Clinical significance of rib fractures' anatomical patterns.

OBJECTIVES: Rib fractures are common and carry significant morbidity. Chest CT provides an accurate mapping of the fractures. The aim of this study is to propose an anatomical classification of rib fractures, and assess their relation to complication development. METHOD: The records of all blunt trauma patients between January 1st 2014 and December 31st 2017 at a university hospital were retrospectively reviewed. Wounded who were hospitalized with rib fractures (two and more) as the primary injury were included in the study. Based on the chest CT scans, the cohort was divided into five groups: upper ribs (1-4) fractures, anterior, lateral and posterior middle ribs (4-7) fractures, and lower ribs (9-12) fractures. Data regarding demographics, complications (pneumothorax, hemothorax, chest drains, pulmonary contusion atelectasis, pneumonia, respiratory failure and death), intensive care admission and hospital stay were collected. RESULTS: A total of 102 wounded were included in the study, with a mean age of 46.3 years. The mean number of fractured ribs per person was 3.82±1.68, and 46 wounded had displaced fractures. Rib fracture distribution was: upper ribs - 13.7%, anterior middle ribs - 28.5%, lateral middle ribs fractures - 27.5%, posterior middle ribs - 14.7%, lower ribs fractures - 15.7%. Wounded sustaining lateral middle ribs fractures had the highest complications rates in relation to any other fracture location group, with 25% respiratory failure rate. CONCLUSIONS: Lateral middle ribs fractures are associated with a higher complication rate and may require closer oabservation.

The potential advantage of "no-touch" aortic technique in off-pump complete arterial revascularization.

OBJECTIVES: Off-pump coronary artery bypass grafting (OPCAB) and complete arterial revascularization without proximal anastomosis to the aorta may decrease neurological events after open-heart surgery. Few reports exist regarding the combination of OPCAB and complete arterial revascularization exploring the theoretical advantage of avoiding manipulation of the aorta. We review our results in 110 patients who underwent multiple grafts off-pump complete arterial revascularization. METHODS: 110 patients underwent multiple grafts OPCAB complete arterial revascularization, and were compared to 216 patients who underwent traditional multiple grafts on pump CABG. Preoperative renal failure was 12.7% (n=14) as compared to 5.1%, (n=11, p=0.01) in the control group and 33.6% (n=37) of the patients were 75 years or older as compared to 19.0% (n=41, p=0.003) in the control group. RESULTS: The mean number of grafts per patient undergoing multiple OPCAB complete arterial revascularization was 2.3, as compared to 3.11 in the control group (p<0.001). The mortality rate was 2.73% as compared to 1.85% (NS) in the control group. The incidence of CVA was 0% as compared to 2.31% (p=0.17) in the control group. CONCLUSIONS: Complete arterial OPCAB revascularization without manipulation of the aorta in high-risk patients can be performed with short-term similar results to conventional CABG and very low neurological complications.