Abstract
Introduction: The method of choice in the treatment of flail chest and other unstable injuries of the chest wall is a rib osteosynthesis. Other indications for surgical stabilization of injured chest wall include deformities or defects of the chest wall, dislocated rib fractures with a lung injury, open rib fractures, open defects of the chest wall, impaired healing of rib fractures, and osteosynthesis of dislocated ribs in patients with acute thoracotomy.
On the basis of extensive experiences with use of Judet plates for stabilisation of rib fractures, innovated version of the rib plates was designed, in cooperation between Traumatology Centre and Department of Surgery of the University Hospital Královské Vinohrady and 3rd Faculty of Medicine, Charles University, and the Department of Development of the Medin a.s., Czech Republic Company. These innovated plates were subsequently used in a clinical trial for treatment of injured patients with unstable chest wall.
Materials, methods: An innovated rib plate, including appropriate instruments, has been developed and constructed in the course of the last three years. The aims of innovation of the new plates included the following: 1.New technical parameters of the plates - possibility to bend the plates in all directions, construction of new fixation clips. 2.Use of locking screws for plate fixation - adequate and safe fixation in cases when the screws penetrate through both cortical layers of the rib. 3.New Instruments - tongs for holding the plate, for bending and fixation tongs. 4.Fixation of plates to the rib by bending the fixation clips - with minimal compression of intercostal vessels and nerves.
The clinical part of the project of stabilizing flail chest fractures with osteosynthesis using the innovated Judet rib plates began in 2017; the innovated plates were used in six patients. Results: The surgical technique using the innovated plates was performed with satisfactory outcomes in six patients with flail chest injuries.
Fixation of the plates in combination with anchoring of the fixation clips and the use of cortical locking screws through both cortical parts of the rib is an adequate and safe procedure for osteosynthesis. All patients underwent revision thoracotomy due to retained haemothorax or haematoma in the pleural cavity.
Pulmonary contusion was confirmed in all patients. Rib osteosynthesis was performed between the third and sixth day after injury.
Postoperative mechanical ventilation lasted between 24 hours and six days. The postoperative course was without complications, with primary healing.
Conclusion: The innovated technique of rib osteosynthesis in flail chest injuries is one of the conditions for extending this technique of stabilization of serious injuries of the chest wall. This technique of rib osteosynthesis is simple, safe, requiring a short time interval for plate fixation and providing sufficient stabilization.
The first clinical experience showed safe performance of rib fixation, with a concomitant possibility to perform revision of the thoracic cavity, with a minimal risk of complications in the postoperative period.