Taking the bull by the horns: Patient trampled by bull requiring surgical fixation of multiple rib fractures including rib 11

Abstract

Rib fractures are a serious problem in thoracic trauma resulting in high morbidity and mortality. Surgical stabilization in the management of rib fractures is gaining more popularity and recognition as outcomes continue to show positive results, however, there is still hesitancy among the trauma community to recommend this intervention. Although there still remains questions as to which patients to provide surgical stabilization to in the non-flail rib fracture patient population, surgical stabilization of rib fractures have been shown to be extremely beneficial in those patients with flail chest and should be strongly considered in this patient population, especially if they require ventilatory support. Here we present a 62-year-old female with severe chest wall deformity from 21 rib fractures after being trampled by a bull. This included a flail segment and a severely angulated 11th rib fracture piercing through the lung into the retroperitoneum. Furthermore, we also introduce a new technique for stabilization of rib fractures that are more posterior. Given the fact we surgically intervened early in our patient with severe chest wall trauma, she had a very favorable outcome, allowing her to be discharged from the hospital in a timely fashion with minimal overall morbidity.

Keywords: Chest wall deformity; Flail chest; Rib fixation; Rib fractures; Surgical stabilization.

Fig. 1

a Chest X-ray demonstrating severe chest wall deforming (Arrows) and early pulmonary contusions. b 3D reconstruction of chest showing severe deformity on the right with significant angulation of rib 11 (Arrow) and flail segment on the left.

Fig. 2

Axial CT scan of the chest showing severe angulation of rib 11 piercing through the right lower lung lobe into the retroperitoneum (Arrow).

Fig. 3

Intra-operative picture demonstrating the great visualization of the posterior portion of ribs 3 and 4 on the left utilizing the 10 mm, 30-degree thoracoscope. With the use of the thoracoscope, we were able to appropriately secure the plates to the ribs without making a secondary incision. The yellow arrow is pointing to the spine.

Fig. 4

Chest X-ray after completion of SSRF of both sides. The patient's chest wall deformity is much improved after fixation. She received a total of 18 new titanium rib plates.