Surgical Stabilization of Rib Fractures Using Inion OTPS Wraps—Techniques and Quality of Life Follow-Up

Campbell, Nicole; Conaglen, Paul; Martin, Katherine; Antippa, Phillip

doi:10.1097/ta.0b013e3181ad8cb7

Cited by 51 publications

(31 citation statements)

References 23 publications

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“…6). This last point is of importance to the patient, because stiffer ribs are less likely to move and cause pain while breathing or coughing [46]. The stiffness is typical to bone repaired by stem cell therapy, and the ribs are expected to remodel over time evolving to be less dense, allowing some elasticity [24, 47].…”

Section: Discussionmentioning

confidence: 99%

Systemic administration of mesenchymal stem cells combined with parathyroid hormone therapy synergistically regenerates multiple rib fractures

et al. 2017

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BackgroundA devastating condition that leads to trauma-related morbidity, multiple rib fractures, remain a serious unmet clinical need. Systemic administration of mesenchymal stem cells (MSCs) has been shown to regenerate various tissues. We hypothesized that parathyroid hormone (PTH) therapy would enhance MSC homing and differentiation, ultimately leading to bone formation that would bridge rib fractures.MethodsThe combination of human MSCs (hMSCs) and a clinically relevant PTH dose was studied using immunosuppressed rats. Segmental defects were created in animals’ fifth and sixth ribs. The rats were divided into four groups: a negative control group, in which animals received vehicle alone; the PTH-only group, in which animals received daily subcutaneous injections of 4 μg/kg teriparatide, a pharmaceutical derivative of PTH; the hMSC-only group, in which each animal received five injections of 2 × 106 hMSCs; and the hMSC + PTH group, in which animals received both treatments. Longitudinal in vivo monitoring of bone formation was performed biweekly using micro-computed tomography (μCT), followed by histological analysis.ResultsFluorescently-dyed hMSCs were counted using confocal microscopy imaging of histological samples harvested 8 weeks after surgery. PTH significantly augmented the number of hMSCs that homed to the fracture site. Immunofluorescence of osteogenic markers, osteocalcin and bone sialoprotein, showed that PTH induced cell differentiation in both exogenously administered cells and resident cells. μCT scans revealed a significant increase in bone volume only in the hMSC + PTH group, beginning by the 4th week after surgery. Eight weeks after surgery, 35% of ribs in the hMSC + PTH group had complete bone bridging, whereas there was complete bridging in only 6.25% of ribs (one rib) in the PTH-only group and in none of the ribs in the other groups. Based on the μCT scans, biomechanical analysis using the micro-finite element method demonstrated that the healed ribs were stiffer than intact ribs in torsion, compression, and bending simulations, as expected when examining bone callus composed of woven bone.ConclusionsAdministration of both hMSCs and PTH worked synergistically in rib fracture healing, suggesting this approach may pave the way to treat multiple rib fractures as well as additional fractures in various anatomical sites.Electronic supplementary materialThe online version of this article (doi:10.1186/s13287-017-0502-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Systemic administration of mesenchymal stem cells combined with parathyroid hormone therapy synergistically regenerates multiple rib fractures

et al. 2017

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“…This will diminish the pneumonia rate and improve oxygenation resulting in a faster recovery. Furthermore, the indicated pain score after surgical fixation is low enabling productive cough, deep breaths, and movement, protecting from pneumonia and other immobility-related complications [24].…”

Section: Discussionmentioning

confidence: 99%

Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

Wijffels

Hagenaars

Latifi

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with nonoperative treatment, with special focus on the impact of surgical complications. Methods A retrospective case series of operatively treated flail chest patients was compared with non-operatively treated patients. Patients' injury and treatment characteristics and outcome parameters (e.g., duration of mechanical ventilation, length of Intensive Care stay (ICLOS) and hospital length of stay (HLOS), mortality, surgery-related complications and pneumonia) were collected from the patients' medical files. Crude and matched-pairs analyses were performed in SPSS. Results Twenty-three operatively and 47 non-operatively treated patients were enrolled. Operatively treated patients required significantly shorter mechanical ventilation; median 4 days versus 12 days for the non-operative group (p = 0.011). The matched-pairs analysis also showed a lower pneumonia rate (35% versus 80%; p = 0.035) and a shorter HLOS (median 21 versus 23 days; p = 0.028) in the operative group. No significant differences in duration of ICLOS, and occurrence of other injury-related adverse events were found between both groups. Seven surgery-related complications occurred, of which three required invasive solutions. Conclusions Operative fixation of a flail chest in trauma patients results in a lower rate of pneumonia, less mechanical ventilation days and shorter hospital stay, compared with non-operative treatment, but at the cost of surgery-related complications requiring invasive solutions in some cases.

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“…We highly recommend considering surgical intervention in patients with multi-organ injuries sustained from many rib fractures as well as in patients in respiratory distress and are unable to be weaned from mechanical support as these are the patients who may decompensate rapidly under conservative medical management [22][23][24]. Figure 1 …”

Section: Diagnosis and Evidence For Surgical Managementmentioning

confidence: 99%

Rib Fixation Following Trauma: A Cardiothoracic Surgeon's Perspective

Chan¹,

Stefancin²,

Cunha³

2016

J Trauma Treat

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The most common result of blunt thoracic injury is indeed the fracture of one or more ribs. Rib fractures consists of nearly 40% of patients admitted to major trauma centers, nearly accounting for 200,000 documented cases in the national trauma databank. This injury is often used as an important indicator of trauma severity and playing a major contributing factor in as many as 50% of fatal cases. What is particularly devastating about rib fractures is their intimacy to many vital structures. The location of the rib fracture may indicate types of injuries that may occur. Patients often present with hemothorax or pneumothorax, particularly if two or more ribs are fractured.

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Surgical Stabilization of Rib Fractures Using Inion OTPS Wraps—Techniques and Quality of Life Follow-Up

Cited by 51 publications

References 23 publications

Systemic administration of mesenchymal stem cells combined with parathyroid hormone therapy synergistically regenerates multiple rib fractures

Systemic administration of mesenchymal stem cells combined with parathyroid hormone therapy synergistically regenerates multiple rib fractures

Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

Rib Fixation Following Trauma: A Cardiothoracic Surgeon's Perspective

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