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Oppizzi G, Xu D, Patel T, Diaz JJ, Zhang LQ. Open reduction internal fixation of rib fractures: a biomechanical comparison between the RibLoc U Plus ® system and anterior plate in rib implants. Eur J Trauma Emerg Surg 2023; 49:383-391. [PMID: 36018371 PMCID: PMC10148598 DOI: 10.1007/s00068-022-02075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In this study, we assessed the bending strength of two surgical repairs of rib fracture using RibLoc® U Plus system made by Acute Innovations and the anterior plate by Synthes. METHODS After a rib fracture was created in seven pairs of cadaveric rib specimens, one side was repaired with the anterior plate and the other side repaired with the RibLoc U Plus® plate. Each of the rib is loaded using a custom device over 360,000 bending cycles to simulate in vivo fatiguing related to respiration. Upon completion of the cyclic loading, the specimens were compressively loaded to failure and the failure bending moment was determined. RESULTS The ribs repaired with the RibLoc U Plus® system showed 79% higher failure bending moment than that of the anterior plate, with a p value of 0.033. The ribs repaired with RibLoc U Plus® showed a trend of less stiffness reduction over the 360,000 loading cycles. CONCLUSION The biomechanical study showed that the RibLoc U Plus® system is stronger in the bending moment loading of repaired ribs, possibly due to the U-shape structure supporting both the inner and outer cortices of a repaired rib.
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Affiliation(s)
- Giovanni Oppizzi
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD, 20742, USA.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Dali Xu
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Tirth Patel
- Chicago College of Osteopathic Medicine, Midwestern University, 555 31st Street, Downers Grove, IL, 60515, USA
| | - Jose J Diaz
- Department of Surgery, School of Medicine, University of Maryland, 22 S Greene Street, Baltimore, MD, 21201, USA.,Department of Orthopedics, School of Medicine, University of Maryland, 110 S. Paca Street, Baltimore, MD, 21201, USA
| | - Li-Qun Zhang
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD, 20742, USA. .,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA. .,Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 W. Redwood Street, Baltimore, MD, 21201, USA. .,Department of Orthopedics, School of Medicine, University of Maryland, 110 S. Paca Street, Baltimore, MD, 21201, USA.
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[Injuries of the posterior and lateral chest wall-importance of an additional clavicular fracture]. Unfallchirurg 2019; 121:615-623. [PMID: 30043074 DOI: 10.1007/s00113-018-0528-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Flail chest wall injuries (FCI) are common in younger patients due to high-speed trauma and in older patients due to low-energy trauma or falls from a low height. They show a high incidence of concomitant injuries and are therefore associated with high morbidity and mortality. If there is also an ipsilateral clavicular fracture (CF), the outcome is significantly poorer. The skeleton of the shoulder and chest loses stability and can lead to a loss of function of the shoulder and a pronounced deformation of the chest wall. OBJECTIVE This article shows the origin and clinical importance of FCI. What importance does a concomitant ipsilateral CF have and how can these costoclavicular injuries (CCI) be managed conservatively and operatively? MATERIAL AND METHODS After primary emergency care of the patients with appropriate diagnostics, in the presence of CCI operative stabilization was carried out by means of locked plate osteosynthesis of the clavicle and the affected ribs via minimally invasive approaches with the patient under general anesthesia. Patients were followed up postoperatively. Various minimally invasive posterolateral approaches to the chest wall were previously performed in a corpse study and then put into practice. RESULTS AND CONCLUSION This study presents therapeutic options for the reconstruction of the chest wall based on the established literature and clinical examples. An ipsilateral CF combined with fractures of the 2nd-4th ribs can be treated through an innovative clavipectoral approach. For the other fractures, standard approaches to the anterolateral and posterolateral chest wall are performed, which are associated with a good outcome in clinical practice. An operative stabilization should be performed at the latest when FCI or CCI together with a dislocating fracture and a marked deformation of the thoracic wall are present. Remaining misalignments are associated with a simultaneous loss of function of the chest wall and shoulder.
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