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Patel K, Rizzo AN, Bach J, DeVoe W. Suture fixation of traumatic rib fracture flail segment with Klebsiella osteomyelitis. Trauma Case Rep 2024; 51:100996. [PMID: 38633376 PMCID: PMC11021944 DOI: 10.1016/j.tcr.2024.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
We report the case of a 71-year-old male who initially presented with urosepsis and was found to have a rib fracture of his right 6th rib with a flail segment and an associated abscess. Given the concern for infection, surgical rib fixation with titanium plating was not pursued during the washout of his abscess and instead, he successfully underwent rib fracture stabilization with bilateral suture transfixation. He was continued on a prolonged course of antibiotics for Klebsiella pneumonia osteomyelitis and was discharged uneventfully with optimal pain control and adequate respiratory effort.
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Affiliation(s)
- Krishna Patel
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
| | - Anthony N. Rizzo
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
| | - John Bach
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
| | - William DeVoe
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
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Al Tannir AH, Pokrzywa CJ, Dodgion C, Boyle KA, Eddine SBZ, Biesboer EA, Milia DJ, de Moya MA, Carver TW. Physiologic parameters and radiologic findings can predict pulmonary complications and guide management in traumatic rib fractures. Injury 2024; 55:111508. [PMID: 38521636 DOI: 10.1016/j.injury.2024.111508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/17/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Traumatic rib fracture is associated with a high morbidity rate and identifying patients at risk of developing pulmonary complications (PC) can guide management and potentially decrease unnecessary intensive care admissions. Therefore, we sought to assess and compare the utility of a physiologic parameter, vital capacity (VC), with the admission radiologic findings (RibScore) in predicting PC in patients with rib fractures. METHODS This is a single-center retrospective review (2015-2018) of all adult (≥18 years) patients admitted to a Level I trauma center with traumatic rib fracture. Exclusion criteria included no CT scan and absence of VC within 48 h of admission. The cohort was stratified into two groups based on presence or absence of PC (pneumonia, unplanned intubation, unplanned transfer to the intensive care unit for a respiratory concern, or the need for a tracheostomy). Multivariable logistic regression models were constructed to identify predictors of PC. RESULTS A total of 654 patients met the inclusion criteria of whom 70 % were males. The median age was 51 years and fall (48 %) was the most common type of injury. A total of 36 patients (5.5 %) developed a pulmonary complication. These patients were more likely to be older, had a higher ISS, and were more likely to require a tube thoracostomy placement. On multivariable logistic regression, first VC ≤30 % (AOR: 4.29), day 1 VC ≤30 % (AOR: 3.61), day 2 VC ≤30 % (AOR: 5.54), Δ(Day2-Day1 VC) (AOR: 0.96), and RibScore ≥2 (AOR: 3.19) were significantly associated with PC. On discrimination analysis, day 2 VC had the highest area under the receiver operating characteristic curve (AuROC), 0.81, and was superior to first VC and day 1 VC in predicting PC. There was no statistically significant difference in predicting PC between day 2 VC and RibScore. On multivariable analysis, first VC ≤30 %, day 1 VC ≤30 %, day 2 VC ≤30 %, and admission RibScore ≥2 were associated with prolonged hospital and ICU LOS. CONCLUSION VC and RibScore emerged as independent predictors of PC. However, VC was not found to be superior to RibScore in predicting PC. Further prospective research is warranted to validate the findings of this study.
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Affiliation(s)
- Abdul Hafiz Al Tannir
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Courtney J Pokrzywa
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher Dodgion
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Kelly A Boyle
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Savo Bou Zein Eddine
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elise A Biesboer
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - David J Milia
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Marc A de Moya
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Thomas W Carver
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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Chen K, Minasian B, Woodford E, Shivashankar P, Ho KA, Muralidaran S, Elhindi J, Hsu J. Together is better - RibScore and SCARF in the prediction of pulmonary complications and association with SSRF. Injury 2024:111562. [PMID: 38649314 DOI: 10.1016/j.injury.2024.111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Optimal treatment of patients with rib fractures requires identification of those patients at risk of pulmonary complications. It is also important to determine which patients would benefit from Surgical Stabilisation of Rib Fractures (SSRF). This study aims to validate two scoring systems (RibScore and SCARF score) in predicting complications and association with SSRF in an Australian trauma population. Clinical observation suggests that complications and criteria for SSRF is associated with anatomical and physiological factors. Therefore it is hypothesized that utilisation of an anatomical (RibScore) and physiological (SCARF) in conjunction will have improved predictive ability. METHOD Retrospective cohort study of rib fracture patients admitted to an Australian Level I trauma centre from Jan 2017 to Jan 2021. RibScore and SCARF score were calculated. Multivariate logistic regression was performed to determine risk factors associated with complications and SSRF, as well the scoring systems' ability via ROC AUC. RESULTS 1157 patients were included. Higher median RibScore (1vs0; p < 0.001) and SCARF score (3vs1, p < 0.001) was associated with development of complications. Similarly for SSRF, RibScore (3vs0; p < 0.001), SCARF score (3vs1; p < 0.001) were higher. On multivariate analysis, increasing RibScore and SCARF score were associated with an increased risk of respiratory failure, pneumonia, death, and SSRF. The sensitivity for a patient with a high risk score in either RibScore or SCARF increased to 96.3 % in identifying pulmonary complications (from 66.7 % in RibScore and 88 % in SCARF, when used individually) and 91.9 % in identifying association with SSRF (from 86.5 % in RibScore and 70.3 % in SCARF). CONCLUSION RibScore and SCARF score demonstrate predictive ability for complications and SSRF in an Australian trauma rib fracture population. Combining a radiological score with a clinical scoring system demonstrates improved sensitivity over each score individually for identifying patients at risk of complications from rib fractures, those who may require SSRF, and those who are low risk. STUDY TYPE Retrospective Cohort Study LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Kabytto Chen
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia.
| | - Bayan Minasian
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Evangeline Woodford
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Pranav Shivashankar
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Kah Ann Ho
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Saimurooban Muralidaran
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia
| | - James Elhindi
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jeremy Hsu
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia
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Navarro SM, Solaiman RH, Zhang J, Diaz-Gutierrez I, Tignanelli C, Harmon JV. Incidence of adult rib fracture injuries and changing hospitalization practice patterns: a 10-year analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02519-6. [PMID: 38592464 DOI: 10.1007/s00068-024-02519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Rib fractures are common after blunt thoracic trauma and can be associated with significant morbidity and mortality. We investigated trends of rib fracture injuries among adults presenting to United States (US) emergency departments, factors related to increased likelihood of hospitalization, and hospitalization practice patterns. METHODS We queried the National Electronic Injury Surveillance System database between 2012 and 2021 for all patients 18 years of age and older with rib fractures. These data were extrapolated to provide national estimates. Regression analysis was performed to identify trends for injury and risk factors for hospitalization. RESULTS We identified 32,233 adult patients with rib fractures; this extrapolated to a national estimate of 1,430,270 patients with rib fractures during the 10-year period. Between 2012 and 2021, there was a 52% increase in the incidence rate per 100,000 persons (R2 = 0.94, p < 0.001). Males accounted for 58% of patients with rib fractures, and 50% of patients were 65 years or older. Hospitalization was required in 38% of patients, and the hospitalization rate increased by 96% during the study period (R2 = 0.96, p < 0.001). When comparing hospitals of different sizes, a 20% greater increase in the odds of hospitalization over time was identified among patients presenting to "larger" hospitals compared to "smaller" hospitals. CONCLUSION The incidence of rib fractures and the associated hospitalization rates are both increasing nationally, with half of cases occurring in patients aged 65 years or older. Our findings emphasize the urgent need to implement evidence-based preventive measures and current management guidelines when managing the increasing caseload of rib fracture injuries.
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Affiliation(s)
- Sergio M Navarro
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
- Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | | | | | - Ilitch Diaz-Gutierrez
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Division of Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - James V Harmon
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Proctor DW, Goodall R, Borsky K, Salciccioli JD, Marshall DC, Shalhoub J. Trends in the incidence of rib and sternal fractures: A nationwide study of the global burden of disease database, 1990-2019. Injury 2024; 55:111404. [PMID: 38354687 DOI: 10.1016/j.injury.2024.111404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Fractures of the ribs and sternum are associated with significant morbidity and mortality. Characterization of the injury burden across England is necessary to inform and evaluate developments in trauma care and infrastructure, however is yet to be comprehensively undertaken. Therefore, the aim of this study was to describe trends in the incidence of sternal and rib fractures across England between 1990 and 2019. MATERIALS AND METHODS Age-standardised incidence rates (ASIRs) for rib and sternal fractures in males and females were extracted from the 2019 Global Burden of Disease (GBD) study by all causes, falls and road traffic collisions for 9 sub-regions of England. Temporal trends within the study period were analysed using Joinpoint regression analysis. RESULTS The overall ASIRs in England in 2019 were 30.34/100,000 and 46.02/100,000 for females and males, respectively. Between 1990 and 2019, the estimated overall percentage change across England was +0.20 % among females and -7.05 % among males. A statistically significant increase in ASIR was observed in all 9 sub-regions of England among females from 2014-2019 (p<0.001). Among males, a statistically significant increase in ASIR was observed in 7 of the 9 regions from 2014-2019 (p<0.001) and in the remaining 2 regions from 2015-2019 (p<0.001). DISCUSSION Increasing ASIRs of rib and sternal fractures were observed among females and decreasing ASIRs among males, with overall ASIRs higher among males. Developments in trauma infrastructure and associated variations in diagnostic and management strategies over the observation period likely contribute to changes in the national injury burden. The findings are suggestive of the importance of ongoing financial investment in trauma infrastructure and of clear clinical guidelines to manage an increasing national injury burden.
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Affiliation(s)
| | | | - Kim Borsky
- Department of Plastic Surgery, Salisbury Hospital, Salisbury, UK
| | - Justin D Salciccioli
- Imperial College London, London, UK; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | | | - Joseph Shalhoub
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
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Serapiglia VE, Patel KA, Varre JSV, Dusseau BT, DeVoe WB. Attempted repair of chest wall injury following penetrating injury with surgical stabilization rib and autologous bone graft: A case report. Trauma Case Rep 2024; 50:100984. [PMID: 38496000 PMCID: PMC10940907 DOI: 10.1016/j.tcr.2024.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 03/19/2024] Open
Abstract
Rib fractures are one of the most common injuries following blunt trauma. When associated with penetrating trauma, the projectile velocity and immense energy transfer cause significant rib fracture displacement and fragmentation. As a result, these patients are potentially exposed to an even higher risk of complications compared to those seen in more simple rib fractures. Unfortunately, there is limited research regarding technical considerations for surgical stabilization of rib fractures (SSRF) in severely displaced rib fractures with bone loss following penetrating injury. We present the case of a 21-year-old male gunshot wound victim with severely displaced and comminuted rib fractures in which we utilized an autologous bone graft bridge during SSRF to enhance fracture unionization, chest wall stability, and cosmesis. Unfortunately, the bone graft failed to incorporate into surrounding tissue.
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Affiliation(s)
- Vincent E. Serapiglia
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Krishna A. Patel
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Jaya Sai V. Varre
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Brian T. Dusseau
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - William B. DeVoe
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
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Vassalou EE, Perysinakis I, Klontzas ME, de Bree E, Karantanas AH. Performance of thoracic ultrasonography compared with chest radiography for the detection of rib fractures using computed tomography as a reference standard. Skeletal Radiol 2024:10.1007/s00256-024-04658-8. [PMID: 38499892 DOI: 10.1007/s00256-024-04658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures' detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard. MATERIALS AND METHODS Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator. All imaging examinations were evaluated for cortical rib fracture(s), and their location was recorded. The cartilaginous rib portions were not assessed. CTs and X-rays were evaluated retrospectively. Concomitant thoracic/extra-thoracic injuries were assessed on CT. Comparisons were performed with the Mann-Whitney U test and Fisher's exact test. RESULTS Fifty-nine patients (32 males, 27 females; mean age, 53.1 ± 16.6 years) were included. CT, ultrasonography, and X-ray (40 posteroanterior/19 anteroposterior views) diagnosed 136/122/42 rib fractures in 56/54/27 patients, respectively. Ultrasonography and X-ray had sensitivity of 100%/40% and specificity of 89.7%/30.9% for rib fractures' detection. Ultrasound accuracy was 94.9% compared to 35.4% for X-rays (P < .001) in detecting individual rib fractures. Most fractures involved the 4th-9th ribs. Upper rib fractures were most commonly overlooked on ultrasonography. Thoracic cage/spine fractures and haemothorax represented the most common concomitant injuries. CONCLUSION Ultrasonography appeared to be superior to X-ray for the detection of rib fractures with regard to a reference CT.
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Affiliation(s)
- Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece.
- Department of Medical Imaging, General Hospital of Sitia, Xserokamares, 72300, Sitia, Crete, Greece.
| | - Iraklis Perysinakis
- Department of Surgical Oncology, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
| | - Eelco de Bree
- Department of Surgical Oncology, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
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Nilsson J, Caragounis EC. Long-term outcome after surgical management of symptomatic non-union rib fractures. Injury 2024; 55:111297. [PMID: 38151437 DOI: 10.1016/j.injury.2023.111297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Traumatic chest wall injuries are common however the incidence of non-union rib fractures is unknown. Previous studies have suggested that surgical management of symptomatic non-union rib fractures could be beneficial in selected patients, although many experience persisting pain despite surgery. The aim of this study is to investigate the long-term outcome after surgical management of symptomatic non-union rib fractures. METHODS This is a cross-sectional study including adults (≥18 years) managed surgically for symptomatic non-union rib fractures with plate fixation during the period 2010-2020 at Sahlgrenska University Hospital. Patients operated for acute chest wall injury or injury due to cardiopulmonary resuscitation were excluded. Patients answered standardized questionnaires concerning remaining symptoms and satisfaction with surgery, quality of life (QoL, EQ-5D-5 L) and disability (Disability Rating Index, DRI). Lung function, movement of chest wall and thoracic spine, and shoulder function (Boström index) were assessed. RESULTS Sixteen patients, 12 men and four women, with mean age 61.6± 11.1 were included in the study. The mechanism of injury was trauma in 10 patients and cough-induced injuries in five patients. Lung disease was significantly more prevalent in cough-induced injuries compared to traumatic injuries, 5 vs 1 (p = 0.008). The mean follow-up time was 3.5 years. Ninety-four percent were satisfied with the surgery and reported that their symptoms had decreased, although 69 % had remaining symptoms, especially pain, from the chest wall. Quality of Life was decreased with EQ-5D-5 L index 0.819 (0.477-0.976) and EQ-VAS 69 (10-100). Disability Rating Index was 31.5 (1.3-76.7) with problems running, lifting heavy objects, and performing heavy work. Predicted lung function was decreased with Forced Vital Capacity (FVC) 86.2 ± 14.2 %, Forced Expiratory Volume in 1 second (FEV1) 79.1 ± 10.7 % and Peak Expiratory Flow (PEF) 89.7 ± 14.5 %. Patients with cough-induced injuries had full shoulder mobility. CONCLUSIONS Chest wall surgery for symptomatic non-union rib fractures results in decreased symptoms and patient satisfaction in most cases despite remaining symptoms, reduced lung function, chest wall movement, and QoL and persistent disability.
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Affiliation(s)
- Julia Nilsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Per Dubbsgatan 15, SE 413 45 Gothenburg, Sweden
| | - Eva-Corina Caragounis
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Per Dubbsgatan 15, SE 413 45 Gothenburg, Sweden.
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Zhang D, Yang Y, Yi Y, Wang D, Jiang L, Huang H, Jin L, Meng H, Xia F, Guo G. Incidence and influence factors of venous thromboembolism in traumatic rib fracture patient: a multicenter study. J Orthop Surg Res 2024; 19:152. [PMID: 38395963 PMCID: PMC10893601 DOI: 10.1186/s13018-024-04622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This study aimed to determine the incidence and influencing factors of venous thromboembolism (VTE) in patients with traumatic rib fractures. METHODS The retrospective study analyzed medical records of patients with traumatic rib fractures from 33 hospitals. RESULTS The overall incidence of VTE in hospitalized patients with traumatic rib fractures was 8.1%. Patients with isolated traumatic rib fractures had a significantly lower incidence of VTE (4.4%) compared to patients with rib fractures combined with other injuries (12.0%). Multivariate analysis identified the number of rib fractures as an independent risk factor for thrombosis. Surgical stabilization of isolated rib fractures involving three or more ribs was associated with a lower VTE incidence compared to conservative treatment. CONCLUSIONS Patients with rib fractures have a higher incidence of VTE, positively correlated with the number of rib fractures. However, the occurrence of thrombosis is relatively low in isolated rib fractures. Targeted thromboprophylaxis strategies should be implemented for these patients, and surgical stabilization of rib fractures may be beneficial in reducing the risk of VTE.
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Affiliation(s)
- Dongsheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, 050000, Hebei, China.
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Yunfeng Yi
- Department of Cardiothoracic Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, 363000, Fujian, China
| | - Dongbin Wang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin, 300211, China
| | - Lei Jiang
- The Second Department of Surgery (Thoracic and Breast Department), Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, Guangdong, China
| | - Hai Huang
- Department of Thoracic Surgery, Fuzhou Second Hospital, Fuzhou, 350007, Fujian, China
| | - Longyu Jin
- Department of Thoracic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China
| | - Hui Meng
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, 519100, Guangdong, China
| | - Fei Xia
- Department of Emergency Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Guangwei Guo
- Department of Cardiothoracic Surgery, Second Hospital of Shanxi Medical University, Taiyuan, 030000, Shanxi, China
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Capelastegui A, Oca R, Iglesias G, Larena JA. MRI in suspected chest wall fractures: diagnostic value in work-related chest blunt trauma. Skeletal Radiol 2024; 53:275-283. [PMID: 37417996 DOI: 10.1007/s00256-023-04399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To describe and analyze MRI findings in suspected early fractures of the chest (ribs and sternum) and assess if this technique can add value in occupational medicine. MATERIALS AND METHODS In this retrospective study, we reviewed 112 consecutive patients with work-related mild closed chest trauma who underwent early thoracic MRI, when there was not a clear fracture on radiograph or when the symptoms were intense and not explained by radiographic findings. MRI was evaluated by two experienced radiologists independently. The number and location of fractures and extraosseous findings were recorded. A multivariate analysis was performed to correlate the fracture characteristics and time to RTW (return-to-work). Interobserver agreement and image quality were assessed. RESULTS 100 patients (82 men, mean age 46 years, range 22-64 years) were included. MRI revealed thoracic wall injuries in 88%: rib and/or sternal fractures in 86% and muscle contusion in the remaining patients. Most patients had multiple ribs fractured, mostly at the chondrocostal junction (n=38). The interobserver agreement was excellent, with minor discrepancies in the total number of ribs fractured. The mean time to return-to-work was 41 days, with statistically significant correlation with the number of fractures. Time to return-to-work increased in displaced fractures, sternal fractures, extraosseous complications, and with age. CONCLUSION Early MRI after work-related chest trauma identifies the source of pain in most patients, mainly radiographically occult rib fractures. In some cases, MRI may also provide prognostic information about return-to-work.
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Affiliation(s)
- Ana Capelastegui
- Department of Radiology, Mutualia, Bilbao, Spain.
- Department of Radiology, Osatek Galdakao-Usansolo, Galdakao, Spain.
| | - Roque Oca
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Osatek Deusto, Bilbao, Spain
| | - Gotzon Iglesias
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Cruces Hospital, Barakaldo, Spain
| | - Jose Alejandro Larena
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Osatek Galdakao-Usansolo, Galdakao, Spain
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Ahn S, Lee S, Kim S, Moon S, Cho H, Shin HJ, Park JH. Risk factors for delayed hemothorax in patients with rib fracture in the emergency department. Am J Emerg Med 2024; 76:173-179. [PMID: 38086183 DOI: 10.1016/j.ajem.2023.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/01/2023] [Accepted: 11/25/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES Although rib fractures are a risk factor, not all rib fracture patients will develop delayed hemothorax. This study aimed to evaluate risk factors which can identify rib fracture patients in the emergency department who may develop delayed hemothorax. METHODS Adult patients seen in the emergency room between January 2016 and February 2021 with rib fractures caused by blunt chest trauma were included in this retrospective observational study. Patients who underwent chest tube insertion within 2 days and those without follow-up chest radiographs within 2-30 days were excluded. We used a stepwise backward-elimination multivariable logistic regression model for analysis. RESULTS A total of 202 patients were included in this study. The number of total (P < 0.001), lateral (P = 0.019), and displaced (P < 0.001) rib fractures were significantly associated with delayed hemothorax. Lung contusions (P = 0.002), and initial minimal hemothorax (P < 0.001) and pneumothorax (P < 0.001) were more frequently associated with delayed hemothorax. Age (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.00-1.06, P = 0.022), mechanical ventilator use (aOR 9.67, 95% CI 1.01-92.75, P = 0.049), initial hemothorax (aOR 2.21, 95% CI 1.05-4.65, P = 0.037) and pneumothorax (aOR 2.99, 95% CI 1.36-6.54, P = 0.006), and displaced rib fractures (aOR 3.51, 95% CI 1.64-7.53, P = 0.001) were independently associated with delayed hemothorax. CONCLUSIONS Age, mechanical ventilation, initial hemo- or pneumothorax, and displaced rib fractures were risk factors for delayed hemothorax. Patients with these risk factors, and especially those with ≥2 displaced rib fractures, require close chest radiography follow-up of 2-30 days after the initial trauma.
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Affiliation(s)
- Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sungjin Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Myeongju Hospital, Yongin, Republic of Korea.
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
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Gupta R, Judkins L, Friday CS, Ulsh JB, Kovach SJ, Mehta S, Tomonto C, Manogharan G, Hast MW. Functionally graded 3D printed plates for rib fracture fixation. Clin Biomech (Bristol, Avon) 2024; 111:106151. [PMID: 37989063 PMCID: PMC10842059 DOI: 10.1016/j.clinbiomech.2023.106151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Design freedom offered by additive manufacturing allows for the implementation of functional gradients - where mechanical stiffness is decreased along the length of the implant. It is unclear if such changes will influence failure mechanisms in the context of rib fracture repair. We hypothesized that our novel functionally graded rib implants would be less stiff than controls and decrease occurrence of secondary fracture at implant ends. METHODS Five novel additively manufactured rib implants were tested along with a clinically used Control implant. Fracture reconstructions were modeled with custom synthetic rib bones with a transverse B1 fracture. Ribs were compressed in a cyclic two-point bend test for 360,000 cycles followed by a ramp to failure test. Differences in cyclic stiffness, 3D interfragmentary motions, ramp-to-failure stiffness, maximum load, and work to failure were determined. FINDINGS The Control group had lower construct stiffness (0.76 ± 0.28 N/mm), compared to all novel implant designs (means: 1.35-1.61 N/mm, p < 0.05) and rotated significantly more about the bending axis (2.7° ± 1.3°) than the additively manufactured groups (means between 1.2° - 1.6°, p < 0.05). All constructs failed via bone fracture at the most posterior screw hole. Experimental implants were stiffer than Controls, and there were few significant differences between functional gradient groups. INTERPRETATION Additively manufactured, functionally graded designs have the potential to change the form and function of trauma implants. Here, the impact of functional gradients was limited because implants had small cross-sectional areas.
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Affiliation(s)
- Richa Gupta
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Judkins
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Chet S Friday
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph B Ulsh
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Kovach
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Samir Mehta
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Guha Manogharan
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Michael W Hast
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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Preda T, Nafi M, Villa M, Cassina T. Traumatic injuries after manual and automatic mechanical compression during cardiopulmonary resuscitation, a retrospective cohort study. Resusc Plus 2023; 16:100465. [PMID: 37711684 PMCID: PMC10497787 DOI: 10.1016/j.resplu.2023.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Chest compressions during advanced cardiac life support is a life-saving, potential harmful procedure with high incidence of severe and life-threatening injuries. Previous studies suggest a possible correlation between the increased incidence of chest and/or abdominal trauma and the use of automatic mechanical compression devices. Methods An observational monocentric retrospective cohort study was conducted including all patients admitted to our Intensive Care Unit suffering from out-of-hospital cardiac arrest (OHCA) in Canton Ticino (Switzerland) from 2012 to 2021. The primary endpoint was to describe any resuscitation-related body injury. The secondary endpoints were to explore possible predictors of cardiopulmonary resuscitation (CPR) related injuries and their association with the 30-day mortality. Results We included 335 patients, 287 treated with manual chest compressions, 48 mechanically assisted. 55.5% of all resuscitated patients presented severe, or life-threatening lesions. Skeletal and thoracic injuries were the most frequent lesions followed by abdominal injuries. Mechanical assisted resuscitated patients presented higher risk of bleeding (OR 5.9; 95% CI 2.9-11.6) and increased CPR-related injuries (aOR 6.2; 95% CI 2.5-15.4) compared to standard manual chest compressions. In particular higher number of extra-thoracic and life-threatening lesions were described among the mechanical assisted CPR group. Patients with life-threatening had statistically significant higher mortality at 30-days compared to the severe and lesion's free cohort. Conclusion Traumatic lesions occurred frequently after chest compression and their severity was associated with increased 30-day mortality. Mechanical devices, compared to manual chest compression, appear to be more harmful and may play a role in causing body lesions and hemorrhagic events.
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Affiliation(s)
- Thierry Preda
- Università della Svizzera Italiana (USI), Lugano, Switzerland
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Matteo Nafi
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michele Villa
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tiziano Cassina
- Università della Svizzera Italiana (USI), Lugano, Switzerland
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Ferreira ROM, Pasqualotto E, Viana P, Schmidt PHS, Andrighetti L, Chavez MP, Flausino F, de Oliveira Filho GR. Surgical versus non-surgical treatment of flail chest: a meta-analysis of randomized controlled trials. Eur J Trauma Emerg Surg 2023; 49:2531-2541. [PMID: 37526708 DOI: 10.1007/s00068-023-02339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Conflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment. METHODS Embase, PubMed, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing surgery to no surgery in patients with acute unstable chest wall injuries. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Random effects meta-analyses were performed. Heterogeneity was assessed using I2 statistics. RESULTS Six RCTs (544 patients) were included, and surgical treatment was used in 269 (49.4%). Compared to no surgery, surgery reduced mechanical ventilation days (WMD - 4.34, 95% CI - 6.98, - 1.69; p < 0.01; I2 = 87%; GRADE: very low; PI - 13.51, 4.84); length of intensive care unit stay (WMD - 4.62, 95% CI - 7.19, - 2.05; p < 0.01; I2 = 78%; GRADE: low; PI - 12.86, 3.61) and the incidence of pneumonia (RR 0.50, 95% CI 0.31, 0.81; p = 0.005; I2 = 54%; GRADE: moderate; PI 0.13, 1.91). No difference in mortality (RR 0.56, 95% CI 0.19, 1.65; p = 0.27; I2 = 23%; GRADE: moderate; PI 0.04, 7.25), length of hospital stay (WMD - 5.39, 95% CI - 11.38, - 0.60; p = 0.08; I2 = 89%; GRADE: very low; PI - 11.38, 0.60), or need for tracheostomy (RR 0.59, 95% CI 0.34, 1.03; p = 0.06; I2 = 54%; GRADE: moderate; PI 0.11, 3.24) was found. CONCLUSIONS Our results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures.
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Affiliation(s)
- Rafael Oliva Morgado Ferreira
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil.
| | - Eric Pasqualotto
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
| | - Patrícia Viana
- University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil
| | | | - Leonardo Andrighetti
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
| | - Matheus Pedrotti Chavez
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
| | - Felippe Flausino
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
- Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil
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Wang Z, Wang G, Jing B, Feng S, Zhang S, Wu D, Song Z, Niu L, Qi B. Does the timing of surgery affect outcomes in young and middle-aged patients undergoing surgical stabilization of rib fractures? Feedback was based on real data from physicians, patients, and family caregivers. Eur J Trauma Emerg Surg 2023; 49:2467-2477. [PMID: 37436467 DOI: 10.1007/s00068-023-02321-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND There is a general clinical consensus that early surgical stabilization of rib fractures (SSRF, ≤ 48-72 h after admission) can benefit patients, and this is only regarding the surgeon's opinions. This study assessed the true outcomes of young and middle-aged patients at different surgical timings. METHODS This retrospective cohort study was conducted among patients aged 30-55 years who were hospitalized with a diagnosis of isolated rib fractures and underwent SSRF between July 2017 and September 2021. The patients were divided into early (≤ 3 days), mid- (4-7 days) and late (8-14 days) groups, according to the interval (days) between surgery and injury date. The impact of different surgical timings on clinical outcomes, patients, and families was assessed by comparing SSRF-related data during hospitalization and follow-up studies of clinicians, patients themselves, and family caregivers 1-2 months after surgery. RESULTS In this study, 155 complete patient data were finally included, including 52, 64, and 39 patients in the early, mid, and late groups, respectively. Length of operation, preoperative closed chest drainage rate, length of hospital stay, intensive care unit length of stay, duration of invasive mechanical ventilation in the early group were lower than those in the intermediate and late groups. Additionally, hemothorax and excess pleural fluid incidence after SSRF was lower in the early group than in the intermediate and late groups. Postoperative follow-up results showed that patients in the early group had higher SF-12 physical component summary scores and shorter duration of absence from work. Family caregivers had lower Zarit Burden Interview scores than those in the mid- and late groups. CONCLUSION From the experience of our institution's SSRF, early surgery is safe and offers additional potential benefits for young and middle-aged patients and families with isolated rib fractures.
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Affiliation(s)
- Zhimeng Wang
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Gang Wang
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Baoli Jing
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Shanghua Feng
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Shaobo Zhang
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Dinghua Wu
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Zhe Song
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Lin Niu
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China
| | - Bin Qi
- Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China.
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O'Connor LA, Houseman B, Cook T, Quinn CC. Intercostal cryonerve block versus elastomeric infusion pump for postoperative analgesia following surgical stabilization of traumatic rib fractures. Injury 2023; 54:111053. [PMID: 37741705 DOI: 10.1016/j.injury.2023.111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Patients with blunt thoracic trauma requiring surgical stabilization of rib fractures (SSRF) frequently experience severe pain. Further, a rising prevalence of opioid-tolerant patients sustain traumatic injuries. The optimal pain management adjunct for concurrent use with SSRF remains uncertain. This study compared outcomes in patients undergoing SSRF with concomitant cryonerve block (CryoNB) or ropivacaine 0.2% elastomeric infusion pump (EIP). METHODS A single-center retrospective comparative analysis was performed at a level II trauma center. A query of our institution's trauma registry of consecutive patients undergoing SSRF from October 2017 to November 2020 with either intercostal CryoNB or ropivacaine 0.2% EIP was conducted. Opioid consumption in oral morphine equivalents (OME), patient-reported pain scores by numerical rating scale, and pulmonary function measured by incentive spirometry effort (mL) were collected at baseline and on postoperative days 1-3. Results were analyzed using a linear-mixed-effects model. Length of stay (LOS), complications, and hospital charges were assessed as secondary outcomes. RESULTS Twenty-six patients meeting inclusion criteria were evaluated. Patient demographics, injury, and surgical variables were similar between groups. The estimated effect for patients treated with CryoNB (n = 14) compared to EIP (n = 12) demonstrated a 25% (estimated -1.37 OME, 95% CI, -2.411 to -0.335, p = 0.01) reduction in hospital opioid requirements, fewer discharge opioids (41.3 mg (37.5-45) versus 175 mg (150- 200), p = 0.03), 22% (estimated -1.506, 95% CI, -2.722 to -0.290, p = 0.02) reduction in pain scores, and shorter postoperative LOS (4 days (4-5) versus 6 days (5-9.5), p = 0.04). Pulmonary function (estimated -48.8 mL, 95% CI, -312.74 to 215.05, p = 0.71), total hospital costs (CryoNB: $90,224 ± 34,633; EIP: $131,498 ± 73,072, p = 0.07), and complications were no different between cohorts. CONCLUSION The addition of intercostal CryoNB as an adjunct to multimodal pain management in trauma patients undergoing surgical fixation of rib fractures may be of benefit. Based on our early data, this technique appears to be promising in reducing opioid requirements and providing an extended duration of pain control without increased costs or complications.
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Affiliation(s)
- Lizabeth A O'Connor
- Elliot Health System, Division of Thoracic Surgery, 1 Elliot Way, Manchester, NH 03103, United States.
| | - Bryan Houseman
- Elliot Health System, Division of Orthopedic Trauma, 1 Elliot Way, Manchester, NH 03103, United States
| | - Thomas Cook
- University of Massachusetts Amherst, Department of Mathematics and Statistics, Lederle Graduate Research Tower, 1623D, University of Massachusetts Amherst, 710N. Pleasant Street, Amherst, MA 01003, United States
| | - Curtis C Quinn
- Elliot Health System, Division of Thoracic Surgery, 1 Elliot Way, Manchester, NH 03103, United States
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Kita N, Tomita N, Takaoka T, Matsuura A, Okazaki D, Niwa M, Torii A, Takano S, Mekata Y, Niimi A, Hiwatashi A. Symptomatic radiation-induced rib fractures after stereotactic body radiotherapy for early-stage non-small cell lung cancer. Clin Transl Radiat Oncol 2023; 43:100683. [PMID: 37790583 PMCID: PMC10543765 DOI: 10.1016/j.ctro.2023.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
Background and purpose The present study investigated the relationships between the risk of radiation-induced rib fractures (RIRF) and clinical and dosimetric factors in stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We also examined dosimetric parameters associated with symptomatic or asymptomatic RIRF and the dosimetric threshold for symptomatic RIRF. Materials and methods We reviewed 244 cases of early-stage NSCLC treated with SBRT. Gray's test and the Fine-Gray model were performed to examine the relationships between clinical and dosimetric factors and grade ≥ 2 (i.e., symptomatic) RIRF. The effects of each dose parameter on grade ≥ 1 and ≥ 2 RIRF were assessed with the Fine-Gray model. The t-test was used to compare each dose parameter between the grade 1 and grade ≥ 2 groups. Optimal thresholds were tested using receiver operating characteristic (ROC) curves. Results With a median follow-up period of 48 months, the 4-year cumulative incidence of grade ≥ 1 and grade ≥ 2 RIRF were 26.4 % and 8.0 %, respectively. Regarding clinical factors, only age was associated with the development of grade ≥ 2 RIRF (p = 0.024). Among dosimetric parameters, only V40Gy significantly differed between the grade 1 and grade ≥ 2 groups (p = 0.015). The ROC curve analysis of grade ≥ 2 RIRF showed that the optimal diagnostic thresholds for D3cc, D4cc, D5cc, and V40Gy were 45.86 Gy (area under the curve [AUC], 0.706), 39.02 Gy (AUC, 0.705), 41.62 Gy (AUC, 0.702), and 3.83 cc (AUC, 0.730), respectively. These results showed that V40Gy ≤ 3.83 cc was the best indicator of grade ≥ 2 RIRF. The 4-year incidence of grade ≥ 2 RIRF in the V40Gy ≤ 3.83 cc vs. > 3.83 cc groups was 1.8 % vs. 14.2 % (p = 0.001). Conclusion The present results recommend V40Gy ≤ 3.83 cc as the threshold for grade ≥ 2 RIRF in SBRT.
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Affiliation(s)
- Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akane Matsuura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Yuji Mekata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Kishawi SK, Badrinathan A, Towe CW, Ho VP. Associations Between Psychiatric Diagnoses on Length of Stay and Mortality After Rib Fracture: A Retrospective Analysis. J Surg Res 2023; 291:213-220. [PMID: 37453222 DOI: 10.1016/j.jss.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/02/2023] [Accepted: 05/13/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Concurrent psychiatric diagnoses adversely impact outcomes in surgical patients, but their relationship to patients with rib fracture after trauma is less understood. We hypothesized that psychiatric comorbidity would be associated with increases in hospital length of stay (LOS) and mortality risk after rib fracture. MATERIALS AND METHODS The 2017 National Inpatient Sample was queried for adult patients who were admitted with rib fracture after trauma. Mental health disorders were categorized into 34 psychiatric diagnosis groups (PDGs) using clinical classifications software refined for International Classification of Diseases-10. Outcomes of interest were LOS and mortality. Bivariable analysis determined associations between PDGs, patient demographics, hospital characteristics, and outcomes. Logistic regression was performed to identify adjusted effects on mortality, and linear regression was performed to identify effects on LOS. RESULTS Of 32,801 patients, median age was 61 y (IQR 46-76), and median LOS was 5 d (IQR 3-9). No PDGs were associated with increased odds of mortality. Concurrent diagnosis of schizophrenia spectrum (Coeff. 3.5, 95% CI 2.7-4.4, P < 0.001) or trauma- or stressor-related (Coeff. 1.6, 95% CI 0.9-2.5, P < 0.001) disorders demonstrated the greatest association with prolonged LOS. Increased odds of death and prolonged hospital stay were also associated with male sex, non-White patient race, and surgery occurring at urban and public hospitals. CONCLUSIONS Psychiatric comorbidities are associated with death after rib fracture but are associated with increased LOS. These findings may help promote multidisciplinary patient management in trauma.
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Affiliation(s)
- Sami K Kishawi
- Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio; Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Avanti Badrinathan
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vanessa P Ho
- Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.
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Franco H, Williamson F, Manzanero S, Schuetz M. Clavicle fixation to reduce short-term analgesia and improve respiratory function in patients with chest wall injuries. Arch Orthop Trauma Surg 2023; 143:6561-6567. [PMID: 37401951 PMCID: PMC10542300 DOI: 10.1007/s00402-023-04952-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION The objective of this study was to determine if operative fixation of clavicle fractures in patients with non-operatively treated ipsilateral rib fractures is associated with a lower overall analgesic requirement and improved respiratory function. MATERIALS AND METHODS A retrospective matched cohort study was conducted involving patients admitted to a single tertiary trauma centre having sustained a clavicle fracture with ipsilateral rib fracture/s between January 2014 and June 2020. Patients were excluded if brain, abdominal, pelvic, or lower limb trauma was identified. 31 patients with operative clavicle fixation (study group) were matched 1:1 to 31 patients with non-operative management of the clavicle fracture (control group) based on age, sex, number of rib fractures and injury severity score. The primary outcome was the number of analgesic types used, and the secondary outcome was respiratory function. RESULTS The study group required a mean of 3.50 types of analgesia prior to surgery which decreased to 1.57 post-surgery. The control group required 2.92 types of analgesia, reducing to 1.65 after the date of surgery in the study group. A General Linear Mixed Model indicated that the intervention (operative vs. non-operative management) had statistically significant effects on the number of required analgesic types (p < 0.001, [Formula: see text] = 0.365), oxygen saturation (p = 0.001, [Formula: see text] = 0.341, 95% CI 0.153-0.529) and temporal decline in daily supplemental oxygen requirement (p < 0.001, [Formula: see text] = 0.626, 95% CI 0.455-0.756). CONCLUSION This study supported the hypothesis that operative clavicle fixation reduces short-term in-patient analgesia use and improves respiratory parameters in patients with ipsilateral rib fractures. LEVEL OF EVIDENCE Level III therapeutic study.
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Affiliation(s)
- Helena Franco
- Trauma Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
- Orthopaedic Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
| | - Frances Williamson
- Trauma Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Emergency and Trauma Center, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - Silvia Manzanero
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Australian Institute of Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Schuetz
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Orthopaedic Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
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20
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Tokumaru T, Kurata H, Mitsui J, Tomioka J. Radical surgery for intractable thoracic empyema complicating traumatic pneumothorax and rib fractures. Surg Case Rep 2023; 9:185. [PMID: 37872459 PMCID: PMC10593627 DOI: 10.1186/s40792-023-01765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Few cases of traumatic pneumothorax complicated by thoracic empyema have been reported. The indication of antibiotic prophylaxis administration for traumatic pneumothorax during tube thoracostomy remains controversial, and thoracic injury complicated by empyema can be life-threatening and intractable. CASE PRESENTATION A 42-year-old male patient was injured during a collision with a passenger car while driving a motorcycle. The patient (body mass index, 37 kg/m2) was diagnosed with right first-to-sixth-rib fractures without a flail segment, right clavicle fracture, and slight hemopneumothorax. Tube thoracostomy was performed for traumatic pneumothorax on day 3 without antibiotic prophylaxis. The patient demonstrated a progressive displaced rib fracture complicated by empyema on day 11. Radical surgery was performed for the empyema with rib fixation on day 15. The postoperative course was uneventful, and the patient was discharged from the hospital on day 31. CONCLUSIONS A traumatic pneumothorax can be complicated by empyema. Thoracic injuries complicated by empyema can be life-threatening and intractable. Antibiotic prophylaxis for traumatic pneumothorax with tube thoracotomy should therefore be considered in select cases. The strategy for thoracic injury requires the assumption of an occult thoracic infection and chest wall instability.
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Affiliation(s)
- Teppei Tokumaru
- Emergency and Critical Care Center, Yamaguchi Prefectural Grand Medical Center, Osaki, Hofu City, Yamaguchi, 10077747-8511, Japan.
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan.
| | - Hideaki Kurata
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan
| | - Jin Mitsui
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan
| | - Joji Tomioka
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan
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21
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Ouwerkerk JJ, Argandykov D, Gerban A, Proaño-Zamudio JA, Dorken-Gallastegi A, Hwabejire JO, Kaafarani HM, Velmahos GC, Parks J. Delayed hemothorax readmissions after rib fracture in blunt trauma patients. J Clin Orthop Trauma 2023; 45:102259. [PMID: 37872975 PMCID: PMC10589369 DOI: 10.1016/j.jcot.2023.102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Background Rib fractures are the most common traumatic injury. Hemothorax is one of the widespread complications associated with a rib fracture and occurs in 10-37 % of all rib fractures. Delayed hemothorax (DHTX) is defined as an accumulation of blood within the pleural cavity. Although there is extensive literature on hemothorax, there is limited literature on rib fractures and DHTX readmissions. The objective of this study was to identify potential risk factors for DHTX readmission and examine descriptive information on readmission. Methods Using the 2016-2019 National Readmission Database (NRD), patients that experienced an admission with a blunt traumatic rib fracture were included. It was determined if the patients experienced DHTX by screening for an admission containing an ICD-10 code for hemothorax within 30 days after an admission containing a ICD-10 code for rib fracture. Univariable and multivariable analysis was performed to determine independent risk factors associated with DHTX readmission. Additionally, information on the clinical and financial characteristics of DHTX readmissions were examined. Results A total of 242,071 patients were included, of whom 635 experienced DHTX readmission ≤30 days after discharge. Diagnosed with hemothorax on the index admission had the largest odds ratio for DHTX readmission (7.43 [6.14-8.99], P < 0.001). Complications found during DHTX readmission included acute respiratory failure (16.9 %), sepsis (6.9 %), and empyema (4.3 %). Treatment mainly consisted of pleural drainage (62.2 %) and video-assisted thoracoscopic surgery (VATS) evacuation of hemothorax (10.1 %). Conclusion Patients admitted for a rib fracture have a low incidence for DHTX readmission within 30 days. However, multivariable analysis has demonstrated some risk and protective factors associated with DHTX readmission. Further studies should focus on exploring these risk factors to screen for potential DHTX readmission and/or protective factors to decrease the change for DHTX readmission.
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Affiliation(s)
- Joep J.J. Ouwerkerk
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Trauma Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Dias Argandykov
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony Gerban
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jefferson A. Proaño-Zamudio
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ander Dorken-Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John O. Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Haytham M.A. Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George C. Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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22
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Sun H, Wang X, Li Z, Liu A, Xu S, Jiang Q, Li Q, Xue Z, Gong J, Chen L, Xiao Y, Liu S. Automated Rib Fracture Detection on Chest X-Ray Using Contrastive Learning. J Digit Imaging 2023; 36:2138-2147. [PMID: 37407842 PMCID: PMC10501970 DOI: 10.1007/s10278-023-00868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
To develop a deep learning-based model for detecting rib fractures on chest X-Ray and to evaluate its performance based on a multicenter study. Chest digital radiography (DR) images from 18,631 subjects were used for the training, testing, and validation of the deep learning fracture detection model. We first built a pretrained model, a simple framework for contrastive learning of visual representations (simCLR), using contrastive learning with the training set. Then, simCLR was used as the backbone for a fully convolutional one-stage (FCOS) objective detection network to identify rib fractures from chest X-ray images. The detection performance of the network for four different types of rib fractures was evaluated using the testing set. A total of 127 images from Data-CZ and 109 images from Data-CH with the annotations for four types of rib fractures were used for evaluation. The results showed that for Data-CZ, the sensitivities of the detection model with no pretraining, pretrained ImageNet, and pretrained DR were 0.465, 0.735, and 0.822, respectively, and the average number of false positives per scan was five in all cases. For the Data-CH test set, the sensitivities of three different pretraining methods were 0.403, 0.655, and 0.748. In the identification of four fracture types, the detection model achieved the highest performance for displaced fractures, with sensitivities of 0.873 and 0.774 for the Data-CZ and Data-CH test sets, respectively, with 5 false positives per scan, followed by nondisplaced fractures, buckle fractures, and old fractures. A pretrained model can significantly improve the performance of the deep learning-based rib fracture detection based on X-ray images, which can reduce missed diagnoses and improve the diagnostic efficacy.
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Affiliation(s)
- Hongbiao Sun
- Department of Radiology, Shanghai Changzheng Hospital, Navy Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Xiang Wang
- Department of Radiology, Shanghai Changzheng Hospital, Navy Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Zheren Li
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai United Imaging Intelligence Co., Ltd., No.701, Yunjin Road, Xuhui District, Shanghai, 200232, China
| | - Aie Liu
- Shanghai United Imaging Intelligence Co., Ltd., No.701, Yunjin Road, Xuhui District, Shanghai, 200232, China
| | - Shaochun Xu
- Department of Radiology, Shanghai Changzheng Hospital, Navy Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Qinling Jiang
- Department of Radiology, Shanghai Changzheng Hospital, Navy Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Qingchu Li
- Department of Radiology, Shanghai Changzheng Hospital, Navy Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Zhong Xue
- Shanghai United Imaging Intelligence Co., Ltd., No.701, Yunjin Road, Xuhui District, Shanghai, 200232, China
| | - Jing Gong
- Departments of Radiology, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Lei Chen
- Shanghai United Imaging Intelligence Co., Ltd., No.701, Yunjin Road, Xuhui District, Shanghai, 200232, China.
| | - Yi Xiao
- Department of Radiology, Shanghai Changzheng Hospital, Navy Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
| | - Shiyuan Liu
- Department of Radiology, Shanghai Changzheng Hospital, Navy Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
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23
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Schmelzer K, Ziegenhain F, Canal C, Pape HC, Neuhaus V. [Bilateral thoracic trauma-"double the trouble"?]. Chirurgie (Heidelb) 2023; 94:789-795. [PMID: 37268786 PMCID: PMC10447262 DOI: 10.1007/s00104-023-01891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and managing resources in thoracic trauma. OBJECTIVE The aim of the study was to analyze concomitant injuries in unilateral and bilateral rib fractures and pulmonary contusions and evaluate differences in complication rates between the two. MATERIAL AND METHODS In a retrospective study, data from all patients diagnosed with thoracic trauma at a level I trauma center were analyzed. Bivariate and multivariate analysis were used to examine an association of unilateral or bilateral rib fractures, serial rib fractures, and pulmonary contusions with multiple injuries and outcomes. In addition, multivariate regression analysis was utilized to determine the impact of age, gender and additional injuries on outcome. RESULTS A total of 714 patients were included in the analysis. The mean Injury Severity Score (ISS) was 19. Patients with an additional thoracic spine injury had a significantly higher incidence of bilateral rib fractures. Pulmonary contusions were associated with younger age. Abdominal injuries were predictors for bilateral pulmonary contusions. Complications occurred in 36% of the patients. Bilateral injuries increased the complication rate up to 70%. Pelvic and abdominal injuries as well as the need for a chest drain were significant risk factors for complications. The mortality rate was 10%, with higher age, head and pelvic injuries as predictors. CONCLUSION Patients with bilateral chest trauma had an increased incidence of complications and a higher mortality rate. Bilateral injuries and significant risk factors must therefore be considered. Injury of the thoracic spine should be excluded in those patients.
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Affiliation(s)
- Katharina Schmelzer
- Chirurgische Klinik, Kantonsspital Glarus (KSGL), Burgstr. 99, 8750, Glarus, Schweiz
| | - Franziska Ziegenhain
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistr. 100, 8091, Zürich, Schweiz
| | - Claudio Canal
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistr. 100, 8091, Zürich, Schweiz
| | - Hans-Christoph Pape
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistr. 100, 8091, Zürich, Schweiz
| | - Valentin Neuhaus
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistr. 100, 8091, Zürich, Schweiz.
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24
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Liu HY, Lin TH, Chen KC, Hsiao WL, Hu RH, Liao HC. Comparison between non-surgical and surgical management of rib fractures in major trauma patients without brain injuries. Am J Surg 2023; 226:350-355. [PMID: 37263888 DOI: 10.1016/j.amjsurg.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study aimed to evaluate the different outcomes between the non-surgical and surgical groups in patients with major trauma without brain injuries. METHODS This study prospectively collected data from patients with traumatic rib fractures without brain injuries from June 2017 to November 2019. The primary outcomes were the pain score at admission and discharge and the length of hospital stay. We performed multiple regression analysis to compare the outcomes and surgical risk as the severity of chest trauma between both groups. RESULTS Fifty-three patients were enrolled. There was no statistically significant difference in baseline characteristics between both groups. However, the surgical group had more severe chest trauma than the non-surgical group. After the analysis, the pain score improved significantly in the surgical group. The hospital stay of the surgical group was four days shorter than that of the non-surgical group, and there was severe chest trauma in the surgical group. CONCLUSIONS Surgical management of rib fractures can reduce pain and hospital stay in major trauma patients.
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Affiliation(s)
- Hao-Yun Liu
- Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Hsin Lin
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Chi Liao
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
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25
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刘 想, 谢 辉, 许 玉, 张 晓, 陶 晓, 柳 林, 王 霄. [Value of artificial intelligence in the improvement of diagnostic consistency of radiology residents]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:670-675. [PMID: 37534650 PMCID: PMC10398781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To explore the value of artificial intelligence (AI) in improving the detection rate of traumatic rib fractures by radiologist residents and the consistency among different readers. METHODS Chest CT images of 393 patients with acute trauma from China-Japan Union Hospital of Jilin University (hospital 02) and Shanghai Ninth People' s Hospital (hospital 03) were collected in this research. The consensus achieved by three radiology experts was regarded as the reference standard. All the images assigned to three hospitals: Peking University First Hospital (hospital 01), hospital 02 and hospital 03, and were then randomly divided into two groups (group A and group B: group A included 197 patients, and group B included 196 patients). Each group was read by one radiologist resident from each hospital for rib fracture detection. Each case was read twice by the same radiologist, with and without the assistance of the AI ["radiologist-only" reading and "radiologist + AI" reading]. The detection rates of different types of rib fractures (displaced fractures and occult fractures) were compared between "radiologist-only" reading and "radiologist + AI" reading. The consistencies of different radiologists with different reading methods were evaluated. RESULTS The detection rates of displaced rib fractures and occult rib fractures by "radiologist + AI" reading were significantly higher than those read by "radiologist-only" reading (94.56% vs. 78.40%, 76.60% vs. 49.42%, P < 0.001). For "radiologist-only reading", the Kappa coefficients of the radiologists between hospital 01 and hospital 03 were slightly greater than 0.4 (indicating moderate consistency), the coefficients of the radiologists between hospital 01/hospital 02 and hospital 02/hospital 03 were less than 0.4 (indicating poor consistency). The Phi coefficients of the radiologists among different hospitals were all less than 0.6 (indicating moderate correlation). With "radiologist + AI" reading, the Kappa and Phi coefficient among the radiologists in dif-ferent hospitals were greater than or equal to 0.6 (indicating good consistency and correlation). CONCLUSION AI software can be used to automatically detect suspected rib fracture lesions, which helps to improve the detection rate of fracture lesions and the consistency among different readers.
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Affiliation(s)
- 想 刘
- 北京大学第一医院医学影像科,北京 100034Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - 辉辉 谢
- 北京大学第一医院医学影像科,北京 100034Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - 玉峰 许
- 北京大学第一医院医学影像科,北京 100034Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - 晓东 张
- 北京大学第一医院医学影像科,北京 100034Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - 晓峰 陶
- 上海交通大学医学院附属第九人民医院影像科,上海 200011Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - 林 柳
- 吉林大学中日联谊医院影像科,长春 130000Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun 130000, China
| | - 霄英 王
- 北京大学第一医院医学影像科,北京 100034Department of Radiology, Peking University First Hospital, Beijing 100034, China
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Li Y, Jiang K, Zhao T, Guo X, Liu K, Zhao Y. If we should remove internal fixation devices for rib fractures? J Cardiothorac Surg 2023; 18:214. [PMID: 37403105 DOI: 10.1186/s13019-023-02330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Internal fixation for rib fractures has been widely carried out worldwide, and its surgical efficacy has been recognized. However, there is still controversy about whether implant materials need to be removed. At present, the research on this topic is still lacking at home and abroad. Therefore, in this study, the patients undergoing removal of internal fixation for rib fractures in our department within one year were followed up, to statistically analyze implant-related complications, postoperative complications and postoperative remission rate. METHODS A retrospective analysis was conducted on 143 patients undergoing removal of internal fixation for rib fractures from 2020 to 2021 in our center. The implant-related complications, postoperative complications and postoperative remission rate of patients with internal fixation were analyzed. RESULTS In this study, a total of 143 patients underwent removal of internal fixation, among which 73 suffered from preoperative implant-related complications (foreign-body sensation, pain, wound numbness, sense of tightness, screw slippage, chest tightness, implant rejection), and 70 had no post operative discomfort but asked for removal of internal fixation. The average interval between rib fixation and removal was 17 ± 9.00 (months), and the average number of removed materials was 5.29 ± 2.42. Postoperative complications included wound infection (n = 1) and pulmonary embolism (n = 1). of the 73 patients with preoperative implant-related complications, the mean postoperative remission rate was 82%. Among the 70 patients without preoperative discomfort, the proportion of discomforts after removal was 10%. No perioperative death occurred. CONCLUSION For patients with internal fixation for rib fractures, removal of internal fixation can be considered in the case of implant-related complications after surgery. The corresponding symptoms can be relieved after removal. The removal presents low complication rate, and high safety and reliability. For patients without obvious symptoms, it is safe to retain the internal fixation in the body. For the asymptomatic patients who ask for removal of internal fixation, the possible risk of complications should be fully informed before removal.
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Affiliation(s)
- Yang Li
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Kaile Jiang
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Tiancheng Zhao
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China.
| | - Xiang Guo
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Kaibin Liu
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yonghong Zhao
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
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Tomesch AJ, Negaard M, Keller-Baruch O. Chest and Thorax Injuries in Athletes. Clin Sports Med 2023; 42:385-400. [PMID: 37208054 DOI: 10.1016/j.csm.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Injuries to the chest and thorax are rare, but when they occur, they can be life-threatening. It is important to have a high index of suspicion to be able to make these diagnoses when evaluating a patient with a chest injury. Often, sideline management is limited and immediate transport to a hospital is indicated.
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Affiliation(s)
- Alexander J Tomesch
- Department of Emergency Medicine, University of Missouri, Columbia, MO, USA.
| | - Matthew Negaard
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA; Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA. https://twitter.com/MattNegaard
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28
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Jiang J, Wang L, Xia H, Liu Y. Watch out for the lung tissue trapped by fractured ribs: a case report. Interdiscip Cardiovasc Thorac Surg 2023:7180279. [PMID: 37233210 DOI: 10.1093/icvts/ivad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
A 52-year-old woman was injured in an accident, emergency tests showed rib fracture and pleural effusion. However, lung incarceration was found during thoracic exploration which was not detected in preoperative imaging findings. Although rare, Clinicians should be careful of this possible pitfall, which may bring about poor prognosis after rib fracture.
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Affiliation(s)
- Jipeng Jiang
- Department of Thoracic Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Linghui Wang
- Department of Thoracic Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hui Xia
- Department of Thoracic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Liu
- Department of Thoracic Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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Tan H, Xu H, Yu N, Yu Y, Duan H, Fan Q, Zhanyu T. The value of deep learning-based computer aided diagnostic system in improving diagnostic performance of rib fractures in acute blunt trauma. BMC Med Imaging 2023; 23:55. [PMID: 37055752 PMCID: PMC10099632 DOI: 10.1186/s12880-023-01012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND To evaluate the value of a deep learning-based computer-aided diagnostic system (DL-CAD) in improving the diagnostic performance of acute rib fractures in patients with chest trauma. MATERIALS AND METHODS CT images of 214 patients with acute blunt chest trauma were retrospectively analyzed by two interns and two attending radiologists independently firstly and then with the assistance of a DL-CAD one month later, in a blinded and randomized manner. The consensusdiagnosis of fib fracture by another two senior thoracic radiologists was regarded as reference standard. The rib fracture diagnostic sensitivity, specificity, positive predictive value, diagnostic confidence and mean reading time with and without DL-CAD were calculated and compared. RESULTS There were 680 rib fracture lesions confirmed as reference standard among all patients. The diagnostic sensitivity and positive predictive value of interns weresignificantly improved from (68.82%, 84.50%) to (91.76%, 93.17%) with the assistance of DL-CAD, respectively. Diagnostic sensitivity and positive predictive value of attendings aided by DL-CAD (94.56%, 95.67%) or not aided (86.47%, 93.83%), respectively. In addition, when radiologists were assisted by DL-CAD, the mean reading time was significantly reduced, and diagnostic confidence was significantly enhanced. CONCLUSIONS DL-CAD improves the diagnostic performance of acute rib fracture in chest trauma patients, which increases the diagnostic confidence, sensitivity, and positive predictive value for radiologists. DL-CAD can advance the diagnostic consistency of radiologists with different experiences.
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Affiliation(s)
- Hui Tan
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Hui Xu
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care Hamilton, 100 West 5th Street, Hamilton, ON, L8P 3R2, Canada.
| | - Nan Yu
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yong Yu
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Haifeng Duan
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Qiuju Fan
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.
| | - Tian Zhanyu
- Institute of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, China
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Carducci MP, Sundaram B, Greenberger BA, Werner-Wasik M, Kane GC. Predictors and characteristics of Rib fracture following SBRT for lung tumors. BMC Cancer 2023; 23:337. [PMID: 37046249 PMCID: PMC10100199 DOI: 10.1186/s12885-023-10776-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated with an increased risk of osteoradionecrosis-induced rib fracture. We aimed to (1) evaluate potential clinical, demographic, and procedure-related risk factors for rib fractures and (2) describe the radiographic features of post-SBRT rib fractures. METHODS We retrospectively identified 106 patients who received SBRT between 2015 and 2018 for a primary or metastatic lung tumor with at least 12 months of follow up. Exclusion criteria were incomplete records, previous ipsilateral thoracic radiation, or relevant prior trauma. Computed tomography (CT) images were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was employed to determine clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location). RESULTS A total of 106 patients with 111 treated tumors met the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total fractured ribs). The highest number of fractured ribs per patient was five. Multivariate regression identified posterolateral tumor location as the only independent risk factor for rib fracture. On CT, fractures showed discontinuity between healing edges in 77% of affected patients. CONCLUSIONS Nearly one third of patients receiving SBRT for lung tumors experienced rib fractures, 34% of whom experienced pain. Many patients developed multiple fractures. Post-SBRT fractures demonstrated a unique discontinuity between the healing edges of the rib, a distinct feature of post-SBRT rib fractures. The only independent predictor of rib fracture was tumor location along the posterolateral chest wall. Given its increasing frequency of use, describing the risk profile of SBRT is vital to ensure patient safety and adequately inform patient expectations.
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Affiliation(s)
- Michael P Carducci
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, suite 840, 19107, Philadelphia, PA, USA.
| | - Baskaran Sundaram
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th St, Floor 10, 19107, Philadelphia, PA, USA
| | - Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, 111 South 11th St Suite G-301, 19107, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, 111 South 11th St Suite G-301, 19107, Philadelphia, PA, USA
| | - Gregory C Kane
- Department of Medicine, Jane and Leonard Korman Respiratory institute at Thomas Jefferson University Hospital, 834 Walnut St, Suite 650, 19107, Philadelphia, PA, USA
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Bauer F, Haag S, Najafi K, Miller B, Kepros J. Surgical stabilization of rib fracture patients versus nonoperative controls treated by a multidisciplinary team in a single institution. Heliyon 2023; 9:e15205. [PMID: 37123889 PMCID: PMC10130754 DOI: 10.1016/j.heliyon.2023.e15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Despite promising evidence, surgical stabilization of rib fractures (SSRF) is not ubiquitously offered in all trauma centers. Some centers struggle with patient selection while some struggle due to surgeon comfort with the technique. To address this issue, our trauma center developed a multidisciplinary SSRF approach between orthopedic and trauma surgery. Methods This retrospective study compared 43 patients who underwent SSRF at a level 1 trauma center with 43 nonoperatively managed controls. Our study Indications were flail chest with >3 segments; non-flail with severe, bi-cortical displacement of >3 contiguous segments. Main outcome measures included mortality, ICU duration, hospital stay LOS, rates of ventilator-associated pneumonia (VAP) and ventilator days. Results Results of SSRF included decreases in mortality (2% vs 16.3%; p = 0.03) and in ICU duration. Patients with SSRF had a significantly shorter duration in the ICU than the nonoperative group (8.72 vs 14 days; p = 0.013) but a similar hospital duration (LOS mean, 12.81 vs 15.2; p = 0.29). Less patients in the SSRF group developed VAP but the difference was not significant (2% vs 14%, p = 0.055). Discussion SSRF patient outcomes supported prior evidence. The tandem approach had benefits as surgeons were able to leverage skills and expertise, increase collaboration between services, and complete more difficult reconstructions. Our experience may serve as a model for trauma centers interested in starting a new program or enhancing current service offerings.
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Harfouche MN, Nigam R, Efron DT, Diaz JJ. Surgical Stabilization of Rib Fractures in Severe Injury Is Not Associated With Worse Outcomes. J Surg Res 2023; 284:106-113. [PMID: 36563451 DOI: 10.1016/j.jss.2022.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This study aimed to determine whether surgical stabilization of rib fractures (SSRF) is associated with worse outcomes in individuals with multicompartmental injuries. MATERIALS AND METHODS A retrospective review of a prospective trauma registry was performed for adult blunt trauma patients (aged ≥ 18 y) with Injury Severity Score ≥ 15 and radiographic evidence of rib fractures (2015-2020). Individuals without concomitant head, abdomen/pelvis, or lower extremity Abbreviated Injury Scale scores ≥ 3 were excluded. Propensity match on demographic and clinical variables was performed comparing patients treated nonoperatively (NO) to those undergoing SSRF. A chart review was performed for additional data. Primary outcome was hospital length of stay (LOS). Secondary outcomes were in-hospital mortality, intensive care unit LOS, and duration of mechanical ventilation. RESULTS One thousand nine hundred ninety three patients fit the inclusion criteria (NO = 1,951, SSRF = 42). After matching, there were 98 in the NO group and 42 in the SSRF group. Mean age was 51 y, 61.4% were male, and 71.4% were of White race. Median time to fixation was 5 d. The SSRF group had more severe chest trauma as evidenced by a higher RibScore (3.2 versus 1.7, P < 0.001) and had a longer LOS (18 versus 9 d, P < 0.001), intensive care unit LOS (13 versus 3 d, P = 0.007), and duration of mechanical ventilation (8 versus 2 d, P = 0.013) on univariate analysis. Multivariable regression analysis demonstrated no association between SSRF and these short-term outcomes. CONCLUSIONS Despite delayed average time to intervention, SSRF in a trauma-patient population with multicompartmental injuries and competing management priorities is not associated with worse short-term outcomes.
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Affiliation(s)
- Melike N Harfouche
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland.
| | | | - David T Efron
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Jose J Diaz
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
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Kim W, Song J, Moon S, Kim J, Cho H, Park J, Kim S, Ahn S. Characteristics of rib fracture patients who require chest computed tomography in the emergency department. BMC Emerg Med 2023; 23:33. [PMID: 36949390 PMCID: PMC10035164 DOI: 10.1186/s12873-023-00807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The disadvantages and complications of computed tomography (CT) can be minimized if CT is performed in rib fracture patients with high probability of intra-thoracic and intra-abdominal injuries and CT is omitted in rib fracture patients with low probability of intra-thoracic and intra-abdominal injuries. This study aimed to evaluate the factors that can identify patients with rib fractures with intra-thoracic and intra-abdominal injuries in the emergency department among patients with rib fracture. METHODS This retrospective observational study included adult patients (age ≥ 18 years) diagnosed with rib fracture on chest radiography prior to chest CT due to blunt chest trauma in the emergency department who underwent chest CT from January 2016 to February 2021. The primary outcomes were intra-thoracic and intra-abdominal injuries that could be identified on a chest CT. Multivariate logistic regression analysis was performed. RESULTS Among the characteristics of rib fractures, the number of rib fractures was greater (5.0 [3.0-7.0] vs. 2.0 [1.0-3.0], p < 0.001), bilateral rib fractures were frequent (56 [20.1%] vs. 12 [9.8%], p = 0.018), and lateral and posterior rib fracture was more frequent (lateral rib fracture: 160 [57.3%] vs. 25 [20.5%], p < 0.001; posterior rib fracture: 129 [46.2%] vs. 21 [17.2%], p < 0.001), and displacement was more frequent (99 [35.5%] vs. 6 [6.6%], p < 0.001) in the group with intra-thoracic and intra-abdominal injuries than in the group with no injury. The number of rib fractures (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.16-1.78; p = 0.001), lateral rib fracture (aOR, 2.80; 95% CI, 1.32-5.95; p = 0.008), and posterior rib fracture (aOR, 3.18; 95% CI, 1.45-6.94; p = 0.004) were independently associated with intra-thoracic and intra-abdominal injuries. The optimal cut-off for the number of rib fractures on the outcome was three. The number of rib fractures ≥ 3 (aOR, 3.01; 95% CI, 1.35-6.71; p = 0.007) was independently associated with intra-thoracic and intra-abdominal injuries. CONCLUSION In patients with rib fractures due to blunt trauma, those with lateral or posterior rib fractures, those with ≥ 3 rib fractures, and those requiring O2 supplementation require chest CT to identify significant intra-thoracic and intra-abdominal injuries in the emergency department.
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Affiliation(s)
- Woosik Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Juhyun Song
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Jooyeong Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Jonghak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Sungjin Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea.
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Öberg Westin E, Fagevik Olsén M, Örtenwall P, Caragounis EC. Retrospective comparison of operative technique for chest wall injuries. Injury 2023:S0020-1383(23)00248-6. [PMID: 36925375 DOI: 10.1016/j.injury.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Surgical management of chest wall injuries is a common procedure. However, operative techniques are diverse, and no universal guidelines exist. There is a lack of studies comparing the outcome with different operative techniques for chest wall surgery. The aim of this study was to compare hospital outcomes between patients operated for chest wall injuries with a conventional method with large incisions and often a thoracotomy or a minimally invasive, muscle sparing method. PATIENTS AND METHODS A retrospective study was carried out including patients ≥18 years operated for chest wall injuries 2010-2020. Patients were divided into two groups based on the surgery performed: conventional surgery (C-group) and minimally invasive surgery (M-group). Data on demographics, trauma, surgery, and outcomes were extracted from patient records. Primary outcome was length of stay on mechanical ventilator (MV-LOS). Secondary outcomes were length of stay in intensive care (ICU-LOS) and in hospital (H-LOS), and complications such as re-operation, incidence of empyema, tracheostomy, pneumonia, and mortality. RESULTS Of 311 included patients, 220 were in the C-group and 91 in the M-group. The groups were similar in demographics and injury pattern. MV-LOS was 0 (0-65) in the C-group vs 0 (0-34) in the M-group (p < 0.001). ICU-LOS and H-LOS were significantly shorter in the M-group as compared to the C-group (p < 0.001), however with a large overlap. Tracheostomy was performed in 22.3% of patients in the C-group vs 5.4% in the M-group (p < 0.001). Pneumonia was diagnosed in 32.3% of patients in the C-group vs 16.1% in the M-group (p = 0.004). In-hospital mortality was lower in the M-group compared to the C-group but there was no difference in mortality within 30 days or a year. CONCLUSIONS Our study indicates that a minimally invasive technique was favorable regarding clinical outcomes for patients operated for chest wall injuries.
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Rüttermann V. [Bruise or fracture? The rib in focused ultrasound]. MMW Fortschr Med 2023; 165:54-56. [PMID: 36894858 DOI: 10.1007/s15006-023-2389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Viktor Rüttermann
- Gemeinschaftspraxis, Nordholter Weg 10, 48317, Drensteinfurt, Deutschland.
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Yang Z, Wen M, Kong W, Li X, Liu Z, Liu X. Complete uni-port video-assisted thoracoscopic surgery for surgical stabilization of rib fractures: a case report. J Cardiothorac Surg 2023; 18:61. [PMID: 36747271 PMCID: PMC9901082 DOI: 10.1186/s13019-023-02167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rib fractures are a common injury in trauma. Potential complications include pain, pneumonia, respiratory failure, disability, and death. Surgical stabilization of rib fractures (SSRF) has become an available treatment option, and complete video-assisted thoracoscopic surgery (VATS) for SSRF is gradually accepted because of minimally invasive and pain relief. To our knowledge, complete uni-port VATS for SSRF has not yet been reported. CASE PRESENTATION A 53-year-old man accidentally fell off a three-meter high scaffolding while working resulting in severe chest pain and shortness of breath. He was found with left 7th through 11th rib fractures with a pulmonary contusion from computed tomography (CT). A 4 cm incision was made in the 7th intercostal space in the midaxillary line, and complete uni-port VATS for SSRF were operated. The patient's pain was significantly relieved after the operation, and the scar was tiny and unapparent. CONCLUSIONS Complete uni-port VATS for SSRF is a novel and modificatory method of operation with the benefit of minimal invasion, meanwhile, intrathoracic injuries could be treated at the same time. Further study is warranted.
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Affiliation(s)
- Zhen Yang
- grid.415444.40000 0004 1800 0367Department of Thoracic Surgery, The Second Affiliated Hospital of Kunming Medical University, 374th Dianmian Road, Yunnan Province 650101 Kunming, China ,grid.412532.3Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507th Zhengmin Road, 200433 Shanghai, China
| | - Ming Wen
- grid.415444.40000 0004 1800 0367Department of Thoracic Surgery, The Second Affiliated Hospital of Kunming Medical University, 374th Dianmian Road, Yunnan Province 650101 Kunming, China
| | - Weiqing Kong
- grid.412478.c0000 0004 1760 4628Department of Neurosurgery and Thoracic Surgery, The First People’s Hospital of Xuanwei, 131th Jianshe Road, Yunnan Province 655400 Xuanwei, China
| | - Xu Li
- grid.415444.40000 0004 1800 0367Department of Thoracic Surgery, The Second Affiliated Hospital of Kunming Medical University, 374th Dianmian Road, Yunnan Province 650101 Kunming, China
| | - Zhuan Liu
- grid.411634.50000 0004 0632 4559Department of Thoracic, Thyroid and Breast Surgery, Panzhou People’s Hospital, 1120th Shengjing Avenue, Panzhou, 553537 Guizhou Province China
| | - Xin Liu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Kunming Medical University, 374th Dianmian Road, Yunnan Province, 650101, Kunming, China.
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Alvarado F, Kaban J, Chao E, Meltzer JA. Surgical stabilization of rib fractures in patients with pulmonary comorbidities. Injury 2023; 54:1287-1291. [PMID: 36759310 DOI: 10.1016/j.injury.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/04/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Prior studies have shown that the surgical stabilization of rib fractures (SSRF) for patients with multiple rib fractures is associated with improved outcomes by restoring chest wall integrity and decreasing time to return to prior functional status. It is unclear if patients with pulmonary comorbidities (PCM) would benefit from this procedure. OBJECTIVE To compare the difference in morbidity and mortality of patients with multiple rib fractures undergoing SSRF who have underlying PCM to those who do not have PCM. METHODS We performed a retrospective cohort study of patients with multiple rib fractures using data from the Trauma Quality Improvement Program (January 2015 to December 2018). Patients with penetrating injuries, those who died within the first 24 h, those with substantial head, spine, or abdominopelvic injuries, and those who were pregnant, were excluded. A PCM was defined as chronic lower respiratory disease, active smoking, or morbid obesity. Dichotomous outcomes were adjusted for potential confounders by creating a propensity score for PCM and applying inverse probability weighting. The propensity score accounted for multiple patient-level and hospital level covariates. Continuous outcomes were adjusted for these same covariates using multivariable quantile regression. RESULTS Of the 4,084 patients who underwent SSRF, 3048 (75%) were males, the median age was 57 years [IQR 47, 66], and 1504 (37%) had at least one PCM. After adjusting for the propensity score, patients with PCM who underwent SSRF had no significant difference in mortality compared to those without PCM (absolute difference, 0.7% [95% CI -0.2, 1.7]). Similarly, there was no significant difference in time on the ventilator (0.6 days [-0.1, 1.4]). Patients with PCM, however, had a statistically significantly longer hospital LOS (0.8 days [0.3, 1.3]) and ICU LOS (0.6 days [0.1, 1.1]), higher risk of tracheostomy (2.7% [0.1, 4.6]) and higher probability of pulmonary complications (2.7% [1.2, 4.2]), compared to those without PCM. CONCLUSION Among patients with multiple rib fractures who undergo SSRF, having a PCM did not result in a clinically important higher probability of dying or experiencing substantial morbidity. This factor should not exclude patients with PCM from receiving SSRF for multiple rib fractures but the small increased risk in morbidity should be discussed with patients prior to SSRF.
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Affiliation(s)
- Francisco Alvarado
- Jacobi Medical Center, Department of Surgery, 1400 Pelham Parkway South, Bronx, NY 10461, United States of America
| | - Jody Kaban
- Jacobi Medical Center, Department of Surgery, Division of Trauma, 1400 Pelham Parkway South, Bronx, NY 10461, United States of America
| | - Edward Chao
- Jacobi Medical Center, Department of Surgery, Division of Trauma, 1400 Pelham Parkway South, Bronx, NY 10461, United States of America
| | - James A Meltzer
- Jacobi Medical Center, Department of Pediatrics, Division of Emergency and Research, 1400 Pelham Parkway South, Bronx, NY 10461, United States of America.
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Prins JTH, Van Wijck SFM, Leeflang SA, Kleinrensink GJ, Lottenberg L, de la Santa Barajas PM, Van Huijstee PJ, Vermeulen J, Verhofstad MHJ, Zadpoor AA, Wijffels MME, Van Lieshout EMM. Biomechanical characteristics of rib fracture fixation systems. Clin Biomech (Bristol, Avon) 2023; 102:105870. [PMID: 36623327 DOI: 10.1016/j.clinbiomech.2023.105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The primary aim of this study was to determine and compare the biomechanical properties of a fractured or intact rib after implant fixation on an embalmed thorax. METHODS Five systems were fixated on the bilateral fractured or intact (randomly allocated) 6th to 10th rib of five post-mortem embalmed human specimens. Each rib underwent a four-point bending test to determine the bending structural stiffness (Newton per m2), load to failure (Newton), failure mode, and the relative difference in bending structural stiffness and load to failure as compared to a non-fixated intact rib. FINDINGS As compared to a non-fixated intact rib, the relative difference in stiffness of a fixated intact rib ranged from -0.14 (standard deviation [SD], 0.10) to 0.53 (SD 0.35) and for a fixated fractured rib from -0.88 (SD 0.08) to 0.17 (SD 0.50). The most common failure mode was a new fracture at the most anterior drill hole for the plate and screw systems and a new fracture within the anterior portion of the implant for the clamping systems. INTERPRETATION The current fixation systems differ in their design, mode of action, and biomechanical properties. Differences in biomechanical properties such as stiffness and load to failure especially apply to fractured ribs. Insight in the differences between the systems might guide more specific implant selection and increase the surgeon's awareness for localizing hardware complaints or failure.
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Bhattacharya D, Mukherjee P, Esquinas AM, Mandal M. Managing patients with multiple rib fractures outside the ICU: Can high flow nasal cannula be a game changer? Injury 2023; 54:800. [PMID: 36424217 DOI: 10.1016/j.injury.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Dipasri Bhattacharya
- Professor and Head, Department of Anaesthesiology, Pain Medicine, and Critical Care, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Prosenjit Mukherjee
- Associate Professor, Department of Anaesthesiology and Critical Care, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - Antonio M Esquinas
- Critical Care Specialist and Staff Physician, Intensive Care Unit, Hospital Morales, Meseguer, Murcia, Spain
| | - Mohanchandra Mandal
- Professor, Department of Anaesthesiology and Critical Care, Institute of Post Graduate Medical Education and Research / S.S.K.M. Hospital, Kolkata, West Bengal, India.
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Hongbiao S, Shaochun X, Xiang W, YuRun T, Yang L, Mingzi Z, Hua Y, Keyang Z, Chi-Cheng F, Qu F, Pengchen G, Yi X, Shiyuan L. Comparison and verification of two deep learning models for the detection of chest CT rib fractures. Acta Radiol 2023; 64:542-551. [PMID: 35300519 DOI: 10.1177/02841851221083519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A high false-positive rate remains a technical glitch hindering the broad spectrum of application of deep-learning-based diagnostic tools in routine radiological practice from assisting in diagnosing rib fractures. PURPOSE To examine the performance of two versions of deep-learning-based software tools in aiding radiologists in diagnosing rib fractures on chest computed tomography (CT) images. MATERIAL AND METHODS In total, 123 patients (708 rib fractures) were included in this retrospective study. Two groups of radiologists with different experience levels retrospectively reviewed images for rib fractures in the concurrent mode aided with RibFrac-High Sensitivity (HS) and RibFrac-High Precision (HP). We compared their diagnostic performance against the reference standard in terms of sensitivity and positive predictive value (PPV). RESULTS On a per-patient basis, RibFrac-HS exhibited a higher sensitivity compared with RibFrac-HP (mean difference=0.051, 95% CI=0.012-0.090; P = 0.011), whereas the latter significantly outperformed the former in terms of the PPV (mean difference=0.273, 95% CI=0.238-0.308; P < 0.0001). The use of RibFrac-HP significantly improved the junior and the senior groups' sensitivities respectively by 0.058 (95% CI=0.033-0.083; P < 0.0001) and 0.058 (95% CI=0.034-0.081; P < 0.0001), and decreased the diagnosis time by 206 s (95% CI=191-220; P < 0.0001) and 79 s (95% CI=67-92; P < 0.0001), respectively, when compared to no software assistance. CONCLUSION The sensitivity and efficiency of radiologists in identifying rib fractures can be improved by using RibFrac-HS and/or RibFrac-HP. With an added module for false-positive suppression, RibFrac-HP maintains the sensitivity and increases the PPV in fracture detection compared to Rib-Frac-HS.
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Affiliation(s)
- Sun Hongbiao
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Xu Shaochun
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Wang Xiang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Tang YuRun
- Company 13, College of Basic Medical Sciences, Naval Medical University, Shanghai, PR China
| | - Lu Yang
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Zhang Mingzi
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Yang Hua
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Zhao Keyang
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Fu Chi-Cheng
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Fang Qu
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Gu Pengchen
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Xiao Yi
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Liu Shiyuan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
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Wu J, Liu N, Li X, Fan Q, Li Z, Shang J, Wang F, Chen B, Shen Y, Cao P, Liu Z, Li M, Qian J, Yang J, Sun Q. Convolutional neural network for detecting rib fractures on chest radiographs: a feasibility study. BMC Med Imaging 2023; 23:18. [PMID: 36717773 PMCID: PMC9885575 DOI: 10.1186/s12880-023-00975-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Chest radiography is the standard investigation for identifying rib fractures. The application of artificial intelligence (AI) for detecting rib fractures on chest radiographs is limited by image quality control and multilesion screening. To our knowledge, few studies have developed and verified the performance of an AI model for detecting rib fractures by using multi-center radiographs. And existing studies using chest radiographs for multiple rib fracture detection have used more complex and slower detection algorithms, so we aimed to create a multiple rib fracture detection model by using a convolutional neural network (CNN), based on multi-center and quality-normalised chest radiographs. METHODS A total of 1080 radiographs with rib fractures were obtained and randomly divided into the training set (918 radiographs, 85%) and the testing set (162 radiographs, 15%). An object detection CNN, You Only Look Once v3 (YOLOv3), was adopted to build the detection model. Receiver operating characteristic (ROC) and free-response ROC (FROC) were used to evaluate the model's performance. A joint testing group of 162 radiographs with rib fractures and 233 radiographs without rib fractures was used as the internal testing set. Furthermore, an additional 201 radiographs, 121 with rib fractures and 80 without rib fractures, were independently validated to compare the CNN model performance with the diagnostic efficiency of radiologists. RESULTS The sensitivity of the model in the training and testing sets was 92.0% and 91.1%, respectively, and the precision was 68.0% and 81.6%, respectively. FROC in the testing set showed that the sensitivity for whole-lesion detection reached 91.3% when the false-positive of each case was 0.56. In the joint testing group, the case-level accuracy, sensitivity, specificity, and area under the curve were 85.1%, 93.2%, 79.4%, and 0.92, respectively. At the fracture level and the case level in the independent validation set, the accuracy and sensitivity of the CNN model were always higher or close to radiologists' readings. CONCLUSIONS The CNN model, based on YOLOv3, was sensitive for detecting rib fractures on chest radiographs and showed great potential in the preliminary screening of rib fractures, which indicated that CNN can help reduce missed diagnoses and relieve radiologists' workload. In this study, we developed and verified the performance of a novel CNN model for rib fracture detection by using radiography.
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Affiliation(s)
- Jiangfen Wu
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,grid.43169.390000 0001 0599 1243The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, 710054 China ,InferVision Institute of Research, Beijing, 100025 China ,grid.11135.370000 0001 2256 9319Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100191 China
| | - Nijun Liu
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,Department of Medical Imaging, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, 712000 China
| | - Xianjun Li
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Qianrui Fan
- InferVision Institute of Research, Beijing, 100025 China
| | | | - Jin Shang
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Fei Wang
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Bowei Chen
- grid.412262.10000 0004 1761 5538School of Information Science and Technology, Northwest University, Xi’an, 710127 China
| | - Yuanwang Shen
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,Department of Medical Imaging, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, 712000 China
| | - Pan Cao
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,Department of Radiology, Tuberculosis Hospital of Shannxi Province (The Fifth People’s Hospital of Shaanxi Province), Xi’an, 710100 China
| | - Zhe Liu
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Miaoling Li
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Jiayao Qian
- InferVision Institute of Research, Beijing, 100025 China
| | - Jian Yang
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,grid.43169.390000 0001 0599 1243The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, 710054 China
| | - Qinli Sun
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,grid.43169.390000 0001 0599 1243The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, 710054 China
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Okabayashi R, Suzuki S, Omura T, Tsuda K, Ishigami N, Suzuki K, Akuzawa S, Kando Y, Arima D, Matsuyama Y. Brachial plexus injury and upper rib fracture after median sternotomy in cardiac surgery. Gan To Kagaku Ryoho 2023; 71:46-50. [PMID: 35879630 DOI: 10.1007/s11748-022-01848-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/18/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Sternal retractors utilized during open-heart surgeries through median sternotomy can cause upper rib fractures which sometimes further leads to brachial plexus injury. We aimed to investigate the incidence of brachial plexus injury and upper rib fractures in open-heart surgeries and how these injuries are associated with each other. METHODS We investigated 1050 cases during the past five years. The incidence of brachial plexus injury and upper rib fractures after median sternotomy was assessed in all patients and the patients who sustained were evaluated for the affected side, the level of paralysis. RESULTS Ten cases (0.95%) exhibited brachial plexus injury after median sternotomy. Nine cases developed paralysis on left upper extremity. In all ten cases, sensory and motor nerve impairment were exhibited in the lower plexus. Rib fractures were observed in 35.0% of cases after median sternotomy and the usage of asymmetric sternal retractors to harvest left internal thoracic artery (LITA) significantly affected the side of fracture. CONCLUSION Sternal retractors utilized during open-heart surgeries through median sternotomy may cause rib fractures and brachial plexus injury, so operators should be aware of these complications.
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Affiliation(s)
- Ryo Okabayashi
- Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu, Japan.
| | - Shigeya Suzuki
- Department of Orthopedic Surgery, Fujieda City Hospital, Fujieda, Japan
| | - Takao Omura
- Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu, Japan
| | - Kazumasa Tsuda
- Department of Cardiovascular Surgery, Hamamatsu Medical University, Hamamatsu, Japan
| | - Naoyuki Ishigami
- Department of Cardiovascular Surgery, Fujieda City Hospital, Fujieda, Japan
| | - Kazuchika Suzuki
- Department of Cardiovascular Surgery, Fujieda City Hospital, Fujieda, Japan
| | - Satoshi Akuzawa
- Department of Cardiovascular Surgery, Fujieda City Hospital, Fujieda, Japan
| | - Yumi Kando
- Department of Cardiovascular Surgery, Fujieda City Hospital, Fujieda, Japan
| | - Daisuke Arima
- Department of Cardiovascular Surgery, Fujieda City Hospital, Fujieda, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu, Japan
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Bass GA, Duffy CC, Kaplan LJ, Sarani B, Martin ND, Ismail AM, Cao Y, Forssten MP, Mohseni S. The revised cardiac risk index is associated with morbidity and mortality independent of injury severity in elderly patients with rib fractures. Injury 2023; 54:56-62. [PMID: 36402584 DOI: 10.1016/j.injury.2022.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/23/2022] [Accepted: 11/10/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Risk factors for mortality and in-hospital morbidity among geriatric patients with traumatic rib fractures remain unclear. Such patients are often frail and demonstrate a high comorbidity burden. Moreover, outcomes anticipated by current rubrics may reflect the influence of multisystem injury or surgery, and thus not apply to isolated injuries in geriatric patients. We hypothesized that the Revised Cardiac Risk Index (RCRI) may assist in risk-stratifying geriatric patients following rib fracture. METHODS All geriatric patients (age ≥65 years) with a conservatively managed rib fracture owing to an isolated thoracic injury (thorax AIS ≥1), in the 2013-2019 TQIP database were assessed including demographics and outcomes. The association between the RCRI and in-hospital morbidity as well as mortality was analyzed using Poisson regression models while adjusting for potential confounders. RESULTS 96,750 geriatric patients sustained rib fractures. Compared to those with RCRI 0, patients with an RCRI score of 1 had a 16% increased risk of in-hospital mortality [adjusted incidence rate ratio (adj-IRR), 95% confidence interval (CI): 1.16 (1.02-1.32), p=0.020]. An RCRI score of 2 [adj-IRR (95% CI): 1.72 (1.44-2.06), p<0.001] or ≥3 [adj-IRR (95% CI): 3.07 (2.31-4.09), p<0.001] was associated with an even greater mortality risk. Those with an increased RCRI also exhibited a higher incidence of myocardial infarction, cardiac arrest, stroke, and acute respiratory distress syndrome. CONCLUSIONS Geriatric patients with rib fractures and an RCRI ≥1 represent a vulnerable and high-risk group. This index may inform the decision to admit for inpatient care and can also guide patient and family counseling as well as computer-based decision-support.
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Affiliation(s)
- Gary Alan Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; School of Medical Sciences, Orebro University, Orebro, Sweden; Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA
| | - Caoimhe C Duffy
- Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Anesthesia and Critical Care, University of Pennsylvania, Philadelphia, USA; Corporal Michael Cresenscz Veterans Affairs Medical Center (CMCVAMC), Philadelphia, USA
| | - Babak Sarani
- Center for Trauma and Critical Care, George Washington University School of Medicine & Health Sciences, Washington D.C., USA
| | - Niels D Martin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | | | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden; Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
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Hoepelman RJ, Beeres FJP, Beks RB, Sweet AAR, Ijpma FF, Lansink KWW, van Wageningen B, Tromp TN, Link BC, van Veelen NM, Hoogendoorn JM, de Jong MB, van Baal MCP, Leenen LPH, Groenwold RHH, Houwert RM. Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study. Eur J Trauma Emerg Surg 2023; 49:461-71. [PMID: 36008560 DOI: 10.1007/s00068-022-02093-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation; however, high-quality evidence to support this development is lacking. METHODS We conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were matched using propensity score matching. RESULTS In total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80 (14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital length of stay (HLOS) of 4.9 days (95%CI 0.8-9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D questionnaire at 1 year of 0.1 (95% CI - 0.2-0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent surgery experienced implant-related irritation. CONCLUSIONS We found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do not recommend rib fixation as the standard of care for patients with multiple rib fractures. TRIAL REGISTRATION Registered in the Netherlands Trial Register NTR6833 on 13/11/2017.
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Dai NV, Son PDH, Tu VN, Anh NV, May NT, Duy VK, Quang NVD, Nguyen TC, Vinh VH, Uoc NH, Lu PH, Hung DQ. Comparison of In-Hospital Outcomes of Surgical Stabilization of Rib Fractures with Nonsurgical Management: A Multicenter, Prospective, Cohort Study. Acta Inform Med 2023; 31:275-279. [PMID: 38379691 PMCID: PMC10875940 DOI: 10.5455/aim.2023.31.275-279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/20/2023] [Indexed: 02/22/2024] Open
Abstract
Background Evidence for the efficacy of surgical stabilization of rib fractures in patients with rib fractures is controversial. Objective We aim to compare the clinical outcomes of surgical rib fixation for rib fracture with non-operative treatment. Methods Our institutional database from three general hospitals (Viet Duc Hospital, Viet Tiep Friendship Hospital & Cho Ray Hospital) was queried to identify patients with flail chest treated with locked plate fixation between December 2021 and February 2023. A medical record review for demographic, injury, hospital, and surgical data was also retrospectively performed for all patients. Characteristics and outcomes of the patients receiving the surgical rib fixation for rib fracture were compared with those without surgery. Results A total of 166 patients with thoracic trauma were included. The majority of patients were male, and the age range was from 18 to 80 years old, with a mean age of 51.6 years. 52 (31.3%) underwent surgical stabilization of rib fractures (SSRF). The highest combined injuries were limb injuries, followed by traumatic brain injury, and maxillofacial trauma. While 1 patient died in the non-surgical group, there was no significant difference in the mortality between the two groups. The surgical group had a slightly shorter hospital stay than the non-surgical group (8.6 days vs. 10.0 days, p-value: 0.038). SSRF group tended toward a lower incidence of pneumonia compared to the non-surgical group (SSRF: 3.8% vs. non-surgical: 7%), but this difference was not statistically significant (p-value: 0.426). SSRF group also had a lower incidence of tracheostomy than the non-operative group (SSRF: 0% vs. non-surgical: 1.8%, p-value: 0.337). Conclusion Operative fixation of a rib fracture in trauma patients resulted in a lower incidence of pneumonia, fewer days of mechanical ventilation, and a shorter hospital stay compared to non-operative treatment group.
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Affiliation(s)
- Nguyen-Van Dai
- Department of Cardiovascular and Thoracic Surgery, Viet-Tiep Friendship Hospital, Hai Phong, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Phung Duy Hong Son
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Vu Ngoc Tu
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Cardiovascular and Thoracic Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Viet Anh
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Nguyen The May
- Department of Cardiovascular and Thoracic Surgery, Viet-Tiep Friendship Hospital, Hai Phong, Vietnam
| | - Vu Kim Duy
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Truong Cao Nguyen
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Vu Huu Vinh
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Huu Uoc
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Pham Huu Lu
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Doan Quoc Hung
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Cardiovascular and Thoracic Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
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Masuda S, Suzuki A, Takahashi S, Tamai K, Nakamura H. Delayed aortic injury after thoracic corrective osteotomy: a case report. Eur Spine J 2022; 31:3703-3707. [PMID: 34609615 DOI: 10.1007/s00586-021-07014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To present a case of delayed aortic perforation due to a nondisplaced fracture of the 9th rib after vertebral osteotomy for degenerative kyphoscoliosis in patients with osteoporosis. METHODS A 78-year-old female patient with osteoporosis had undergone T9-iliac correction surgery for degenerative kyphoscoliosis. After 2 years, the patient underwent T10 pedicle subtraction osteotomy for a T10 vertebral fracture and progression of kyphosis. Postoperatively, the patient had been doing well for 3 weeks; however, just before the day of discharge, she died following a cardiopulmonary arrest. An autopsy was performed with the consent of her family. RESULTS Autopsy revealed a large amount of blood and a clot in the left thoracic cavity. Aortic perforation was found just in front of a nondisplaced fracture of the left 9th rib. CONCLUSION This report describes a new critical complication after spinal correction surgery. Even without pedicle screw malposition, aortic injuries can happen to patients with osteoporosis after corrective osteotomy for degenerative kyphoscoliosis due to positional change of aorta and fragility of the ribs. The spine surgeon should be aware of this type of complication, and rib fractures around the aorta after vertebral osteotomy should not be neglected even when there is no displacement.
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Affiliation(s)
- Sho Masuda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan.
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
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Rampersadh C, Agnew AM, Malcolm S, Gierczycka D, Iraeus J, Cronin D. Factors affecting the numerical response and fracture location of the GHBMC M50 rib in dynamic anterior-posterior loading. J Mech Behav Biomed Mater 2022; 136:105527. [PMID: 36306670 DOI: 10.1016/j.jmbbm.2022.105527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Rib fractures are common traumatic injuries, with links to increased morbidity and mortality. Finite element ribs from human body models have struggled to predict the force-displacement response, force and displacement at fracture, and the fracture location for isolated rib tests. In the current study, the sensitivity of a human body model rib with updated anisotropic and asymmetric material models to changes in boundary conditions, material properties, and geometry was investigated systematically to quantify contributions to response. The updated material models using uncalibrated average material properties from literature improved the force-displacement response of the model, whereas the cross-sectional geometry was the only parameter to effect fracture location. The resulting uncalibrated model with improved material models and cross-sectional geometry closely predicted experimental average force-displacement response and fracture location.
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Affiliation(s)
- Claire Rampersadh
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada
| | - Amanda M Agnew
- Injury Biomechanics Research Center, The Ohio State University, Columbus, United States
| | - Skye Malcolm
- Honda Development & Manufacturing of America, Raymond, United States
| | - Donata Gierczycka
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada
| | - Johan Iraeus
- Division of Vehicle Safety, Department of Mechanics and Maritime Sciences, Chalmers University of Technology, Göteborg, Sweden
| | - Duane Cronin
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada.
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Marasco SF, Nguyen Khuong J, Fitzgerald M, Summerhayes R, Sekandarzad MW, Varley V, Campbell RJ, Bailey M. Flail chest injury-changing management and outcomes. Eur J Trauma Emerg Surg 2022; 49:1047-1055. [PMID: 36318281 PMCID: PMC9628626 DOI: 10.1007/s00068-022-02152-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess trends in management of flail chest injuries over time and to determine impact on patient outcomes. METHODS A retrospective review of data from a prospectively collated database of all trauma patients admitted to a level 1 trauma service in Victoria was conducted. All trauma patients admitted to the hospital between July 2008 and June 2020 with an Abbreviated Injury Scale (AIS) code for flail chest injury were included. RESULTS Our study included 720 patients, mean age was 59.5 ± 17.3 years old, and 76.5% of patients were male. Length of ICU stay decreased on average by 9 h each year. Regional anaesthesia use increased by 15% per year (0% in 2009 to 36% in 2020) (p < 0.001). Surgical stabilisation of rib fractures increased by 16% per year (2.9% in 2009 to 22.3% in 2020) (p = 0.006). The use of invasive ventilation decreased by 14% per year (70% in 2008 to 27% in 2020) (p < 0.001), and invasive ventilation time decreased by 8 h per year (p = 0.007). CONCLUSION Over the past decade, we have seen increasing rates of regional anaesthesia and surgical rib fixation in the management of flail chest. This has resulted in lower requirements for and duration of invasive mechanical ventilation and intensive care unit stay but has not impacted mortality in this patient cohort.
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Affiliation(s)
- Silvana F. Marasco
- Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, VIC 3004 Australia ,Department of Surgery, Monash University, Melbourne, VIC Australia
| | | | - Mark Fitzgerald
- Department of Surgery, Monash University, Melbourne, VIC Australia ,National Trauma Research Institute, Melbourne, VIC Australia ,Trauma Service, The Alfred Hospital, Melbourne, VIC Australia
| | - Robyn Summerhayes
- Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, VIC 3004 Australia
| | - Mir Wais Sekandarzad
- Department of Anesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, VIC Australia
| | - Vincent Varley
- Department of Surgery, Monash University, Melbourne, VIC Australia
| | - Ryan J. Campbell
- Department of Surgery, Monash University, Melbourne, VIC Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC Australia
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49
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Gerner P, Cozowicz C, Memtsoudis SG. Outcomes After Orthopedic Trauma Surgery - What is the Role of the Anesthesia Choice? Anesthesiol Clin 2022; 40:433-444. [PMID: 36049872 DOI: 10.1016/j.anclin.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The body of literature concerning the influence of anesthetic type on many perioperative outcomes has grown considerably in recent years. Most studies have suggested that particularly in orthopedic patients, regional anesthesia may be associated with improved perioperative outcomes. Orthopedic trauma presents itself as a field that might benefit from increased utilization of regional techniques with the goal to improve outcomes. This narrative review concludes that, indeed, regional anesthesia seems to provide benefits for morbidity, pain control, and improved return to function in hip fracture, rib fracture, and isolated extremity fracture patients.
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Affiliation(s)
- Philipp Gerner
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02143, USA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Muellner Hauptstrasse 48, Salzburg 5020, Austria
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Muellner Hauptstrasse 48, Salzburg 5020, Austria.
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50
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Wang CC, Chen SA, Cheng CT, Tee YS, Chan SY, Fu CY, Liao CA, Hsieh CH, Kuo LW. The role of acute care surgeons in treating rib fractures-a retrospective cohort study from a single level I trauma center. BMC Surg 2022; 22:271. [PMID: 35836219 PMCID: PMC9281009 DOI: 10.1186/s12893-022-01720-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Rib fractures are the most common thoracic injury in patients who sustained blunt trauma, and potentially life-threatening associated injuries are prevalent. Multi-disciplinary work-up is crucial to achieving a comprehensive understanding of these patients. The present study demonstrated the experience of an acute care surgery (ACS) model for rib fracture management from a single level I trauma center over 13 years. METHODS Data from patients diagnosed with acute rib fractures from January 2008 to December 2020 were collected from the trauma registry of Chang Gung Memorial Hospital (CGMH). Information, including patient age, sex, injury mechanism, Abbreviated Injury Scale (AIS) in different anatomic regions, injury severity score (ISS), index admission department, intensive care unit (ICU) length of stay (LOS), total admission LOS, mortality, and other characteristics of multiple rib fracture, were analyzed. Patients who received surgical stabilization of rib fractures (SSRF) were analyzed separately, and basic demographics and clinical outcomes were compared between acute care and thoracic surgeons. RESULTS A total of 5103 patients diagnosed with acute rib fracture were admitted via the emergency department (ED) of CGMH in the 13-year study period. The Department of Trauma and Emergency Surgery (TR) received the most patients (70.8%), and the Department of Cardiovascular and Thoracic Surgery (CTS) received only 3.1% of the total patients. SSRF was initiated in 2017, and TR performed fixation for 141 patients, while CTS operated for 16 patients. The basic demographics were similar between the two groups, and no significant differences were noted in the outcomes, including LOS, LCU LOS, length of indwelling chest tube, or complications. There was only one mortality in all SSRF patients, and the patient was from the CTS group. CONCLUSIONS Acute care surgeons provided good-quality care to rib fracture patients, whether SSRF or non-SSRF. Acute care surgeons also safely performed SSRF. Therefore, we propose that the ACS model may be an option for rib fracture management, depending on the deployment of staff in each institute.
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Affiliation(s)
- Chia-Cheng Wang
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Szu-An Chen
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chi-Tung Cheng
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Yu-San Tee
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Sheng-Yu Chan
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chih-Yuan Fu
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chien-An Liao
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chi-Hsun Hsieh
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Ling-Wei Kuo
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
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