Abby Choke1, Yoke Rung Wong2, Janna-Vale Joethy1. 1. Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore 169856, Singapore. 2. Department of Gastrointestinal and Pediatric Surgery, Mie University School of Medicine, Tsu, Japan.
Abstract
BACKGROUND: Surgical stabilization of rib fractures is an established form of treatment for complex rib fractures. Plate fixation with bicortical screws placement can cause injury to intra-thoracic organs and pleural irritation from protruding screw tips. The aim of this study is to compare the biomechanical properties of monocortical and bicortical plate fixation for rib fractures using a locking plate system. METHODS: Ten pairs of fresh-frozen cadaveric ribs were harvested. Native ribs were mounted onto a biomechanical tester and statically loaded to failure to induce a rib fracture. The native stiffness of the rib was measured. Next, the ribs were stabilized using the Synthes MatrixRIB (Johnson & Johnson, USA) locking plate. Left-sided ribs were fixed in a bicortical manner and right-sided ribs were fixed in a monocortical manner. The repaired ribs were subjected to cyclic loading of 50,000 cycles between 2 to 6 N to simulate physiological respiration, followed by static loading at a rate of 10 N/min until failure. The pre and post-repaired stiffness were measured. A high-speed camera was used to record the mechanism of failure. RESULTS: One left-sided rib was omitted from the study because the fracture occurred at the drill hole site. Left-sided ribs demonstrated a mean native stiffness of 10.0 N/mm (SD 3.71) and right-sided 11.92 N/mm (SD 3.57). After plate fixation, pre and post cyclic stiffness was 3.32 N/mm (SD 1.21) and 4.41 N/mm (SD 3.29) for the bicortical group; 3.14 N/mm (SD 1.24) and 3.91 N/mm (SD 1.98) for the monocortical group. There is no statistical difference found between the two groups (P=0.872). CONCLUSIONS: Our results show that there is no difference in stability between monocortical and bicortical fixation for rib fractures using a locking plate system. Monocortical fixation is recommended to avoid potential complications. 2019 Journal of Thoracic Disease. All rights reserved.
BACKGROUND: Surgical stabilization of rib fractures is an established form of treatment for complex rib fractures. Plate fixation with bicortical screws placement can cause injury to intra-thoracic organs and pleural irritation from protruding screw tips. The aim of this study is to compare the biomechanical properties of monocortical and bicortical plate fixation for rib fractures using a locking plate system. METHODS: Ten pairs of fresh-frozen cadaveric ribs were harvested. Native ribs were mounted onto a biomechanical tester and statically loaded to failure to induce a rib fracture. The native stiffness of the rib was measured. Next, the ribs were stabilized using the Synthes MatrixRIB (Johnson & Johnson, USA) locking plate. Left-sided ribs were fixed in a bicortical manner and right-sided ribs were fixed in a monocortical manner. The repaired ribs were subjected to cyclic loading of 50,000 cycles between 2 to 6 N to simulate physiological respiration, followed by static loading at a rate of 10 N/min until failure. The pre and post-repaired stiffness were measured. A high-speed camera was used to record the mechanism of failure. RESULTS: One left-sided rib was omitted from the study because the fracture occurred at the drill hole site. Left-sided ribs demonstrated a mean native stiffness of 10.0 N/mm (SD 3.71) and right-sided 11.92 N/mm (SD 3.57). After plate fixation, pre and post cyclic stiffness was 3.32 N/mm (SD 1.21) and 4.41 N/mm (SD 3.29) for the bicortical group; 3.14 N/mm (SD 1.24) and 3.91 N/mm (SD 1.98) for the monocortical group. There is no statistical difference found between the two groups (P=0.872). CONCLUSIONS: Our results show that there is no difference in stability between monocortical and bicortical fixation for rib fractures using a locking plate system. Monocortical fixation is recommended to avoid potential complications. 2019 Journal of Thoracic Disease. All rights reserved.
Authors: John B Holcomb; Neil R McMullin; Rosemary A Kozar; Marjorie H Lygas; Frederick A Moore Journal: J Am Coll Surg Date: 2003-04 Impact factor: 6.113
Authors: K Hellberg; E R de Vivie; K Fuchs; B Heisig; W Ruschewski; H G Luhr; M Poutot Journal: Thorac Cardiovasc Surg Date: 1981-10 Impact factor: 1.827
Authors: M Bottlang; S Walleser; M Noll; S Honold; S M Madey; D Fitzpatrick; W B Long Journal: Eur J Trauma Emerg Surg Date: 2010-09-24 Impact factor: 3.693