Skip to main content
SpringerLink
Log in

Minimally invasive surgery rib fracture fixation based on location and anatomical landmarks

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Rib fracture is closely related to thoracic injury with high morbidity and mortality. This study aimed to investigate the clinical effect of Zhang ZhiFei (ZZF) zoning method on the selection of incision and approach in minimally invasive surgery for rib fracture.

Methods

A total of 110 patients with rib fractures from July 2017 to July 2019 were enrolled in the study. Preoperative computed tomography and three-dimensional reconstruction of ribs was performed. Then, the rib fractures to be surgically fixed were divided into costal cartilage zone, chest zone, lateral costal zone, high posterior costal zone, low posterior costal subscapular zone, and low posterior costal paraspinal zone, which was called ZZF zoning method. Rib fractures in each zone had unique minimally invasive incision approach, and the open reduction and internal fixation of rib fracture was performed under minimally invasive surgery of corresponding small incision.

Results

The average incision length and number of incisions of the 110 patients were 6.2 cm and 1.3, respectively. The average number of internal fixation was 5.3 and the average operation time was 82 min. The postoperative fracture end was well aligned. After 3 months of follow-up, no internal fixation was displaced or detached.

Conclusion

Based on the anatomical characteristics of different zones of the chest wall, ZZF zoning method provides a new idea and reference for the selection of incision and approach in minimally invasive internal fixation for rib fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. de Moya M, Bramos T, Agarwal S, Fikry K, Janjua S, King DR, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma. 2011;71(6):1750–4. https://doi.org/10.1097/TA.0b013e31823c85e9.

    Article  PubMed  Google Scholar 

  2. Elham P, Moloud F. Conventional radiography or ultra sound for rib fracture diagnosis: a literature review. Rev Clin Med. 2014;1(3):154–9.

    Google Scholar 

  3. Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618–26. https://doi.org/10.1097/TA.0000000000001350.

    Article  PubMed  Google Scholar 

  4. Mitev K, Neziri D, Stoicovski E, Mitrev Z. Surgical plate fixation of multiple rib fractures: a case report. J Med Case Rep. 2018;12(1):150. https://doi.org/10.1186/s13256-018-1683-2.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nandhakumar A, Nair A, Bharath VK, Kalingarayar S, Ramaswamy BP, Dhatchinamoorthi D. Erector spinae plane block may aid weaning from mechanical ventilation in patients with multiple rib fractures: case report of two cases. Indian J Anaesth. 2018;62(2):139–41. https://doi.org/10.4103/ija.IJA_599_17.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wu WM, Yang Y, Gao ZL, Zhao TC, He WW. Which is better to multiple rib fractures, surgical treatment or conservative treatment? Int J Clin Exp Med. 2015;8(5):7930–6.

    PubMed  PubMed Central  Google Scholar 

  7. Xie ZX, Zhou XT, Zhang DS, Yang Y, Zhang GL, Chen MH, et al. Minimally invasive plate osteosynthesis for the treatment of sternal fracture in the lower chest: a case report. J Int Med Res. 2019;47(8):4033–8. https://doi.org/10.1177/0300060519865074.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Merchant NN, Onugha O. Novel extra-thoracic VATS minimally invasive technique for management of multiple rib fractures. J Vis Surg. 2018;4:103. https://doi.org/10.21037/jovs.2018.05.08.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zhou XT, Zhang DS, Yang Y, Zhang GL, Xie ZX, Chen MH, et al. Analysis of the advantages of 3D printing in the surgical treatment of multiple rib fractures: 5 cases report. J Cardiothorac Surg. 2019;14(1):105. https://doi.org/10.1186/s13019-019-0930-y.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lee TH, Lee JH, Chay SW, Jang KS, Kim HJ. Comparison of clinical and radiologic outcomes between non-operative and operative treatment in 5th metatarsal base fractures (zone 1). Injury. 2016;47(8):1789–93. https://doi.org/10.1016/j.injury.2016.05.016.

    Article  PubMed  Google Scholar 

  11. Ge JH, Xu RS, Lei YK, Lu XB, Zhuo NQ. Surgical treatment for rotationally and vertically unstable pelvis fracture. Zhongguo Gu Shang. 2008;21(11):821–3.

    PubMed  Google Scholar 

  12. Kurt A, Turut H, Acipayam A, Kirbas A, Yuce S, Cumhur Cure M, et al. Investigation of surfactant protein-D and interleukin-6 levels in patients with blunt chest trauma with multiple rib fractures and pulmonary contusions: a cross-sectional study in Black Sea Region of Turkey. BMJ Open. 2016;6(10):e011797. https://doi.org/10.1136/bmjopen-2016-011797.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Galos D, Taylor B, McLaurin T. Operative fixation of rib fractures indications, techniques, and outcomes. Bull Hosp Jt Dis (2013). 2017;75(1):15–20.

    Google Scholar 

  14. Wiese MN, Kawel-Boehm N, de la Santa PM, Al-Shahrabani F, Toffel M, Rosenthal R, et al. Functional results after chest wall stabilization with a new screwless fixation device. Eur J Cardiothorac Surg. 2015;47(5):868–75. https://doi.org/10.1093/ejcts/ezu318.

    Article  PubMed  Google Scholar 

  15. Bemelman M, van Baal M, Yuan JZ, Leenen L. The role of minimally invasive plate osteosynthesis in rib fixation: a review. Korean J Thorac Cardiovasc Surg. 2016;49(1):1–8. https://doi.org/10.5090/kjtcs.2016.49.1.1.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nirula R, Diaz JJ Jr, Trunkey DD, Mayberry JC. Rib fracture repair: indications, technical issues, and future directions. World J Surg. 2009;33(1):14–22. https://doi.org/10.1007/s00268-008-9770-y.

    Article  PubMed  Google Scholar 

  17. Schulz-Drost S, Grupp S, Pachowsky M, Oppel P, Krinner S, Mauerer A, et al. Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability. Eur J Trauma Emerg Surg. 2017;43(2):169–78. https://doi.org/10.1007/s00068-016-0664-7.

    Article  CAS  PubMed  Google Scholar 

  18. Du W, Luo L, Wang S, Liu J, Sunden B. Enhanced heat transfer in a labyrinth channels with ribs of different shape. Int J Numer Methods Heat Fluid Flow. 2019;30(2):724–41.

    Article  Google Scholar 

  19. Taylor BC, French BG, Fowler TT. Surgical approaches for rib fracture fixation. J Orthop Trauma. 2013;27(7):e168–73. https://doi.org/10.1097/BOT.0b013e318283fa2d.

    Article  PubMed  Google Scholar 

  20. Lee SK, do Kang K. Nuss procedure for surgical stabilization of flail chest with horizontal sternal body fracture and multiple bilateral rib fractures. J Thorac Dis. 2016;8(6):E390–2. https://doi.org/10.21037/jtd.2016.04.05.

    Article  PubMed  PubMed Central  Google Scholar 

  21. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1994;19(15):1741–4. https://doi.org/10.1097/00007632-199408000-00014.

    Article  CAS  Google Scholar 

  22. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325–33. https://doi.org/10.1097/01.brs.0000182986.43345.cb.

    Article  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China

    Dongsheng Zhang, Xuetao Zhou, Yang Yang, Zexin Xie, Menghui Chen, Zheng Liang & Guoliang Zhang

Authors
  1. Dongsheng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xuetao Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yang Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zexin Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Menghui Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zheng Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guoliang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dongsheng Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

This study was approved by the Ethics Committee of the Shijiazhuang Third Hospital (Approval No. (2019) Research Ethics Approval No. 024).

Statement of informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, D., Zhou, X., Yang, Y. et al. Minimally invasive surgery rib fracture fixation based on location and anatomical landmarks. Eur J Trauma Emerg Surg 48, 3613–3622 (2022). https://doi.org/10.1007/s00068-021-01676-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-021-01676-2

Keywords

Search

Navigation