A Contribution of Multidetector Computed Tomography to Indications for Chest Wall Stabilisation in Multiple Rib Fractures
Abstract
Multidetector computed tomography (MDCT) is more sensitive for the detection of injury to the thoracic wall and intrathoracic organs than a plain chest radiograph. The chest wall deformity and instability following multiple rib fracture involves fractures of four or more adjacent ribs at two levels, sometimes including a sternal fracture.
It may also be associated with lung trauma (pneumothorax, haemothorax, rupture, laceration or pulmonary contussion). An isolated multiple-rib fracture can successfully be treated conservatively.
Early intubation and mechanical ventilation are indicated in patients with progressive respiratory insufficiency. Indications for surgical stabilisation of this fracture are based on the signs of respiratory failure and the results of imagining methods (MDCT at the present time).
CONCLUSIONS Based on 3D reconstruction from MDCT images, it is possible to make the pre-operative considerations for rib osteosynthesis more specific and to choose the best approach. At the same time MDCT enables us to diagnose associated intra-thoracic injuries and provides indications for their treatment.
In addition, it gives us a possibility to evaluate the role of a flail segment in breathing dysfunction and to establish indications for surgical stabilization in multiple rib fractures. Rib osteosynthesis allowed for early stabilization of the chest wall and improved the mechanics of breathing, thus requi - ring a shorter period of mechanical ventilation.
The evaluation of statistical significance of these facts will be made when a larger group of patients examined by MDCT is available.