ABSTRACT
AIM: To improve surgical treatment of patients with multiple and flotating ribs fractures. MATERIAL AND METHODS: A comparative analysis of two groups of victims with rib fractures was carried out. 148 patients of the control group underwent conservative treatment, mechanical ventilation, skeletal traction. In 167 patients of the main group we used advanced surgical tactics based on differentiated, stepwise and combined chest stabilization including osteosynthesis of ribs and thoracoscopy. RESULTS: Immediate results for each type of stabilization were evaluated. The most durable respiratory support was observed in case of ventilation alone - internal pneumatic stabilization without surgical stabilization. Osteosynthesis of the ribs had the best outcomes compared with other methods. An efficacy of developed tactics was confirmed by significantly reduced morbidity, mortality, mechanical ventilation time and ICU-stay in main group. CONCLUSION: Surgical tactics in patients with multiple and flotating fractures of the ribs is determined by type of ribs and internal organs damage, combined trauma severity and conditions of medical care. Differentiated, stepwise and combined chest stabilization by using of high-tech methods of medical care (osteosynthesis, thoracoscopy) improves the outcomes in these patients.
Subject(s)
Fracture Fixation, Internal/methods , Rib Fractures , Thoracic Injuries/complications , Thoracoscopy/methods , Wounds, Nonpenetrating/complications , Adult , Conservative Treatment/methods , Female , Humans , Male , Middle Aged , Patient Selection , Respiration, Artificial/methods , Rib Fractures/diagnosis , Rib Fractures/etiology , Rib Fractures/surgery , Rib Fractures/therapy , Russia , Trauma Severity Indices , Treatment OutcomeABSTRACT
The authors report a case of thoracic disc herniation at T11/12 level which was downward migrated, presenting with signs of progressive spinal cord compression. The lesion was diagnosed by MRI. The operation was done by transthoracic transpleural approach using surgical microscope and the rib was not resected due to floating ribs of T11, 12. A Carbon cage with cancellous bones were used for the graft at the partial corpectomy site. The result of operation was good.
