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Xue H, Zhang Z, Liu M, Lin Z, Endo Y, Liu G, Mi B, Zhou W, Liu G. Finite element analysis of different fixation methods of screws on absorbable plate for rib fractures. Front Bioeng Biotechnol 2022; 10:960310. [PMID: 35935502 PMCID: PMC9354002 DOI: 10.3389/fbioe.2022.960310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple rib fractures caused by trauma are common injuries and the internal fixation methods of these injuries have been paid more and more attention by surgeons. Absorbable plates and screws are the effective way to treat rib fractures, but there are no reports on which type of screw fixation method is most effective. In this study, finite element analysis was used to study the effects of five different types of screw fixation methods on anterior rib, lateral rib and posterior rib. The finite element model of the ribs was reconstructed from CT images, and the internal pressure (40 kPa) and intercostal force (30 N) on the surfaces of the ribs were simulated accordingly. An intercostal force of 30 N was applied to the upper and lower surfaces of the ribs to simulate the effect of intercostal muscle force. The pressure of 40 kPa was applied to the inner surface of the ribs, and the normal direction was applied to the inner surface of the ribs. The positive direction was considered inspiratory pressure, and the negative direction was considered expiratory pressure. The results indicate the optimal type of screw fixation on the absorbable plate for rib fractures, and provide a basis and reference for clinical application.
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Affiliation(s)
- Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenhe Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengfei Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ze Lin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yori Endo
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Guodong Liu
- Medical Center of Trauma and War Injuries, Daping Hospital, Army Medical University, Chongqing, China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Guohui Liu, ; Wu Zhou,
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Guohui Liu, ; Wu Zhou,
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Xu S, Zhu J, Yu Q, Peng L, Tao Y, Qi S, Han H, Liu Y. Surgical treatment of sternum comminuted fracture with memory alloy embracing fixator. J Thorac Dis 2021; 13:2194-2202. [PMID: 34012570 PMCID: PMC8107563 DOI: 10.21037/jtd-20-3603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sternal fracture can result from multiple types of severe chest trauma and carries significant risk. Surgical fixation is an effective method for sternal fracture. Methods The clinical data of patients with sternal fractures who presented to our hospital between August 2016 and July 2019 were collected. The 42 patients were divided into three groups, with 15 patients treated by internal fixation with NI-TI memory alloy embracing fixator, 10 patients receiving steel wire fixation, and 17 who received non-surgical treatment and who was designated as a control (conservative) group. Differences in clinical indices included the duration of surgery, blood loss, hospitalization, wound healing, hospitalization expenses, VAS scores, and patient satisfaction scores between the three groups was compared. The analysis of variance and t-test were used for quantitative variables, which were approximately normally distributed. Dichotomous data were compared used Pearson χ2 or Fisher’s exact test, and a P value less than 0.05 was considered as statistically significant. Results All patients were cured, and there were no significant differences in general clinical features between the three groups (P>0.05). Thoracic deformity in the surgical groups was corrected anatomically and received better pain scores, while patients in the NI-TI memory alloy embracing fixator group showed advantages of bleeding and patient satisfaction (P<0.05). Conclusions Operative treatment for a sternal fracture is safe, effective and can quickly restore the stability of the thorax. Memory alloy embracing fixator is markedly superior to other fixator materials.
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Affiliation(s)
- Shun Xu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China.,Department of Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Zhu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Qi Yu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Leilei Peng
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Yu Tao
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Shengbo Qi
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Hao Han
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Yongjing Liu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
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Ahmed K, Nady MA. Sternal reconstruction using locking compression plates (LCP): our experience in Egypt, a case series. J Cardiothorac Surg 2020; 15:224. [PMID: 32825827 PMCID: PMC7441539 DOI: 10.1186/s13019-020-01266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Sternal fractures are rare accounting for about 3–8% of traumatic chest. There are many lines of treatments for sternal fractures which can be classified as conservative or surgical. Surgical techniques include wire fixation and sternal plating. There are no standardization of indications for each line of management. We explore if sternal reconstruction using locking titanium plates and self-tapping screws provide the patient with the best chance of proper sternal healing avoiding chronic pain and its complications and allow the patient early mobilization and rapid restoring of his normal life at its maximum. Methods Our inclusion criteria are patients of both gender from 20 to 60 years of age presented with traumatic sternal fracture at any site or pathological fracture due to metastatic or primary tumors infiltrating the sternum. High Associated Injury Scale scores were excluded. Exclusion criteria also included patients younger than 20 years or older than 60 years. Primary outcome is post-operative pain score and is measured using numerical pain scale ranging from zero to 10 where zero means there is no pain at all and ten is the worst imaginable pain ever. Results Sternal reconstruction using titanium plates has proven to be an efficient method of stabilization with tremendous immediate relief of pain showed by the differences between pre-operative and post-operative pain scale scores in our patients (n = 5) with Median scores being 7 and 1.5 with range being from 7 to 9 and 1 to 3 respectively (p-value = .039). Operative time range between 150 min and 90 min with median of 120 min. Extubation of patients was smooth with no events with median time of extubation being 120 min. From our experience, there were no observed wound complications except at the third patient who suffered a small wound hematoma that was resolved by gentle compressing only and needed no further intervention. Conclusion We recommend adopting sternal reconstruction using titanium plating systems more readily encouraging even larger clinical trials on the way to a clear guidelines. Plating systems show promising results with least pain, better stability, less complications and rapid, smooth recovery. Trial registration NCT04092374
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Affiliation(s)
- Kareem Ahmed
- Cardiothoracic Surgery Department, Assiut University Heart Hospital, Assiut, Egypt.
| | - Mohamed Alaa Nady
- Cardiothoracic Surgery, Assiut University Heart Hospital, Assiut, Egypt
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Xia H, Sun Z, Wang J, Tian A, Li J, Li X, Zhu S, Miao J, Wang D. Application of rib surface positioning ruler combined with volumetric CT measurement technique in endoscopic minimally invasive thoracic wall fixation surgery. Exp Ther Med 2020; 20:1616-1620. [PMID: 32742393 PMCID: PMC7388419 DOI: 10.3892/etm.2020.8862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/04/2020] [Indexed: 12/20/2022] Open
Abstract
Application value of rib surface positioning ruler combined with volumetric CT measurement in selection of the incision for minimally invasive internal fixation of rib fracture was investigated. A total of 80 patients who received internal fixation of rib fractures in Tianjin Hospital Affiliated to Tianjin University (Tianjin, China) from May 2018 to April 2019 were selected. Patients were treated with the rib surface positioning ruler combined with volumetric CT measurement method (n=42) or traditional positioning method (n=38). The following parameters were compared between the two groups: Preset incision accuracy, operation incision length, operation time, intraoperative bleeding volume, postoperative wound drainage volume and postoperative pain score. Compared with the traditional positioning method, rib surface positioning ruler combined with volumetric CT measurement method can improve preset incision accuracy, reduce operation time, incision length, intraoperative bleeding volume, postoperative wound drainage volume, and postoperative pain score, with statistically significant differences (P<0.05). In conclusion, the application of rib surface positioning ruler combined with volumetric CT measurement technique has obvious effect on the selection of incision for internal fixation of rib fracture, and is an effective method worth promoting.
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Affiliation(s)
- Honggang Xia
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Zhongyi Sun
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Juping Wang
- Department of Cardiology, Beichen District Hospital of Traditional Chinese Medicine, Tianjin 300400, P.R. China
| | - Aixian Tian
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Jing Li
- Department of Basic Nursing, Tianjin Medical College, Tianjin 300222, P.R. China
| | - Xuan Li
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Shan Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Jun Miao
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Dongbin Wang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
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Xia H, Zhu D, Li J, Sun Z, Deng L, Zhu P, Zhang Y, Li X, Wang D. Current status and research progress of minimally invasive surgery for flail chest. Exp Ther Med 2019; 19:421-427. [PMID: 31885692 PMCID: PMC6913304 DOI: 10.3892/etm.2019.8264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/25/2019] [Indexed: 01/27/2023] Open
Abstract
Chest trauma accounts for ~13.5% of all traumas, and direct death from chest trauma accounts for 20–25% of all traumatic deaths. Chest trauma is the second cause of death from trauma. Frequent rib fractures, especially in patients with flail chest, often cause severe pain, chest wall softening, abnormal breathing and severe lung contusion and laceration, usually requiring thoracic surgery. In recent years, the open reduction and internal fixation treatment of rib fractures with flail chest has achieved satisfactory results, and some surgical indications have reached consensus. A number of scholars and medical centers have demonstrated the practicality and cost-effectiveness of rib fixation in flail chest, including the small incidence of pulmonary complications, the short ICU mechanical ventilation time, and the reduction of digestive tract inhibition. Open reduction and internal fixation of rib fractures involves multiple ribs. Conventional rib fractures require a large incision to achieve satisfactory exposure. Chest wall muscles, blood vessels and nerves (long thoracic and thoracodorsal nerves) are injured, resulting in a high infection rate of the incision and postoperative dysfunctions, such as limited upper limb, shoulder and back function, and long time numbness on the affected side of the chest. Therefore, the damage of muscles and nerves caused by conventional surgical methods limits the development of such surgical technique. Although the video-assisted thoracoscopic technique has become a necessary technical means for the treatment of thoracic trauma and has been applied to thoracic exploration and hemostasis, there is no report on the application of open reduction and internal fixation for rib fracture. The difficulty lies in the tightly combined bony thorax and the soft tissue of the chest wall. Therefore, experts have explored a variety of minimally invasive surgical methods for the flail chest. The current status and research progress of minimally invasive surgery for thoracic surgery are reviewed.
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Affiliation(s)
- Honggang Xia
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China.,School of Medical Engineering and Translational Medicine, Tianjin 300000, P.R. China
| | - Deqing Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Jing Li
- Teaching and Research Division, Tianjin Medical College, Tianjin 300000, P.R. China
| | - Zhongyi Sun
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Limin Deng
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Pengzhi Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Yongmin Zhang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Xuan Li
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Dongbin Wang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
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Divisi D, Barone M, Crisci R. Surgical Management of Flail Chest: State of Art and Future Perspectives. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0184-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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