Progresses in clinical treatment of multiple rib fractures and flail chest / 中国胸心血管外科临床杂志

@#The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.

Pattern and management of penetrating and nonpenetrating thoracic injuries

Background: Chest trauma constitutes a major public health problem which  includes the injuries to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, oesophagus, heart and great vessels. It consist of more than ten percent of all traumas and twenty five percent of death due to trauma occurs because of chest injury. Chest trauma is increasing in frequency in urban hospitals. Penetrating and nonpenetrating thoracic injuries the most serious injuries leading to significant morbidity and mortality.Methods: This study was prospective observational study of 220 patients of thoracic trauma both penetrating and non-penetrating. These patients admitted in general surgical units from August 2017 to May 2018  of Pandit Bhagwat Dayal  Sharma,  PGIMS  Rohtak Haryana India. The study was pertaining to both penetrating  and non-penetrating chest trauma.Results: Out of 220 chest injury patients who were studied during the said period, Males were 203 and females 17 by a ratio of 12:1 and age ranged from lowest 18 years to 85 years of age. Majority of the patients (90.45%) sustained blunt injuries. RTA was the common mechanism of blunt injury affecting (50.45%) of patients. Multiple Rib fractures was the commonest type of chest injury (21.36%) followed by head injury (17.27%). Head injury was the commonest associated injury seen in our patients. Conclusions: Chest trauma resulting from road traffic accident remains a major mechanism of chest injury. The  measures to decrease the trauma are, educating people about traffic rules and regulations and strictly implementing them is necessary to reduce incidence of chest injuries.

Comparison of different therapeutic effects between video-assisted thoracoscopic surgery and traditional surgery for multiple rib fractures / 中国内镜杂志

Objective To analyze the effect of video-assisted thoracoscopic surgery and traditional surgery for multiple rib fractures. Methods 102 cases of patients with multiple rib fractures from January 2014 - December 2017 was selected and divided into two groups after different therapy: 51cases in control group were treated with traditional surgery, 51cases in study group were treated with thoracoscopic assisted surgery, the clinical results was compared and analyzed. Results The observation group of intraoperative bleeding, postoperative drainage were significantly higher than the control group (P < 0.05); the operation time of observation group was significantly longer than the control group, with significant differences between the two groups (P < 0.05); the study group of pain time (8.39 ± 2.24) d, ambulation time (5.76 ± 2.43) d and the hospitalization time (10.53 ± 3.51) d was significantly shorter than the control group, the difference between the two groups was statistically significant (P < 0.05), study group complication rate was 3.92% and the control group complication rate was 17.64% with significant difference (P < 0.05). Conclusion The clinical effect of video-assisted thoracoscopic surgery in patients with multiple rib fractures is significant, can prevent complications, reduce medical costs, it is worth learning.

Performed titanium locking plate versus nickel-titanium memory alloy embracing fixator in the treatment of multiple rib fractures / 中国胸心血管外科临床杂志

@#Objective     To compare clinical outcomes between the performed titanium locking plate and nickel-titanium memory alloy embracing fixator for the treatment of multiple rib fractures, and to select a better internal fixator for multiple rib fractures. Methods     A total of 206 consecutive patients with multiple rib fractures were admitted to Department of Cardiothoracic Surgery in Beijing Luhe Hospital of Capital Medical University from October 2011 to September 2016. According to different treatment strategies, the patients were divided into 2 groups: a performed titanium locking plate group (a titanium plate group, n=105) and a nickel-titanium memory alloy embracing fixator group (an embracing fixator group, n=101). There were 82 males and 23 females with a mean age of 46.5±9.7 years ranging from 23 to 65 years in the titanium plate group, and 83 males and 18 females with a mean age of 44.7±10.3 years ranging from 19 to 63 years in the embracing fixator group. The preoperative data, curative outcomes, visual analogue scale (VAS) and postoperative complications were compared between the two groups. Results     There was no statistical difference in the preoperative data between the two groups, and all patients successfully completed the operation. Compared with the embracing fixator group, the incision length and operation time were shorter, intraoperative bleeding and VAS score were less, and curative outcome was better in the titanium plate group. Conclusion     The performed titanium locking plate has a great advantage in the clinic, which can be preferred.

Overview of Blunt Chest Injury with Multiple Rib Fractures.

Introduction: Thoracic trauma leading to multiple fractured ribs (MFR) remains common. The significant chest pain of multiple rib fractures can be difficult to manage and can lead to decreased pulmonary function, increased hospital stay, and increased health care expenditures. Aims: To evaluate the treatment options available for pain control in blunt chest injury with multiple rib fractures. Study Design: Internet research. Methodology: Literature review on pain management of blunt chest injury associated with multiple rib fractures was done from 1970 to 2014 using manual library search, journal publications on the subject, and Medline. Results: Various modalities have been in use including systemic modalities, regional modalities, transcutaneous modalities and cutaneous modalities. Conclusion: The current research has shown differs modalities available for control of chest pain in blunt chest injury and multiple rib fractures in the ranges of systemic therapy, regional therapy and trans-cutaneous therapy. Summation of evidences favours regional therapy over others.

Comparative analysis on thoracoscopic surgery and conventional thoracotomy for emergency surgical treatment in multiple rib fracture complicating pulmonary laceration / 重庆医学

Objective To compare the effect of video‐assisted thoracoscopic(VAT) surgery and conventional thoracotomy in emergency treatment of multiple rib fracture complicating pulmonary laceration to provide the reference for clinical treatment .Meth‐ods Forty‐seven cases of multiple rib fracture complicating pulmonary laceration in our hospital from April 2013 to April 2014 were selected and divided into the VAT group(n=32) and thoracotomy group(n=15) according to the willingness of patients .The two groups performed the thoracoscopic and traditional thoracotomy titanium nickel alloy rib plate treatment respectively .The sur‐gery situation ,complications and changes of perioperative blood gas levels were compared between the two groups .Results The op‐eration time ,intraoperative bleeding volume ,ICU hospitalization time ,total hospitalization time and postoperative analgesic in the VAT group were lower than those in the thoracotomy group ,the differences were statistically significant (P0 .05) .The excellent rate in the VAT group was 90 .6% ,which was higher than 66 .7% in the thoracotomy group ,and the differ‐ence was statistically significant (P<0 .05) .Conclusion Thoracoscopic internal fixation for the treatment of multiple rib fractures complicating laceration has the advantages of minimal trauma ,convenient operation and high safety ,could effectively alleviate the patient′s sufferring ,improve the living quality ,and be a better way of treatment .

Clinical study on fast track surgery in the rib internal fixation of multiple rib fractures / 中国综合临床

Objective To evaluate the application of fast track surgery (FTS) in the rib internal fixation of multiple rib fractures. Methods Forty-eight chest trauma with multiple rib fractures patients from March 2008 to March 2010 were divided into FTS group and traditional care group randomly. Meanwhile two groups accepted FTS and conventional management of perioperative period respectively. The degree and duration of the chest pain, early exercise tolerance, intravenous infusion time, the length of postoperative hospital stay,chest scar and postoperative complications were observed and compared between the two groups. Results The duration of chest pain was significantly shorter in FTS group than in the traditional care group([ 112. 46 ±23. 24 ] mins vs [ 180. 23 ± 51.56 ] mins, t = 4. 23 ,P ＜ 0. 05); the early exercise tolerance was longer([ 68. 35 ±9. 30 ] mins vs [ 33.48± 5. 18 ] mins,t = 2. 87, P ＜ 0. 05) ;the intravenous infusion time was shorter ([ 10. 83 ±1.87 ] d vs [ 13. 30 ± 2. 12 ] d, t = 2. 38, P ＜ 0. 05); the length of postoperative hospital stay was shorter([ 12. 35 ± 2.03 ] d vs [ 16. 48 ± 3. 18 ] d, t = 3.04, P ＜ 0. 05); the less postoperative complications(8.3% vs 37. 5 %, x2 = 5. 005,P ＜ 0. 05); chest pain was relieved([ 3.43 ± 0. 45 ] cm vs. [ 6. 62 ± 0. 62 ] cm, P ＜ 0. 05);the scar healed well. All patients were successfully discharged. Conclusion The perioperative idea of fast track surgery was feasible and effective in the chest trauma with multiple rib fractures patients. FTS can improve the patients long term living quality.