound therapy (n=3), and antibiotic beads (n=4). Hardware was removed in 3 patients at 140, 190, and 192 days after index operation. Cultures grew only gram-positive organisms. No patients required reintervention after hardware removal, and all achieved bony union and were taking no narcotics or antibiotics at the latest follow-up. Conclusions Although uncommon, hardware infection after SSRF carries considerable morbidity. With the use of an aggressive multimodal management strategy, however, bony union and favorable long-term outcomes can be achieved. Level of Evidence Therapeutic study, level V.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Infected hardware after surgical stabilization of rib fractures

Thiels

Aho

Naik

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…The clamp systems are managed through similar approaches as the rib plates. They encompass the rib and generally require slightly extended intercostal dissection, which is not generally associated with a higher risk of a lesion of intercostal vessels or nerves, but the biomechanical properties are based on a different principle from that of the locked plate osteosynthesis with a considerable risc of implant failure (24,25). A retrosternal metal bar, as is very well known from the minimized pectus excavatum reconstructions according to Nuss, can also effect stabilization of the chest wall in certain cases.…”

Section: Discussionmentioning

confidence: 99%

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Schulz-Drost¹,

Krinner²,

Langenbach³

et al. 2017

chr

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RezumatDate generale: Leziunile de volet costal (FCI) sunt unele dintre cele mai grave leziuni toracice. Mai mult decât atât, o fractură de stern suplimentară (SF) chiar agravează rezultatele, cum ar fi durata ventilaţiei mecanice, prin urmare o fixare chirurgicală a fracturilor poate fi luată în considerare în anumite cazuri pentru a grăbi deconectarea ventilatorului. Această lucrare urmăreşte să sublinieze managementul diferitelor tipuri de SF în FCI. Metode: Toate cazurile tratate chirurgical (2012)(2013)(2014)(2015)(2016) Original ArticleCuvinte cheie: volet costal, fractură de stern, fractură sternală, fractură costală, osteosinteză cu placă blocată, Matrix Rib Abstract Background: Flail Chest Injuries (FCI) are one of the most severe thoracic injuries. Moreover, an additional sternal fracture (SF) even worsens the outcome, such as the duration of mechanical ventilation, therefore an surgical fixation of the fractures could be considered in certain cases to improve the weaning from the ventilator. This paper aims to emphasize on the management of different types of SF in FCI. Methods: All surgically treated cases (2012)(2013)(2014)(2015)(2016) that showed the combination of FCI and SF have been evaluated for their clinical details, the morphology of the fractures and the technical aspects of the surgical procedure in a retrospective investigation.Results: All of the SF (n=15) had been fixed by locked plate osteosynthesis through a median approach in a supine position. Three main regions of the sternum showed the need for different fixation strategies: the upper manubrium, central and lower corpus sterni. Concomitant rib fractures were addressed either through the same approach or through additional limited incisions. Conclusions: Combinations of SF and FCI are high risc injuries with high demand on surgical skills. They can be properly fixed with a locking plate osteosynthesis through a combination of limited incisions employing different types of plates depending on the type of SF.

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