Treatment of open chest rib fractures with the matrix rib in
A 31-year-old woman was admitted to our hospital with right chest trauma, as well as pain and bleeding as a result of a traffic accident 1 hour previously. At admission, we observed wounds on the right chest wall from the 4th intercostal of the axillary posterior line to the sternum; the wound was approximately 40 cm in size. Moreover, the entire breast was torn open; the pectoralis major, latissimus dorsi, and serratus anterior were torn; and the third to seventh ribs on the right side were fractured. Furthermore, the fifth to seventh ribs on the right side were comminuted with certain intercostal muscle defects. Chest CT indicated open chest trauma, multiple rib fractures, flail chest, hemopneumothorax, and lung contusion on the right side.

After examination and preoperative evaluation, the patient was administered general anesthesia, and underwent single-lumen intubation, emergent debridement, and video-assisted thoracoscopic (VAT) exploration to remove the blood and contaminants from the chest cavity. After thorough debridement, we performed one stage of internal fixation to reconstruct the thorax. As the fractures of the 3, 4, and 5 ribs were moderate, 2 locking screws were fixed at both ends with 6-hole steel plates, and the fixation was smooth. However, the sixth and seventh ribs were fractured at several sites, and were also partially broken and split in a parallel manner along the ribs. We bound the split broken ribs with silk thread, and then fixed the 2 locking screws with 18-hole steel plates at both ends. We then adjusted the ribs bound with silk thread to their original position, and fixed and secured the ribs with locking screws.

Thereafter, the incision was then sutured based on the original anatomical level. Five drainage tubes were used under the incision and removed after drainage fluid less than 50 ml. Cephalothin was given by intravenous injection for infection prevention. The patient in the present case was discharged 15 days after the surgery, and recovered well with a satisfactory outcome. During half a year follow-up after treatment, the patient recovered well with good movement of the right upper limb and lung function.

Source: Medicine: May 2019 - Volume 98 - Issue 20 - p e15683

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