Biomechanical characteristics of individual methods of rib osteosynthesis

S.I. Panasenko, S.B. Kovalchuk, S.O. Guriev, O.V. Goryk, V.D. Shejko, O.A. Burlaka

Abstract


Background. The analytical review of the sources of scientific information considered a number of problems in the process of changing the paradigm of the treatment of rib fractures with a floating chest. The recommendations for internal osteosynthesis of ribs have controversial nature in relation to the traumatological recommendations on the inexpediency of this methodology in case of severe polytrauma. In addition, a direct extrapolation of the osteosynthesis techniques of long bones in the techniques of the rib osteosynthesis does not take into account their histoanatomical and functional features, and the evidence base of all the studies is based only on the clinical effects of treatment. None of the existing methods of rib osteosynthesis have biotechnical justification. The article presents the results of an experimental comparison of the biomechanical characteristics of the rib osteosynthesis methods most common in Ukraine. Materials and methods. The study was conducted with the use of 34 ribs and muscular fragments of the thoracic wall of pigs, and the experiment included the study of stiffness characteristics of native rib samples before and after the osteosynthesis according to various methods: 1 — internal intramedullary method with the use of wires; 2 — extrafocal extrapleural method with the use of original external fixation device; 3 — internal extramedullary method with the use of plates. The rib and muscular blocks were fixed in the hinge device developed by us, which has the dial detecting heads that facilitated the dosage static stepped loads. Results. Certain levels of irreversible deformities in the first cycles of static loads revealed all of the used osteosynthesis systems, but their greatest values were registered during the internal osteosynthesis with the wires and plates. Also, the tendency of individual elements to migrate with the destruction of the ribs bearing structures and the emergence of backlash under static loads were noticed, as well as poor characteristics of restoring the rib block stiffness. Conclusions. The extrafocal extrapleural osteosynthesis with the original external fixation device based on plates-rods enables to achieve the stiffness values closest to the physiological level (in the experiment, the natural stiffness amounted to 93 %).

Keywords


floating chest; rib fractures; osteosynthesis

References


Simon B. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline / B. Simon, J. Ebert, F. Bokhari, J. Capella, T. Emhoff, T. Hayward 3rd, A. Rodriguez, L. Smith; Eastern Association for the Surgery of Trauma // J. Trauma Acute Care Surg. – 2012. - №73(5 Suppl 4). – P. 351-361. PMID: 23114493 DOI: 10.1097/TA.0b013e31827019fd

Dehghan N. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank / N. Dehghan, C. de Mestral, M. D. McKee, E. H. Schemitsch, A. Nathens // J. Trauma Acute Care Surg. - 2014. - №76(2). – Р. 462-468 PMID: 24458051 DOI: 10.1097/TA.0000000000000086

Doben A. R. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation / A. R. Doben, E. A. Eriksson, C. E. Denlinger, S. M. Leon, D. J. Couillard, S. M. Fakhry, C. T. Minshall // J. Crit. Care, 2014. - №29(1). – Р. 139-143. PMID: 24075300 DOI: 10.1016/j.jcrc.2013.08.003

Nirula R. Rib fracture repair: indications, technical issues, and future directions / R. Nirula, J. J. Diaz Jr, D. D. Trunkey, J. C. Mayberry // World J. Surg., 2009. - №33(1). – Р. 14-22 PMID: 18949513 DOI: 10.1007/s00268-008-9770-y

Panasenko S. I. Methodological paradoxes on paradigme changes of surgical tactics in traumatic instability of sternocostal trame / S. I. Panasenko, V. D. Sheyko, S. O. Guryev, V. V. Burluka, N. M. Baramiya // Klinichna hirurgija. – 2013. - №8. - С. 54-56. PMID:24171291

Lichte P. Damage control orthopedics: current evidence / P. Lichte, P. Kobbe, D. Dombroski, H. C. Pape // Curr. Opin. Crit. Care. – 2012. - №18(6). - Р. 647-650 PMID: 23037876 DOI: 10.1097/MCC.0b013e328359fd57

Anavian J. Surgical management of multiple painful rib nonunions in patient with a history of severe shoulder girdle trauma: a case report and literature review / J. Anavian, S. T. Guthrie, P. A. Cole // J. Orthop. Trauma. – 2009. -№23 (8). – Р. 600-604. PMID: 19704277 DOI: 10.1097/BOT.0b013e3181a15e90

Cacchione R. N. Painful nonunion of multiple rib fractures managed by operative stabilization / R. N. Cacchione, J. D. Richardson, D. Seligson // J. Trauma 2000. - №48 (2). - Р. 319-321. PMID: 10697096




DOI: https://doi.org/10.22141/1608-1706.2.18.2017.102570

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