Rib Fixation

Surgical treatment of broken ribs uses titanium plates to stabilize fractured ribs while they heal and hold the ribs in their correct anatomic location.

Fractured ribs, also referred to as broken or cracked ribs, are common in blunt chest wall trauma and active lifestyle injuries from cycling to football. The fractured ribs usually heal on their own without specific treatment, but a subset of patients have fractures that produce overlaying bone fragments that may produce symptoms like severe rib pain, respiratory compromise, chest wall deformity, and/or a clicking sensation. The pain/rib soreness with rib fractures can make coughing and sleeping uncomfortable and difficult.

Broken Rib Treatment
Most of the fractured ribs are treated with conservative non-operative care. These include aggressive pain management (epidural analgesia, oral analgesics and/or bracing techniques), and in more serious cases, ventilation and tracheotomy¹ until fibrous stabilization (partial bone healing) is achieved.

More severe chest wall trauma is a major cause of morbidity and mortality, especially in the presence of a flail chest, defined as fracture of at least three consecutive ribs in at least two locations each, where paradoxical inward movement of the flail segment in inspiration is found. Patients with flail chest often require aggressive pain control, ventilation and prolonged ICU stay.¹

About 10% of chest wall trauma cases result in a flail chest.⁴ Flail chest injuries, are associated with a mortality rate of up to 36%.^{4 5} Flail chest injuries develop paradoxical inward movement of the flail segment which prevents effective inspiration and require prolonged mechanical ventilation which can lead to pneumonia and sepsis.⁴

The need to improve rib fracture treatment has been recognized for many years and some surgeons have been using operative approaches including plates, intramedullary devices, vertical bridging, wire, sutures, and struts to repair the chest wall.^{2 3 4 5 6 7 8 9 10} These attempts indicate a trend in better rib fracture treatment to improve pain control, reduce duration of mechanical ventilation, reduce ICU stays, and ultimately improve patient care.

DePuy Synthes CMF markets MatrixRIB™ Fixation System, a surgical system to treat rib fractures.

References

¹Tanaka A, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002 Apr;52(4):727-32; discussion 732.
²Schüpbach P, Meier P. Indications for the reconstruction of the unstable thorax due to serial rib fractrures and respiratory insufficiency. [Article in German]. Helv Chir Acta. 1976 Dec;43(5-6):497-502.
³Balci AE, Eren S, Cakir O, Eren MN. Open fixation in flail chest: review of 64 patients. Asian Cardiovasc Thorac Ann. 2004 Mar;12(1):11-5.
⁴Mohr M, Abrams E, Engel C, et al. Geometry of human ribs pertinent to orthopedic chestwall reconstruction. J Biomech 2007;40:1310-1317.
⁵Ciraulo DL, Elliott D, Mitchell KA, Rodriguez A. Flail chest as a marker for significant injuries. J Am Coll Surg. 1994 May;178(5):466-70.
⁶Meier, P., et al., Zur Therapie des instabilen Thorax bei Rippenserienfrakturen, Schweiz. Med. Wschr., 108:606-613(1978).
⁷Moore, B.P., Operative stabilization of non-penetrating chest injuries, J. Thorac. Cardiovasc. Surg., 70, 619-639 (1975).
⁸Samarrai AR. Costosynthetic stabilization of massive chest wall instability. Int Surg. 1990 Oct-Dec;75(4):231-3.
⁹Paris, F., et al., Surgical stabilization of traumatic flail chest, Thorax, 30, 521-527 (1975)
¹⁰Mayberry JC, Trunkey DD. The fractured rib in chest wall trauma. Chest surgery clinics of North America. 1997 May;7(2):239-61.

100792-181015 DSUS