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. 2016 Jan;30(1):388-95.
doi: 10.1007/s00464-015-4207-9. Epub 2015 Apr 15.

The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure

Yih-Wen Tarng  1   2 , Yuan-Yuarn Liu  2 , Fong-Dee Huang  2 , Hsing-Lin Lin  3   4   5 , Tzu-Chin Wu  6   7   8 , Yi-Pin Chou  9   10
Affiliations

The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure

Yih-Wen Tarng et al. Surg Endosc. 2016 Jan.

Abstract

Background: Blunt chest injuries are usually combined with multiple rib fractures and severe lung contusions. This can occasionally induce acute respiratory failure and prolong ventilations. In order to reduce the periods of ventilator dependency, we propose a less invasive method of fixing multiple rib fractures.

Methods: Since October 2009, we have developed a new method to fix fractured ribs caused by blunt trauma. Rib fixations were performed using 2.0- or 2.5-mm intramedullary titanium elastic nails (TEN), with the help of video-assisted thoracoscopic surgery (VATS) and minimal thoracic incisions. All the patients' demographics and postoperative data were collected.

Results: From January 2010 to December 2012, a total of 65 patients presenting with multiple rib fractures resulting in acute respiratory failure were included in the study. Twelve patients received the new surgical fixation. Rib fixations were performed at an average of 4 days after trauma. Patients were successfully weaned off ventilators after an average of 3 days. The average length of stay in the hospital and the intensive care unit (ICU) was shorter for the patients with fixation than for nonsurgical patients. All twelve patients returned to normal daily activities and work.

Conclusions: In the reconstruction of an injured chest wall, the VATS with TENs fixation in multiple rib fractures is feasible. This method is also effective in decreasing the length of the surgical wound. Because the structure of the chest cage is protected, the period of mechanical ventilation is shortened and the length of stay in the hospital and the ICU can be reduced.

Keywords: Acute respiratory failure; Blunt chest trauma; Rib fracture; Surgical fixation; Titanium nail.

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Figures

Fig. 1
Fig. 1
Redact the fractured rib closely using tower clips
Fig. 2
Fig. 2
Titanium elastic nail (TEN) inserted in rib, providing three-point pressure on the inner cortex
Fig. 3
Fig. 3
Patient receive TENs for fixation of fractured ribs
See this image and copyright information in PMC

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