Two-stage osteosynthesis of bilateral multiple multifragmental fractured ribs in patients with severe respiratory failure

Abstract

Patients with bilateral multiple multifragmental fractured ribs with the formation of flotating chest wall accounted for 0.4% of all patients with thoracic injury being treated.

Objective: to evaluate the efficiency of the step-wise metallic osteosynthesis in bilateral multiple multifragmental rib fractures.

Materials and methods. A retrospective analysis of the treatment of six patients was carried out. For the stabilization of the chest were carried out two-stage osteosynthesis of the ribs, pneumatic stabilization and traction of the flotating flap. Osteosynthesis of the ribs was conducted by using Ilizarov's needles in two stages to reduce surgical injury and stabilization of the patient between the staged surgical interventions.

Results. In patients who underwent osteosynthesis of the ribs, there was a decrease in the artificial lung ventilation duration (6.75±3.4 days) and the stay time in the intensive care unit (12.0±2.4 days) observed as compared to the unoperated patients. Also in the group of operated patients, it was observed a quantity reduction of respiratory complications, length of hospital stay and mortality.

Conclusions. Carrying out the two-stage osteosynthesis of the ribs in patients with a flotating chest wall allows reducing the surgical injury and operation length and achieving stabilization of the thoracic framework, reducing mortality, shortening the terms of artificial ventilation, staying in the intensive care unit, the length of hospital stay and the number of respiratory complications. Conservative methods of chest wall stabilization can be used to prepare the patient for surgical treatment.