Rib fracture fixation in a South African public trauma service

  • George V Oosthuizen University of KwaZulu-Natal
  • Jacques De Wet University of KwaZulu-Natal
  • John L Bruce University of KwaZulu-Natal
  • Damian L Clarke University of KwaZulu-Natal
Keywords: Rib fracture fixation, rib plating, open reduction and internal fixation of rib fractures

Abstract

Background: Rib fractures and flail chests have traditionally been treated nonoperatively. Current literature suggests that it is not only safe and feasible but also desirable to perform fixation of severe rib fractures. Our unit in the Pietermaritzburg public sector adopted rib fracture fixation in 2014 and in this audit we assess its feasibility in our setting.

Methods and Results: We audited our first nine cases of rib fracture fixation performed to date, of which seven were males. The age range was 29 to 67 years. All patients had multiple rib fractures with severe displacement; one had bilateral flail segments and one had severely displaced unilateral single fractures without flail; all others had unilateral flail chests. Time from injury to operation ranged from 3 to 20 days. Of six ventilator dependent patients, all but one were liberated from the ventilator within 3 days after fixation (1–3 days). The remaining patient remained ventilator dependent for 10 days while recovering from traumatic brain injury. This patient aside, all were discharged from ICU within 5 days. Patients with no other significant injuries were discharged from hospital within five to eight days; all being mobile within five days. Procedure-related complications included accidental pleural breach during rib mobilization necessitating intercostal drain placement (2 patients) and superficial wound infection (1 patient). All patients were discharged well. 

Conclusion: Rib fracture fixation is safe and feasible in our unit and is feasible in the South African public sector.

Author Biographies

George V Oosthuizen, University of KwaZulu-Natal

Pietermaritzburg Metropolitan Trauma Service
University of KwaZulu-Natal
Pietermaritzburg

Jacques De Wet, University of KwaZulu-Natal

Department of Orthopaedics
Edendale Hospital
University of KwaZulu-Natal
Pietermaritzburg

John L Bruce, University of KwaZulu-Natal

Pietermaritzburg Metropolitan Trauma Service
University of KwaZulu-Natal
Pietermaritzburg

Damian L Clarke, University of KwaZulu-Natal

Pietermaritzburg Metropolitan Trauma Service
University of KwaZulu-Natal
Pietermaritzburg

Published
2017-11-16
How to Cite
Oosthuizen, G., De Wet, J., Bruce, J., & Clarke, D. (2017). Rib fracture fixation in a South African public trauma service. South African Journal of Surgery, 55(4), 4-8. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2389
Section
Trauma