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DeGenova DT, Peabody JT, Schrock JB, Homan MD, Peguero ES, Taylor BC. Symptomatic rib fracture nonunion: a systematic review of the literature. Arch Orthop Trauma Surg 2024; 144:1917-1924. [PMID: 38492065 DOI: 10.1007/s00402-024-05264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Rib fractures commonly occur in trauma patients with varying presentations. Though the literature in recent years has moved toward favoring more early intervention of acute rib fractures, little has been reported on the matter of surgical fixation for symptomatic rib fracture nonunions. MATERIALS AND METHODS We performed a review of PubMed and Cochrane databases for articles published since 2000. Inclusion criteria were studies with greater than six months of follow-up, while case studies were excluded. A thorough analysis was performed on patient outcomes, complications reported, operative techniques utilized, and fixation systems used, among other parameters reported by the articles. RESULTS One hundred and thirty-nine studies resulted from our review, and a total of nine studies met our inclusion criteria with a combined total of 182 patients who underwent open reduction and internal fixation for symptomatic rib fracture nonunions. All studies reported a significant reduction of pain with increased satisfaction in the majority of patients. There were a total of 71 postoperative complications, the most common of which included surgical site infections, hardware failure, and hematoma. The most serious complications were insulting injury to the lung parenchyma or pleura; however, these were extremely rare based off the current literature. The use of bone grafting was common with eight of the nine studies mentioning the benefits of grafting. CONCLUSION Surgical stabilization of rib fracture nonunions appears to be an appropriate treatment alternative, and various techniques and approaches may be used with similar success. Further studies with higher level of evidence are recommended on the subject.
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Yao J, Zeng Y, Yang J, Wu Q, Chen L, Zheng L, Wang R, Zhu H, Cui H, Huang Y, Cheng S. Repairing tendon-exposed wounds by combing the Masquelet technique with dermoplasty. Front Surg 2022; 9:995316. [PMID: 36451681 PMCID: PMC9704049 DOI: 10.3389/fsurg.2022.995316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/10/2022] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Wound repair is a new field that has emerged in China in the last 5 years. Exposed tendon wounds are one of the most common problems faced in wound treatment today, as the poor blood supply leads to low survival rates of skin grafts. This paper explores the feasibility of applying the Masquelet technique to repair tendon-exposed wounds. METHOD We examined 12 patients with tendon-exposed wounds, 5 males and 7 females, from January 2021 to November 2021, including 2 patients with post-traumatic wounds, 8 diabetic patients with dorsal wounds, and 2 patients with various chronic infections. The Masquelet technique was employed to treat these wounds. The wound surface was sealed with antibiotic bone cement to form an induction membrane, the cement was removed after 3-4 weeks, and the wound was repaired with skin grafts to observe survival, appearance, texture, healing, and related functions. RESULTS All wounds were covered with antibiotic bone cement, and after 3-4 weeks, an induction membrane was applied, and in 10 out of 12 patients, full-thickness skin grafts were applied, and the patients survived. However, in 2 patients, the skin became partially necrotic, but these patients recovered by changing medications. CONCLUSION The current study found that direct skin grafting may effectively treat exposed tendon wounds once the Masquelet approach generates the induction membrane. Further, this method is less difficult, less expensive, and easier to care for the procedure that deserves to be used more frequently.
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Affiliation(s)
- Jiangling Yao
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Yunfu Zeng
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Jian Yang
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Qian Wu
- Academy of Pediatrics, Hainan Medical University, Haikou, China
| | - Liying Chen
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Linyang Zheng
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Rong Wang
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Hengjie Zhu
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Hongwang Cui
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
| | - Yuesheng Huang
- Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology School of Medicine; Department of Wound Repair, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Shaowen Cheng
- Emergency and Traumatology Department, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
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Abstract
INTRODUCTION Rib fractures are common injuries in trauma patients that often heal without intervention. Infrequently, symptomatic rib fracture nonunions are a complication after rib fractures. There is a paucity of literature on the surgical treatment of rib fracture nonunion. The purpose of this study was to describe the efficacy of rib fracture nonunion operative fixation with particular focus on surgical technique, healing rates, and complications. MATERIALS AND METHODS Patients aged ≥ 18 years with symptomatic rib fracture nonunions treated with open reduction and internal fixation (ORIF) with locking plates at a single urban level 1 trauma center were retrospectively reviewed. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed. RESULTS A total of 18 patients met inclusion criteria. The mean time from injury to undergoing ORIF for rib fracture nonunion was just under a year and the number of ribs plated was 2.95 ± 1.16 (1-5 ribs) with bone grafting used in six cases. All patients (100%) showed evidence of healing at an average of 2.65 ± 1.50 months (2-8 months). All patients reported a decrease in pain. No narcotic pain medication was used at an average of 3.88 ± 3.76 weeks (0-10 weeks) post-operatively. Intraoperative and postoperative complications were found in 4 (22.2%) patients. CONCLUSION This study concluded that operative fixation of symptomatic rib fracture nonunion demonstrated favorable outcomes with reduction in preoperative pain levels, decreased use of narcotic pain medication, minimal complications, and a high rate of fracture union. This described method provides symptomatic relief, reduction in pain, and promotes bony healing of the fracture nonunion without development of major complications. We suggest that operative fixation should be considered as the primary method of treatment of symptomatic rib nonunions.
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Abstract
OBJECTIVE To assess the outcomes of patients after rib nonunion reconstruction. DESIGN Retrospective case series. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Between January 2007 and August 2019, 25 consecutive patients with 51 nonunions with disabling pain or chronic instability were treated for nonunited rib fractures. INTERVENTION Rib nonunion reconstructions performed using plate and screw fixation, recannalizing the medullary canal and augmented with autogenous iliac crest bone graft. MAIN OUTCOME MEASUREMENTS Patient demographics, mechanism of injury, number of rib nonunions, and postoperative radiographs were assessed. Satisfaction, patient-reported complications, return to occupation and activity, and general health measures were captured using patient questionnaires. RESULTS In 25 patients, 51 painful rib nonunions were surgically treated. The average length from injury to surgical rib reconstruction was 25.1 months (range = 3-118 months; median = 12 months). Follow-up was obtained in 18 of 25 patients (72%) with a mean of 46.1 months (range = 13-139 months). All ribs achieved radiographic union at an average of 12.3 weeks (range = 8-24 weeks) after surgery. Sixteen of 18 patients (89%) reported satisfaction with surgery and 15 patients (83%) reported mild to no pain at final follow-up. Five patients had complications that all resolved after subsequent treatment. CONCLUSIONS Successful treatment of symptomatic rib nonunion is possible using rib plates in conjunction with bone grafting and has high union rates, satisfactory results, and limited complications. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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