[Osteosynthesis of rib fractures, unstable chest wall, pseudoarthroses, and acquired defects of the chest wall]

Several patients suffer from rib fractures after traumas, and in severe cases it can be life-threatening. Until recently, attempts to perform surgical fixation in patients with instability have been unsuccessful. Chronic non-union causes persistent pain, disability and loss of quality of life. Implementation of surgical stabilization of rib fractures with tailored plates seems to improve pain relief, especially in cases of non-union but also in patients with instability of the chest wall after severe traumas, where advanced pain treatment (epidural catheter) is insufficient or weaning off fails.

[Third degree atrioventricular block in a young woman with congenital central hypoventilation syndrome]

Congenital central hypoventilation syndrome (CCHS) is a rare multisystem disorder characterized by autonomic nervous system dysfunction, which often manifests as failure to maintain ventilatory homeostasis during sleep. We present a case with a third degree atrioventricular block in a young woman with CCHS, which to our knowledge has not been seen before. As sudden death is known to occur among patients with CCHS, and it is under consideration to offer regularly monitoring of patients throughout childhood and adolescence.

Systems redesign in rehabilitation

A performance improvement team overhauled its facility's rehabilitation systems. A rehabilitation care plan was revised and an integrated assessment reduced 29 pages of documentation to 17 pages. Case management goals and documentation are integrated into one care plan.