The Utilization of Surgical Rib Fixation: Age

Restrictions

Caitlyn Ryan, Summer Research InternAndrew R. Doben, M.D.

Objectives

Flail Chest and how it is treatedBackground information on rib fractures

Surgical Rib Fixation (SRF) and how it is utilized at Baystate

Study methods and results/conclusions

Future of SRF?

What is Flail Chest?

• A flail chest occurs when a segment of the thoracic cage is separated from the rest of the chest wall.

• Result of a crushing chest injury• Paradoxical respiration

http://medical-dictionary.thefreedictionary.com/flail+segment

This image shows the paradoxical movements of the flail segments

Rib Fractures Background Information

Major source of morbidity in the U.S.

Significant advances in pain control, no improvement in the outcomes

Various reports beginning in the 1950s and sporadic attempts through the mid 80’s

The safety and efficiency of SRF remains uncertain (especially in age ≥ 65 population)

RISKS OF FRACTURES

11,807 Deaths from Thoracic Trauma

Mortality was 22% for the elderly versus 10% for the young

The most common complication of rib fractures is pneumonia

Up to 60% patients do not return to full time employment

What is SRF?

Surgical Rib Fixation is a surgery that allows surgeons to apply artificial support to fractured ribs

There are different methods of support that can be used during SRF; these include Rib Loc, Synthes Rib Matrix, and Intramedullary Nail

Here at Baystate, the Synthes Rib Matrix is utilized

Synthes Rib Matrix

Ribs are realigned and osteosynthes plates are bent/cut to fit specific ribs. The ribs are held together by the osteosynthes plate, which is screwed into the ribs.

Important for restoration of the integrity of the chest wall:• Plate apposition• tissue mobilization• shape formation

What do we do here at Baystate?

Baystate Medical Center has created a multidisciplinary team approach to the care of rib fracture patients. This includes specific pain regimens,

multimodality target respiratory therapy, and surgical intervention

The study conducted here at Baystate focused on the concept of age restrictions within the SRF patient population

Study Methods: Demographics Patients with flail chest or severe rib fractures

who were admitted to a Level 1 Trauma Center for SRF between July 2010 and June 2014 were evaluated

Patients age ≥ 65 and age ≤ 64 were evaluated and compared in the outcome variables:

1. Injury Severity Score 2. Total number of Fractures3. Hospital Length of Stay4. ICU LOS5. Ventilator Days6. Fractures Repaired

Study Methods: Data Collection

Utilized REDCap Database, which is a secure, web-based application for building and managing online databases

Research Electronic Data Capture

Also provides automated export procedures for easy statistical analysis

Results of SRF Data Collection

The median number of ventilator days, ISS, ICU LOS, and Hospital LOS were similar in both groups, signaling that there should not be age restrictions on surgical rib fixations.

Future Plans for SRF

This project is intended to improve the care and outcomes of patients with rib fractures.

Presentation at EAST (Eastern Association for Aurgical Trauma) at end of January 2015

Creation of a national registry

http://www.swedish.org/about/blog/august-2012/rib-fractures-essentials-of-management-treatment

Thank You

Thank you to Andrew Doben, M.D., who is the primary researcher of this project

Thank you to Jeffry Nahmias, M.D., who made this internship opportunity possible

Thank you to Jane Sicard and the Summer Scholars for giving me the opportunity to present my research here today

Works Cited1. Flail chest. (n.d.). Medterms. Retrieved July 21, 2014, from

http://www.medterms.com/script/main/art.asp?articlekey=34732. flail segment. (n.d.). TheFreeDictionary.com. Retrieved July 16, 2014, from

http://medical-dictionary.thefreedictionary.com/flail+segment(flail segment image/definition)

3. M.D., A. D. (Director) (2014, July 21). Surgical Management of Traumatic Rib Fractures. Lecture conducted from , Springfield, MA.

4. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. (0001, January 18). Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Retrieved July 16, 2014

5. REDCap. (n.d.). REDCap. Retrieved August 4, 2014, from https://collaborate.tuftsctsi.org/redcap/

6. SRF Abstract by Dr. Andrew Doben, M.D.7. Swedish Medical Center Seattle and Issaquah. (n.d.). Swedish. Retrieved July 16,

2014, from http://www.swedish.org/about/blog/august-2012/rib-fractures-essentials-of-management-treatment

8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. (n.d.). AccessMedicine. Retrieved July 16, 2014, from http://accessmedicine.mhmedical.com/content.aspx?bookid=348§ionid=40381746&jumpsectionID=40408000&Resultclick=2

9. TRAUMA.ORG: Thoracic Trauma. (n.d.). TRAUMA.ORG: Thoracic Trauma. Retrieved July 16, 2014, from http://www.trauma.org/archive/thoracic/CHESTflail.html(flail chest definition)

THANK YOU

QUESTIONS?

Are the plates ever removed?

Who performs the surgeries?

How long does it take to recover from SRF?

Can patients of any age undergo SRF?