Historic overview of treatment techniques for rib fractures and flail chest

Abstract

Introduction: From the beginning of the twentieth century till the current time, an overview is presented of the surgical treatment for rib fractures and flail chest.

Methods: Many techniques have been used to stabilize the thorax wall. There has been no follow-up for the most described techniques and the evidence provided is at its best at L3-4. This, together with the noninvasiveness of mechanical ventilation, has made the latter the golden standard.

Conclusion: However, the recent introduction of better and fully dedicated materials provides the possibility of exploring the surgical treatment of chest injuries. The authors make a case for operative treatment of rib fractures and flail chest.

Fig. 1

Bennet^® respirator. Reproduced with the permission of Jeff Weisman

Fig. 2

Drinker^® respirator. The patient would be positioned in the cylinder with their head inserted through a metal plate with a rubber seal. From http://commons.wikimedia.org (free of copyright)

Fig. 3

The “Cape Town Limpet” is analogous to a normal sink plunger. Vacuum is created through the metal tube, which is then sealed. Traction is then applied by pulling on the metal bar. Reproduced from [39] with permission

Fig. 4

Bullet forceps

Fig. 5

Hook from an ordinary clothes hanger

Fig. 6

Patient with the hook placed in the sternum and traction applied. Note that the weight is hanging above the patient; imagine the rope breaking or the hook being pulled out! Reproduced from [26] with permission

Fig. 7

Patient with traction applied to the sternum after placing reduction forceps. Reproduced from [23] with permission

Fig. 8

Troicart bent at a 90° angle; a T shape is formed after twisting one half

Fig. 9

Patient with the troicart placed intercostally and fixed under traction to a board on the patient. Reproduced from [9] with permission

Fig. 10

Schematic drawing made by Guernelli of where he put the “skewers” in the patient. Reproduced from [20] with permission

Fig. 11

Picture of the Lunque^® fixator after removal from the patient. Note the large cutter and the coupling device, which was probably positioned outside the patient. Reproduced from [31] with permission

Fig. 12

Illustration from Paris showing the use of the plates. Reproduced from [34] with permission

Fig. 13

Illustration from Paris showing the percutaneous placement of a plate. This could be the first illustration of a MIPO technique

Fig. 14

The plate designed and used by Labitzke. Note the asymmetric joints between the clamps. Reproduced from [30] with permission

Fig. 15

Judet plate; note the use of additional sutures to hold the plate in position. Reproduced from [7] with permission

Fig. 16

Sanchez–Lloret plate. Reproduced from [7] with permission

Fig. 17

The RibLoc^® plate, manufactured by Acute Innovations™

Fig. 18

Medin^® plates. Reproduced from [42] with permission

Fig. 19

Chest X-ray with the K wires and cerclage in situ. Reproduced from [25] with permission