Long-term follow-up after rib fixation for flail chest and multiple rib fractures

Beks, Reinier B.; Jong, Mirjam B. de; Houwert, Roderick M.; Sweet, Arthur A. R.; Bruin, Ivar G. J. M. de; Govaert, Geertje A M; Wessem, Karlijn J. P. van; Simmermacher, R. K. J.; Hietbrink, Falco; Groenwold, Rolf H H; Leenen, Luke P. H.

doi:10.1007/s00068-018-1009-5

Cited by 44 publications

(67 citation statements)

References 29 publications

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“…Of this latter group > 70% recovers to an acceptable level [17]. This also holds true for instance for patients with specific injuries like rib fractures, hand-or wrist injuries or complex foot injuries [29][30][31].…”

Section: The Evolution Of Mortality In Traumamentioning

confidence: 98%

The evolution of trauma care in the Netherlands over 20 years

Hietbrink

Houwert

Wessem

et al. 2019

Eur J Trauma Emerg Surg

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Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a regionwide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

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Section: The Evolution Of Mortality In Traumamentioning

confidence: 98%

The evolution of trauma care in the Netherlands over 20 years

Hietbrink

Houwert

Wessem

et al. 2019

Eur J Trauma Emerg Surg

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“…Beks et al 8 reported as long-term results that 48% of their patients had implant-related irritation and 9% required implant removal. In the present study, irritation was also reported by some patients, but the incidence rate was approximately 10% among the patients followed up.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there are few studies evaluating the long-term outcomes or complications of patients undergoing rib fixation, although some studies have described the long-term assessment of factors such as irritation or quality of life of these patients. 8 9 16–18 Importantly, these past studies have small sample sizes, their follow-up rates are limited to only about 50% of the patients, and the follow-up duration is within several months up to 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…Some previous studies described the sufficient effectiveness of surgical rib fixation, but their follow-up rate was only about 50% and follow-up duration was approximately within 1 year. 8 9 Therefore, the purpose of this study was to assess the exact long-term patient quality of life and implant-related complications after recent surgical rib fixation for both flail chest and multiple rib fractures.…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of surgical rib fixation in patients with flail chest and multiple rib fractures

Uchida

Miyashita

Kaga

et al. 2020

Trauma Surg Acute Care Open

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BackgroundRecently, interest has increased in surgical fixation for severe thoracic wall injury with good short-term outcomes. However, few reports have evaluated long-term outcomes or complications. This study aimed to assess long-term quality of life and implant-related complications after rib fixation for flail chest and multiple rib fractures.MethodsWe interviewed patients who had undergone rib fixation from January 2014 to December 2019 about their current ability to work and their usual life.ResultsTwenty-two patients underwent rib fixation during the study period. Two patients with flail chest had already died after the surgery due to senescence; thus, follow-up information was obtained from 20 patients (91%), with a follow-up duration of 47.5 (IQR 22–58) months. The most undesirable event occurring during the study period was irritation caused by a palpable plate (n=2, 10%), probably due to the thin skin of patients over 70 years old. Eighteen patients were able to return to their usual life or same work as in the premorbid state with no complaints. Two patients are still undergoing rehabilitation due to concomitant extremities fractures. The median EQ-5D-5L index score was 0.89 (IQR 0.84–0.93). There were no implant-related complications requiring plate explantation.DiscussionWe concluded that rib fixation offers good long-term benefits, with the ability of the patient with flail chest or multiple rib fractures to return to activity in the premorbid state. Elderly patients especially with thin, soft tissue may complain of irritation caused by the plate and should be informed of this prior to surgery.Level of evidenceLevel IV therapeutic care/management.

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“…As short-term results in many studies show favorable results, there is only scarce information of the long-term results of fixation of rib fractures. In a long-term follow-up study by Beks et al, patient-reported outcomes were also studied in patients several years after rib fixation [6]. They show that rib fixation is a safe procedure and that patients reported a relative good quality of life.…”

Section: Dear Colleaguesmentioning

confidence: 99%