Outcomes after fixation of rib fractures sustained during cardiopulmonary resuscitation: A retrospective single center analysis.

Background: Historically rib fractures have been typically treated non-operatively. Recent studies showed promising results after osteosynthesis of rib fractures in trauma patients with flail segments or multiple rib fractures. However, there is a paucity of data on rib fixation after cardiopulmonary resuscitation (CPR). This study evaluated the outcomes of patients who received rib fixation after CPR. Methods: Adult patients who received surgical fixation of rib fractures sustained during CPR between 2010 and 2020 were eligible for inclusion in this retrospective study. Outcome measures included complications, quality of life (EQ 5D 5L) and level of dyspnea. Results: Nineteen patients were included with a mean age of 66.8 years. The mean number of fractured ribs was ten, seven patients additionally had a sternum fracture. Pneumonia occurred in 15 patients (74%), of which 13 were diagnosed preoperatively and 2 post-operatively. Six patients developed a postoperative pneumothorax, none of which required revision surgery. One patient showed persistent flail chest after rib fixation and required additional fixation of a concomitant sternum fracture. One infection of the surgical site of sternal plate occurred, while no further surgery related complications were reported. Mean EQ-5D-5L was 0.908 and the average EQ VAS was 80. One patient reported persisting dyspnea. Conclusion: To date, this is the largest reported cohort of patients who received rib fixation for fractures sustained during CPR. No complications associated with rib fixation were reported whereas one infection after sternal fixation did occur. Current follow-up demonstrated a good long-term quality of life after fixation, warranting further studies on this topic. Deeper knowledge on this subject would be beneficial for a wide spectrum of physicians.

Nonunion of traumatic rib fractures: a suitable indication for surgery?

PURPOSE: Nonunion of traumatic rib fractures is a clinical/radiological diagnosis caused by an alteration of bone healing reparative process. Since it is a painful condition, nonunion has a significative impact on patient's morbidity and quality of life. The aim of this study was to evaluate the outcomes after surgical stabilization of ribs affected by nonunion after traumatic fractures. METHODS: We conducted a retrospective cohort analysis of all patients who were treated with surgical stabilization of nonunion after traumatic rib fractures. We analyzed demographic data as well as clinical and patient-reported outcomes. RESULTS: Nineteen patients were identified and included in this analysis. Median age was 49 years (range 25-69 years). Mean length of stay was 5.4 days. No in-hospital mortality was observed. After a median follow-up of 46.94 months (range 0-103), 16 (84.2%) patients were completely asymptomatic, while 3 (15.8%) were still suffering from pain after surgery. CONCLUSIONS: Surgical stabilization in patients affected by rib nonunion can be safely performed with few complications, good clinical outcomes and satisfactory quality of life.

Long-term quality of life and functional outcome after rib fracture fixation.

PURPOSE: The primary aim of this study was to assess the long-term quality of life and functional outcome after rib fracture fixation for patients with multiple rib fractures or flail chest. Secondarily, this study sought to identify risk factors associated with the quality of life. METHODS: A retrospective cohort study with a follow-up by questionnaire was performed at a level-1 trauma center in Switzerland. All adult patients with three or more rib fractures treated with rib fixation between 2010 and 2018 were eligible for inclusion. All outcomes were independently assessed for patients with multiple rib fractures and patients with a flail chest. The outcome measures were quality of life, level of dyspnea, return to work, implant irritation, and implant removal after a minimum of 12 months of follow-up. Quality of life was assessed using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) and level of dyspnea was determined with the modified Medical Research Council dyspnea (mMRC) scale. RESULTS: The survey was completed by 74 out of 102 patients (73%) at a median follow-up of 26 months (IQR 15-37). The median EQ-5D utility index score was 0.91 (0.89-1.0), which was equivalent to the reference population (0.902, p = 0.523). The vast majority of patients experienced 'no problems' or 'slight problems' in any of the EQ-5D-5L dimensions. The complication rate associated with rib fracture fixation was low, implant-related irritation was the most common long-term sequela and occurred in 31% of patients. In multivariable regression analyses, total length of stay on the intensive care unit (ICU-LOS) was independently associated with a worse quality of life. CONCLUSIONS: Patients who underwent rib fracture fixation for multiple rib fractures or flail chest after severe chest trauma experienced a good quality of life at least 1 year after surgery. A longer ICU-LOS was independently associated with impaired quality of life. In addition, there were no significant differences in the long-term quality of life and functional outcome between patients with multiple rib fractures and a flail chest. Implant-related irritation was the most important long-term sequela and occurred in one-third of patients.

The evaluation of pulmonary function after rib fixation for multiple rib fractures and flail chest: a retrospective study and systematic review of the current evidence.

PURPOSE: The primary aim of this retrospective cohort study was to evaluate the pulmonary function after rib fixation for patients with multiple rib fractures and flail chest. Secondary, a systematic review was performed to give an overview of the current literature and to allow comparison with our results. METHODS: All adult (≥ 18 years) patients who underwent rib fixation for multiple rib fractures or flail chest between 2010 and 2018 and who received a control pulmonary function test during the postoperative follow-up at our level-1 trauma center were retrospectively reviewed. Secondary, the PubMed, EMBASE and Cochrane databases were searched to identify studies reporting on the pulmonary function after rib fixation. The primary outcome parameters were the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, maximum vital capacity (VCmax), total lung capacity (TLC), residual volume (RV), and RV/TC ratio. RESULTS: Of the 103 patients who underwent rib fixation, a total of 61 (59%) patients underwent a pulmonary function test in our hospital and were ultimately included. In the majority of patients all pulmonary function parameters fell within the normal range of the reference values. Obstructive impairment was predominantly seen in patients with pre-existing chronic obstructive pulmonary disease (COPD). Patients with multiple rib fractures had better recovery compared to those with a flail chest. The systematic review included a total of 15 studies and showed comparable results. CONCLUSION: The present study demonstrates that rib fixation for multiple rib fractures or flail chest results in adequate recovery of the pulmonary function within 3 months after surgery. In addition, based on the current literature, further gradual improvement to maximum pulmonary values appears to occur during the first 12 months after rib fixation.

Localisation of ectopic mediastinal parathyroid adenoma by 18F-fluorocholine PET/CT.

We report the case of two patients with newly diagnosed primary hyperparathyroidism: a 40-year-old woman during pregnancy and a 60-year-old man with initial hypercalcaemic crisis. In the first case, a bilateral neck exploration with parathyroidectomy during the second trimester of pregnancy was unsuccessful and the patient remained hypercalcaemic. Postpartum imaging assessment with technetium (99mTc)-sestamibi scintigraphy could not supply conclusive diagnostic results. The use of 18F-fluorocholine (FCH) positron emission tomography (PET)/CT provided the accurate localisation of an ectopic parathyroid adenoma in the anterior mediastinum which was successfully resected by a thoracoscopic approach. In the second case, 99mTc-sestamibi scintigraphy was inconclusive as well and FCH-PET/CT localised an ectopic parathyroid adenoma in the mediastinum and thus bilateral neck exploration could be spared. Both patients had surgical cure of their disease.

Popliteal aneurysm: diagnostic workup and results of surgical treatment.

Untreated popliteal aneurysm (PA) may cause serious complications. Early detection and surgery are beneficial. What are the circumstances under which the diagnosis of PA is made? What risks are associated with the treatment? A total of 36 consecutive PAs in 22 men and 2 women were treated in a single-center series. Altogether, 26 surgical reconstructions (group 1) were performed using a medial approach, and two PAs were resected through a dorsal approach. Eight patients with eight PAs did not undergo surgery (group 2): Two were awaiting surgery, and six had refused it. At the time of diagnosis, 25 PAs were symptomatic: local pain, swelling, or "pulsation" in the popliteal groove (29%); claudication of the foot/calf (39%); critical ischemia (21%). Eleven asymptomatic cases were discovered during screening duplex sonography of known aortic aneurysms. Among the 28 PAs that underwent surgery, 6 produced acute symptoms. The following complications were observed: five postoperative hematomas, one infected polytetrafluoroethylene (PTFE) graft, two early graft occlusions, and two significant stenoses of the distal anastomosis. After a mean follow-up of 15 months (range 2-43 months), group 1 had a limb salvage rate of 100% and a secondary patency rate of 96%. Two patients are still awaiting surgery. Critical ischemia represents an absolute indication for surgical repair, but the observed zero mortality and relatively low morbidity associated with the intervention combined with a favorable patency rate justify the liberal use of surgery even for asymptomatic PAs. The extensible medial approach is preferred. Sequential reconstruction is advised for bilateral PAs.