M B de Jong1, R M Houwert2, S van Heerde2, M de Steenwinkel3, F Hietbrink2, L P H Leenen2. 1. Department of Traumasurgery, University Medical Center Utrecht, The Netherlands. Electronic address: m.b.dejong-33@umcutrecht.nl. 2. Department of Traumasurgery, University Medical Center Utrecht, The Netherlands. 3. Emergency Department, Erasmus University Medical Center Rotterdam, The Netherlands.
Abstract
INTRODUCTION: In contrast to the emerging evidence on the operative treatment of flail chest, there is a paucity of literature on the surgical treatment of rib fracture nonunion. The purpose of this study was to describe our standardized approach and report the outcome (e.g. patient satisfaction, pain and complications) after surgical treatment of a rib fracture nonunion. METHODS: A single centre retrospective cohort study was performed at a level 1 trauma centre. Symptomatic rib nonunion was defined as a severe persistent localized pain associated with the nonunion of one or more rib fractures on a chest CT scan at least 3 months after the initial trauma. Patients after initial operative treatment of rib fractures were excluded. RESULTS: Nineteen patients (11 men, 8 women), with symptomatic nonunions were included. Fourteen patients were referred from other hospitals and 8 patients received treatment from a pain medicine specialist. The mean follow-up was 36 months. No in-hospital complications were observed. In 2 patients, new fractures adjacent to the implant, without new trauma were observed. Furthermore 3 patients requested implant removal with a persistent nonunion in one patient. There was a mean follow-up of 36 months, the majority of patients (n = 13) were satisfied with the results of their surgical treatment and all patients experienced a reduction in the number of complaints. Persisting pain was a common complaint. Three patients reporting severe pain used opioid analgesics on a daily or weekly basis. Only 1 patient needed ongoing treatment by a pain medicine specialist. CONCLUSION: Surgical fixation of symptomatic rib nonunion is a safe and feasible procedure, with a low perioperative complication rate, and might be beneficial in selected symptomatic patients in the future. In our study, although the majority of patients were satisfied and the pain level subjectively decreases, complaints of persistent pain were common.
INTRODUCTION: In contrast to the emerging evidence on the operative treatment of flail chest, there is a paucity of literature on the surgical treatment of rib fracture nonunion. The purpose of this study was to describe our standardized approach and report the outcome (e.g. patient satisfaction, pain and complications) after surgical treatment of a rib fracture nonunion. METHODS: A single centre retrospective cohort study was performed at a level 1 trauma centre. Symptomatic rib nonunion was defined as a severe persistent localized pain associated with the nonunion of one or more rib fractures on a chest CT scan at least 3 months after the initial trauma. Patients after initial operative treatment of rib fractures were excluded. RESULTS: Nineteen patients (11 men, 8 women), with symptomatic nonunions were included. Fourteen patients were referred from other hospitals and 8 patients received treatment from a pain medicine specialist. The mean follow-up was 36 months. No in-hospital complications were observed. In 2 patients, new fractures adjacent to the implant, without new trauma were observed. Furthermore 3 patients requested implant removal with a persistent nonunion in one patient. There was a mean follow-up of 36 months, the majority of patients (n = 13) were satisfied with the results of their surgical treatment and all patients experienced a reduction in the number of complaints. Persisting pain was a common complaint. Three patients reporting severe pain used opioid analgesics on a daily or weekly basis. Only 1 patient needed ongoing treatment by a pain medicine specialist. CONCLUSION: Surgical fixation of symptomatic rib nonunion is a safe and feasible procedure, with a low perioperative complication rate, and might be beneficial in selected symptomatic patients in the future. In our study, although the majority of patients were satisfied and the pain level subjectively decreases, complaints of persistent pain were common.
Authors: Daniel T DeGenova; Klay B Miller; Tanner T McClure; Hayden B Schuette; Bruce G French; Benjamin C Taylor Journal: Arch Orthop Trauma Surg Date: 2022-07-13 Impact factor: 2.928
Authors: Fabrizio Minervini; Jesse Peek; Nicole M van Veelen; Peter B Kestenholz; Valerie Kremo; Alfred Leiser; Matthias Knobe; Frank J P Beeres Journal: Eur J Trauma Emerg Surg Date: 2022-01-13 Impact factor: 2.374
Authors: Suzanne F M Van Wijck; Esther M M Van Lieshout; Jonne T H Prins; Michael H J Verhofstad; Pieter J Van Huijstee; Jefrey Vermeulen; Mathieu M E Wijffels Journal: Eur J Trauma Emerg Surg Date: 2022-01-27 Impact factor: 2.374