2. Flail Chest and how it is treated
Background information on rib
fractures
Surgical Rib Fixation (SRF) and how it
is utilized at Baystate
Study methods and
results/conclusions
Future of SRF?
3. • A flail chest occurs when a segment of the
thoracic cage is separated from the rest of the
chest wall.
• Result of a crushing chest injury
• Paradoxical respiration
http://medical-dictionary.thefreedictionary.com/flail+segment
This image shows the
paradoxical movements
of the flail segments
4. Major source of morbidity in the U.S.
Significant advances in pain control, no
improvement in the outcomes
Various reports beginning in the 1950s and
sporadic attempts through the mid 80’s
The safety and efficiency of SRF remains
uncertain (especially in age ≥ 65 population)
5. 11,807 Deaths from Thoracic Trauma
Mortality was 22% for the elderly versus 10%
for the young
The most common complication of rib
fractures is pneumonia
Up to 60% patients do not return to full time
employment
6. Surgical Rib Fixation is a surgery that allows
surgeons to apply artificial support to fractured
ribs
There are different methods of support that can
be used during SRF; these include Rib Loc,
Synthes Rib Matrix, and Intramedullary Nail
Here at Baystate, the Synthes Rib Matrix is
utilized
7. Ribs are realigned and
osteosynthes plates are
bent/cut to fit specific ribs.
The ribs are held together by
the osteosynthes plate, which
is screwed into the ribs.
Important for restoration of
the integrity of the chest wall:
• Plate apposition
• tissue mobilization
• shape formation
8. Baystate Medical Center has created a
multidisciplinary team approach to the care of rib
fracture patients.
This includes specific pain regimens,
multimodality target respiratory therapy, and
surgical intervention
The study conducted here at Baystate focused
on the concept of age restrictions within the
SRF patient population
9. Patients with flail chest or severe rib fractures who
were admitted to a Level 1 Trauma Center for SRF
between July 2010 and June 2014 were evaluated
Patients age ≥ 65 and age ≤ 64 were evaluated and
compared in the outcome variables:
1. Injury Severity Score
2. Total number of Fractures
3. Hospital Length of Stay
4. ICU LOS
5. Ventilator Days
6. Fractures Repaired
10. Utilized REDCap Database, which is a
secure, web-based application for building
and managing online databases
Research Electronic Data Capture
Also provides automated export
procedures for easy statistical analysis
11. The median number of
ventilator days, ISS, ICU
LOS, and Hospital LOS were
similar in both groups,
signaling that there should
not be age restrictions on
surgical rib fixations.
12. This project is intended
to improve the care and
outcomes of patients
with rib fractures.
Presentation at EAST
(Eastern Association for
Aurgical Trauma) at end
of January 2015
Creation of a national
registry
http://www.swedish.org/about/blog/august-2012/rib-fractures-
essentials-of-management-treatment
13. Thank you to Andrew Doben, M.D., who is the
primary researcher of this project
Thank you to Jeffry Nahmias, M.D., who made
this internship opportunity possible
Thank you to Jane Sicard and the Summer
Scholars for giving me the opportunity to present
my research here today
14. 1. Flail chest. (n.d.). Medterms. Retrieved July 21, 2014, from
http://www.medterms.com/script/main/art.asp?articlekey=3473
2. flail segment. (n.d.). TheFreeDictionary.com. Retrieved July 16, 2014, from http://medical-
dictionary.thefreedictionary.com/flail+segment(flail segment image/definition)
3. M.D., A. D. (Director) (2014, July 21). Surgical Management of Traumatic Rib Fractures.
Lecture conducted from , Springfield, MA.
4. Operative management of rib fractures in the setting of flail chest: a systematic review and
meta-analysis. (0001, January 18). Operative management of rib fractures in the setting of flail chest: a
systematic review and meta-analysis. Retrieved July 16, 2014
5. REDCap. (n.d.). REDCap. Retrieved August 4, 2014, from
https://collaborate.tuftsctsi.org/redcap/
6. SRF Abstract by Dr. Andrew Doben, M.D.
7. Swedish Medical Center Seattle and Issaquah. (n.d.). Swedish. Retrieved July 16, 2014, from
http://www.swedish.org/about/blog/august-2012/rib-fractures-essentials-of-management-
treatment
8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. (n.d.). AccessMedicine.
Retrieved July 16, 2014, from
http://accessmedicine.mhmedical.com/content.aspx?bookid=348§ionid=40381746&jumpsect
ionID=40408000&Resultclick=2
9. TRAUMA.ORG: Thoracic Trauma. (n.d.). TRAUMA.ORG: Thoracic Trauma. Retrieved July 16,
2014, from http://www.trauma.org/archive/thoracic/CHESTflail.html(flail chest definition)
Notes de l'éditeur
Talk about flail chest and the effects it has on pulmonary function… how would flail chest be treated if SRF was unavailable?
Give background info on the severity of rib fractures and the complications that can follow… also talk about how they are treated and the risks of poor treatment
What exactly is SRF and how does baystate manage rib fracture cases?
How did we conduct this study/what was the protocol for our research?
What are the future plans for SRF?
Flail Chest is defined as a loss of stability of the chest wall due to three or
more ribs that are broken in two or more places as a result of a crushing
chest injury. (THIS IS AN ANTIQUATED DEFINITION)…The loose chest segment moves in a direction in the reverse of
normal; that is, the segment moves inward during inhalation and outward
during exhalation (also known as paradoxical respiration).
The frequency of flail chest is 150/100K injuries
Rib fractures remain a major source of morbidity and although there have been advances in pain control, the outcomes have not improved
The safety and efficiency of SRF remains uncertain because few studies have been conducted, especially in the age>65 population
Chest deformity and permanent respiratory struggles
60% never return to work
Different types of SRF procedures
A quick slide showing a summarized view of the SRF process using Synthes Rib Matrix
The Baystate team has created a multidisciplinary team approach in the care of fractured ribs
There are specific pain regimens and surgical interventions
All patients whom underwent SRF were reviewed in our study
This group of patients was then sub-divided into age <65 and age >65 presentation groups
Data was analyzed, revealing similarities between the two group
Wording? Who did we choose and why?
REDCap was the database software that was utilized for this study
Outcome variables
It was observed that the two study groups, ages > 65 and ages <64 were nearly identical in all variable outcomes. The median number of ventilator days, ISS, ICU LOS, and Hospital LOS were similar in both groups, signaling that there should not be age restrictions on surgical rib fixations.
Our results are consistent with others like it. We hope to present this data at a national conference where we will encourage other institutions to begin to share their data and outcomes of surgical rib fixation to create a national registry that perhaps will help determine the overall benefit to patients.