Long-Term Morbidity, Vain, and Disability after Repair of Severe Chest Wall Injuries

Abstract

Long-term morbidity after severe chest wall injuries is common. We report our experience with acute chest wall injury repair, focusing on long-term outcomes and comparing our patients’ health status with the general population. We performed a retrospective medical record review supplemented with a postal survey of long-term outcomes including the McGill Pain Questionnaire (MPQ) and RAND-36 Health Survey. RAND-36 outcomes were compared with reference values from the Medical Outcomes Study and from the general population. Forty-six patients underwent acute chest wall repair between September 1996 and September 2005. Indications included flail chest with failure to wean from the ventilator (18 patients), acute, intractable pain associated with severely displaced rib fractures (15 patients), acute chest wall defect/deformity (5 patients), acute pulmonary herniation (3 patients), and thoracotomy for other traumatic indications (5 patients). Three patients had a concomitant sternal fracture repair. Fifteen patients with a current mean age of 60.6 years (range 30-91) responded to our surveys a mean of 48.5 ± 22.3 months (range 19-96) postinjury. Mean long-term MPQ Pain Rating Index was 6.7 ± 2.1. RAND-36 indices indicated equivalent or better health status compared with references with the exception of role limitations due to physical problems when compared with the general population. The operative repair of severe chest wall injuries is associated with low long-term morbidity and pain, as well as health status nearly equivalent to the general population. Both the MPQ and the RAND-36 surveys were useful tools for determining chest wall pain and disability outcomes.

Pain Managment of Multiple Rib Fractures on the Basis of Early Reduction and Fixation in Patients without Intensive Care Unit.

“…The treatment options are pain control and complication management with conservative follow-up or open surgical reduction [1]. Most of the studies in the literature have been done in patients in need of intensive care or some of the cases in the studies had intensive care support [14,15]. In evaluating the surgical indication, it should be considered that the cases with or without intensive care have different risks.…”

Crossed Kirschner’s wires for the treatment of anterior flail chest: an extracortical rib fixation

“…Thoracic cage injuries were observed in 113 patients (82.48%) with an average of 3.2 fractured ribs per patient (mean 1.62 on the right and 1.75 on the left side). Sternal fractures (24, 17.5%), clavicle fractures (19,13.9%) and vertebral ones (15, 10.9%) were also associated. Seventeen (12.41%) patients presented a flail chest and of these, 13 (9.49%) had an anterior one due to the presence of multiple rib fractures with or without a sternal one causing a paradoxical movement of the thorax.…”

“…The reasons of this underutilization have to be found in many causes, including unfamiliarity with the surgical technique and the lack of knowledge of the surgical indications for a prompt parietal stabilization (9). The operative treatment, on the other hand, is characterized by a reduction of mechanical ventilation, intensive care unit (ICU) stay, hospitalization, tracheostomy, mortality rates (10,11) and only few reports report post-operative long-term complications (12,13). But rib surgical stabilization is difficult both for the characteristics of the fractures (lack of uniformity and alignment) and for clinical conditions of trauma patients.…”

A Novel and Effective Acupuncture Modality as a Complementary Therapy to Acute Pain Relief in Inpatients with Rib Fractures

“…The intersection of these two axes was the acupuncture point, located in abdomen or lumbar area, into which the needle was inserted usually leads to increased mortality in older population and prolonged disability. [1,2,[6][7][8][9] Acute pain management in inpatients with rib fractures has been highly emphasized by practitioners. The commonly used oral analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), seem to provide limited relief from severe pain.…”

“…[1,10] Rib taping and other invasive modalities such as intercostal nerve block and operative repair have also been practiced to relieve the pain due to rib fractures, but still some controversies have been shown over the benefit and their indications. [1,[9][10][11][12] A novel and effective therapy for relieving pain from fractured ribs is, therefore, inevitably needed for both physicians and patients.…”