Far posterior rib plating: Preliminary results of a retrospective case series |
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| Institution: | 1. OhioHealth/Doctors Hospital, Department of Orthopedics, Columbus, OH 43228, United States;2. OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, United States;1. Experimental Surgery and Simulation Center, Division of Gastrointestinal Surgery, Pontificia Universidad Católica de Chile, Chile;2. Trauma Surgery and Emergency Medicine Department, Hospital Dr. Sótero del Río, Chile;1. York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD;2. The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW;3. NDORMS, University of Oxford, research supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC);4. Trauma and Audit Research Network, Manchester Medical Academic Health Sciences Centre, University of Manchester, The Mayo Building, Salford Royal Hospital, Salford M6 8HD;1. Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198;2. Division of Trauma Surgery, Overland Park Regional Medical Center, Overland Park, KS, USA 66215 |
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| Abstract: | IntroductionFar posterior, or paraspinal rib fractures, defined as fractures that are medial to the medial border of the scapula (and may involve the costovertebral articulation), are often treated nonoperatively. However, in certain cases, including severe displacement, persistent pain, nonunion, or persistent respiratory distress, stabilization with open reduction and internal fixation (ORIF) may be warranted. There is a paucity of literature regarding the surgical approach and clinical outcomes following ORIF for far posterior rib fractures and fracture-dislocations. The purpose of this paper is to describe the surgical approach and to report the first collection of clinical outcomes for patients undergoing paraspinal rib ORIF.Patients and methodsA retrospective case series was performed at a single urban level 1 trauma center. Patients 18 years of age or older who underwent ORIF of far posterior rib fractures were included in this study. Far posterior rib fractures were defined as fractures that occurred medial to the medial border of the scapula underneath the paraspinal musculature. Data collection including patient demographics, injury characteristics, operative variables, and postoperative outcomes were collected and analyzed.ResultsTwenty-six patients, with a mean age of 50.7 years, who underwent paraspinal rib ORIF were included in this study. The mean follow-up was 12.1 months. 80.8% of patients had a flail chest injury. On average, 3.4 ribs were instrumented posteriorly with 22.8% of patients requiring fixation spanning the costotransverse articulation. No intraoperative complications occurred. Only one patient required a repeat procedure. Total hospital length of stay averaged 17.3 days with an intensive care unit stay averaging 6.2 days. Total ventilator time averaged 4 days. 7 patients were diagnosed with postoperative pneumonia and 6 patients required tracheostomy.ConclusionOpen reduction and internal fixation for far posterior, or paraspinal rib fractures and fracture-dislocations is a safe procedure with low complications rates and favorable postoperative outcomes including hospital length of stay, ICU length of stay, need for tracheostomy, postoperative pneumonia, and mechanical ventilation time. |
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