Advertisement

The evaluation of pulmonary function after rib fixation for multiple rib fractures and flail chest: a retrospective study and systematic review of the current evidence

  • Jesse PeekEmail author
  • Reinier Bart Beks
  • Valerie Kremo
  • Nicole van Veelen
  • Alfred Leiser
  • Roderick Marijn Houwert
  • Björn-Christian Link
  • Matthias Knobe
  • Reto Hansjörg Babst
  • Frank Joseph Paulus Beeres
Original Article
  • 42 Downloads

Abstract

Purpose

The primary aim of this retrospective cohort study was to evaluate the pulmonary function after rib fixation for patients with multiple rib fractures and flail chest. Secondary, a systematic review was performed to give an overview of the current literature and to allow comparison with our results.

Methods

All adult (≥ 18 years) patients who underwent rib fixation for multiple rib fractures or flail chest between 2010 and 2018 and who received a control pulmonary function test during the postoperative follow-up at our level-1 trauma center were retrospectively reviewed. Secondary, the PubMed, EMBASE and Cochrane databases were searched to identify studies reporting on the pulmonary function after rib fixation. The primary outcome parameters were the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, maximum vital capacity (VCmax), total lung capacity (TLC), residual volume (RV), and RV/TC ratio.

Results

Of the 103 patients who underwent rib fixation, a total of 61 (59%) patients underwent a pulmonary function test in our hospital and were ultimately included. In the majority of patients all pulmonary function parameters fell within the normal range of the reference values. Obstructive impairment was predominantly seen in patients with pre-existing chronic obstructive pulmonary disease (COPD). Patients with multiple rib fractures had better recovery compared to those with a flail chest. The systematic review included a total of 15 studies and showed comparable results.

Conclusion

The present study demonstrates that rib fixation for multiple rib fractures or flail chest results in adequate recovery of the pulmonary function within 3 months after surgery. In addition, based on the current literature, further gradual improvement to maximum pulmonary values appears to occur during the first 12 months after rib fixation.

Keywords

Rib fixation Flail chest Multiple rib fractures Pulmonary function 

Notes

Acknowledgements

A special thanks goes to Dr. med. Reinhard Schläpfer and the Department of Pulmonology for their assistance with the data extraction.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplementary material

68_2019_1274_MOESM1_ESM.docx (15 kb)
Supplementary file1 (DOCX 15 kb)
68_2019_1274_MOESM2_ESM.docx (13 kb)
Supplementary file2 (DOCX 12 kb)

References

  1. 1.
    Vana PG, Neubauer DC, Luchette FA. Contemporary management of flail chest. Am Surg. 2014;80(6):527–35.PubMedGoogle Scholar
  2. 2.
    Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975–9.CrossRefGoogle Scholar
  3. 3.
    Lin FC-F, Li R-Y, Tung Y-W, Jeng K-C, Tsai SC-S. Morbidity, mortality, associated injuries, and management of traumatic rib fractures. J Chin Med Assoc. 2016;79(6):329–34.CrossRefGoogle Scholar
  4. 4.
    Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):715–7.CrossRefGoogle Scholar
  5. 5.
    Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017;25(1):42.CrossRefGoogle Scholar
  6. 6.
    Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–7.CrossRefGoogle Scholar
  7. 7.
    Sonny A, Pino RM. Rib fracture and lung contusion: impact on pulmonary function tests. In: Moya M, Mayberry J, editors. Rib fracture management. Cham: Springer; 2018. p. 85–92.CrossRefGoogle Scholar
  8. 8.
    Kasotakis G, Hasenboehler EA, Streib EW, 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.CrossRefGoogle Scholar
  9. 9.
    Beks RB, Peek J, Jong MB, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2019;45(4):631–44.CrossRefGoogle Scholar
  10. 10.
    Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9.CrossRefGoogle Scholar
  11. 11.
    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–34.CrossRefGoogle Scholar
  12. 12.
    Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews ofinterventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. https://handbook.cochrane.org. Accessed 7 May 2019.
  13. 13.
    Caragounis EC, Olsén MF, Pazooki D, Granhed H. Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study. World J Emerg Surg. 2016;11:27.CrossRefGoogle Scholar
  14. 14.
    Ali-Osman F, Mangram A, Sucher J, et al. Geriatric (G60) trauma patients with severe rib fractures: is muscle sparing minimally invasive thoracotomy rib fixation safe and does it improve post-operative pulmonary function? Am J Surg. 2018;216(1):46–51.CrossRefGoogle Scholar
  15. 15.
    Wiese MN, Kawel-Boehm N, Santa PM, et al. Functional results after chest wall stabilization with a new screwless fixation device. Eur J Cardio Thorac Surg. 2015;47(5):868–75.CrossRefGoogle Scholar
  16. 16.
    Lardinois D, Krueger T, Dusmet M, Ghisletta N, Gugger M, Ris HB. Pulmonary function testing after operative stabilisation of the chest wall for flail chest. Eur J Cardio Thorac Surg. 2001;20(3):496–501.CrossRefGoogle Scholar
  17. 17.
    Balci AE, Eren S, Cakir O, Eren MN. Open fixation in flail chest: review of 64 patients. Asian Cardiovasc Thorac Ann. 2004;12(1):11–5.CrossRefGoogle Scholar
  18. 18.
    Granetzny A, El-Aal MA, Emam E, Shalaby A, Boseila A. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005;4(6):583–7.CrossRefGoogle Scholar
  19. 19.
    Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32.PubMedGoogle Scholar
  20. 20.
    Zhang X, Guo Z, Zhao C, Xu C, Wang Z. Management of patients with flail chest by surgical fixation using claw-type titanium plate. J Cardiothorac Surg. 2015;10:145.CrossRefGoogle Scholar
  21. 21.
    Fagevik Olsen M, Slobo M, Klarin L, Caragounis E-C, Pazooki D, Granhed H. Physical function and pain after surgical or conservative management of multiple rib fractures—a follow-up study. Scand J Trauma Resusc Emerg Med. 2016;24(1):128.CrossRefGoogle Scholar
  22. 22.
    Moslam KE, Badawy MSH, Asida SM. Evaluation of respiratory functions in chest trauma patients treated with thoracic wall stabilization. Egypt J Chest Dis Tuberc. 2015;64(1):213–7.CrossRefGoogle Scholar
  23. 23.
    Said SM, Goussous N, Zielinski MD, Schiller HJ, Kim BD. Surgical stabilization of flail chest: the impact on postoperative pulmonary function. Eur J Trauma Emerg Surg. 2014;40(4):501–5.CrossRefGoogle Scholar
  24. 24.
    Jayle CPM, Allain G, Ingrand P, et al. Flail chest in polytrauma-tized patients: surgical fixation using stracos reduces ventilator time and hospital stay. Biomed Res Int. 2015;2015:624723.CrossRefGoogle Scholar
  25. 25.
    Bottlang M, Long WB, Phelan D, et al. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury. 2013;44(2):232–8.CrossRefGoogle Scholar
  26. 26.
    Nickerson TP, Thiels CA, Kim BD, Zielinski MD, Jenkins DH, Schiller HJ. Outcomes of complete versus partial surgical stabilization of flail chest. World J Surg. 2016;40:236–41.CrossRefGoogle Scholar
  27. 27.
    Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013;216(5):924–32.CrossRefGoogle Scholar
  28. 28.
    Bakhos C, O’Connor J, Kyriakides T, Abou-Nukta F, Bonadies J. Vital capacity as a predictor of outcome in elderly patients with rib fractures. J Trauma. 2006;61:131–4.CrossRefGoogle Scholar
  29. 29.
    Livingston DH, Richardson DJ. Pulmonary disability after sever blunt chest trauma. J Trauma. 1990;30(5):562–7.CrossRefGoogle Scholar
  30. 30.
    Kishikawa M, Yoshioka T, Shimazu T, Sugimoto H, Yoshioka T, Sugimoto T. Pulmonary contusion causes long-term respiratory dysfunction with decreased function residual capacity. J Trauma. 1990;31(9):1203–10.CrossRefGoogle Scholar
  31. 31.
    de Moya M, Nirula R, Biffl W. Rib fixation: who, what, when? Trauma Surg Acute Care Open. 2017;2(1):e000059.CrossRefGoogle Scholar
  32. 32.
    Mayberry JC, Kroeker AD, Ham LB, Mullins RJ, Trunkey DD. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg. 2009;75(5):389–94.PubMedGoogle Scholar
  33. 33.
    Shelat VG, Eileen S, John L, Teo LT, Vijayan A, Chiu MT. Chronic pain and its impact on quality of life following a traumatic rib fracture. Eur J Trauma Emerg Surg. 2012;38(4):451–5.CrossRefGoogle Scholar
  34. 34.
    Gordy S, Fabricant L, Ham B, Mullins R, Mayberry J. The contribution of rib fractures to chronic pain and disability. Am J Surg. 2014;207(5):659–62.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jesse Peek
    • 1
    • 2
    Email author
  • Reinier Bart Beks
    • 1
    • 2
  • Valerie Kremo
    • 1
  • Nicole van Veelen
    • 1
  • Alfred Leiser
    • 3
  • Roderick Marijn Houwert
    • 2
  • Björn-Christian Link
    • 1
  • Matthias Knobe
    • 1
  • Reto Hansjörg Babst
    • 1
  • Frank Joseph Paulus Beeres
    • 1
  1. 1.Department of Orthopedic and Trauma SurgeryCantonal Hospital LucerneLucerneSwitzerland
  2. 2.Department of SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Department of Thoracic and Cardiovascular SurgeryCantonal Hospital LucerneLucerneSwitzerland

Personalised recommendations