Table Of ContentRib Fracture
Management
A Practical Manual
Marc de Moya
John Mayberry
Editors
123
Rib Fracture Management
Marc de Moya • John Mayberry
Editors
Rib Fracture Management
A Practical Manual
Editors
Marc de Moya John Mayberry
Medical College of Wisconsin Saint Alphonsus Regional Medical Center
Froedtert Trauma Center Boise, ID
Milwaukee, WI USA
USA
ISBN 978-3-319-91643-9 ISBN 978-3-319-91644-6 (eBook)
https://doi.org/10.1007/978-3-319-91644-6
Library of Congress Control Number: 2018950421
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Foreword
This is a timely and necessary contribution to the literature, written and edited by
true experts in the field. The management of chest wall injuries has often played a
secondary role in the minds of trauma surgeons. Attracted by more “flamboyant”
injuries, such as internal organ lacerations and exsanguinating conditions, they have
often concluded their evaluation of rib and sternal fractures with a single, routine
statement about managing pain. But these injuries are so much more than that. They
cause significant suffering, are indicators of other injuries, cause short- and long-
term complications, and can easily be a dominant factor in an ultimate bad outcome.
Relatively recently, rib fractures have been placed more prominently on the surgical
radar screen due to the reemergence of interest in stabilizing them surgically.
Unfortunately, the research on the topic is still suboptimal, the indications uncer-
tain, and the techniques under evolution.
To that effect, the current book serves to clarify the confusion by offering expert
opinions, supported by the existing evidence and, equally importantly, by many
years of personal experience. I congratulate the editors because they did not make
operative strategy the sole centerpiece of the book. As important as surgery is, it is
even more important for the reader to understand the pathophysiology and conse-
quences of chest wall injuries. It is important to learn standardized algorithms of
care, but also be able to individualize therapies according to age, injury severity, and
expected outcomes. By examining the issue from A to Z, from history to future
directions, and by including every possible aspect of diagnosis and treatment of
chest wall injuries, the authors provide the readership with an invaluable piece of
knowledge, one that I suspect will be a standard of reference for many years to
come.
George C. Velmahos, MD, PhD
John Burke Professor of Surgery
Harvard Medical School
Boston, MA, USA
v
Preface
Rib Fracture Management is a comprehensive text focused on the physiology and
management of trauma-related injuries to the chest wall. The management of lung
contusion, rib fractures, and chest wall dysfunction has evolved more recently as a
result of the introduction of advanced mechanical ventilation strategies, extracorpo-
real membrane oxygenation technology, and rib fixation techniques. However,
much remains unknown and continues to evolve. This text is the first to bring
together chest wall injury experts from across the globe to review and consolidate
evidence-based medicine for practitioners providing care for trauma patients. The
content of the text was constructed in a way to provide a strong foundation in chest
wall injury physiology and nonsurgical management options and covers the spec-
trum of injury that may benefit from surgical reconstruction using references to the
most current evidence. Our intended audience is surgeons and intensivists who
manage traumatic chest injuries.
I would like to acknowledge my coeditor, Dr. John Mayberry, and the contribu-
tors to the first comprehensive textbook focused on chest wall injury. We would
especially like to acknowledge the staff at Springer for providing an accurate and
high-quality text and in particular Margaret Burn from Springer for her devotion to
ensuring the completion of this work.
I would also like to thank my wife, Adriana, and my two children, Andre and
Sophia, for their support and love. Dr. Mayberry would like to thank Amy, Billie,
John Jr., and Eliza for their patience during his long work hours and research
endeavors.
Milwaukee, WI Marc de Moya
Ketchum, ID John Mayberry
vii
Contents
1 History of Rib Fracture Management . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Michael Bemelman, William Long, and John Mayberry
2 Chest Wall Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Noelle N. Saillant
3 Pathophysiology of Rib Fractures and Lung Contusion . . . . . . . . . . . 35
Jeffrey J. Skubic, Barbara U. Okafor, and Deepika Nehra
4 Scoring Systems of Blunt Thoracic Trauma and Rib Fractures . . . . . 45
Fredric M. Pieracci
5 Medical Management of Rib Fractures . . . . . . . . . . . . . . . . . . . . . . . . 55
Tashinga Musonza and S. Rob Todd
6 Lung Contusion Management: Invasive and Noninvasive . . . . . . . . . 69
Umar Bhatti and Lena M. Napolitano
7 Rib Fracture and Lung Contusion: Impact
on Pulmonary Function Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Abraham Sonny and Richard M. Pino
8 Indications for Rib Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Tiffany Zens, Krista Haines, and Suresh Agarwal
9 Slipping Rib Syndrome and Other Causes of Chest Wall Pain . . . . . 105
Marisa Gasparri and Mario Gasparri
10 Rib Fracture Management Algorithm for
the Traumatically Injured, Non- intubated Patient . . . . . . . . . . . . . . . 117
Walter Biffl and Frank Zhao
11 Non-union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
John G. Edwards and William J. Hunt
12 Operative Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Andrew Doben and Thomas W. White
ix
x Contents
13 Review of Currently Available Tools of the Trade . . . . . . . . . . . . . . . . 145
Silvana Marasco and Jose J. Diaz Jr.
14 Postoperative Complications After Rib Fracture Repair . . . . . . . . . . 159
Raminder Nirula
15 Billing and Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Andrew Doben
16 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Fredric M. Pieracci
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Contributors
Suresh Agarwal, MD, FACS, FCCM Division of Trauma and Critical Care Surgery,
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Michael Bemelman, MD Elisabeth Two Cities Hospital, Tilburg, The Netherlands
Umar Bhatti, MD Acute Care Surgery, Trauma, Burn, Surgical Critical Care,
Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
Walter Biffl, MD Trauma and Acute Care Surgery Scripps Memorial Hospital,
La Jolla, CA, USA
Scripps Memorial Hospital, La Jolla, CA, USA
Jose J. Diaz Jr, MD, CNS, FACS, FCCM Division Acute Care Surgery,
Department of Surgery, R Adams Cowley Shock Trauma, University of Maryland
School of Medicine, Baltimore, MD, USA
Andrew Doben, MD Division of Trauma, Acute Care Surgery and Surgical Critical
Care, Department of Surgery, University of Massachusetts Medical School–
Baystate, Springfield, MA, USA
John G. Edwards, MB, ChB, PhD, FRCS (C/Th) Department of Cardiothoracic
Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation
Trust, Sheffield, South Yorkshire, United Kingdom
Mario Gasparri, MD Department of Thoracic Surgery, Medical College of
Wisconsin, Milwaukee, WI, USA
Marisa Gasparri University of Wisconsin – Madison, Madison, WI, USA
Krista Haines, DO Division of Trauma and Critical Care Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, USA
William J. Hunt, BMedSci Department of Cardiothoracic Surgery, Northern
General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
South Yorkshire, UK
William Long, MD Legacy Emanuel Medical Center, Portland, OR, USA
xi
xii Contributors
Silvana Marasco, MD Department of Cardiothoracic Surgery, The Alfred
Hospital, Melbourne, Melbourne, VIC, Australia
John Mayberry, MD St. Lukes Wood River Medical Center, Ketchum, ID, USA
Tashinga Musonza, MD Michael E. DeBakey Department of Surgery, Baylor
College of Medicine, Houston, TX, USA
Lena M. Napolitano, MD, FACS, FCCP, MCCM Acute Care Surgery, Trauma,
Burn, Surgical Critical Care, Department of Surgery, University of Michigan Health
System, Ann Arbor, MI, USA
Deepika Nehra, MD Division of Trauma, Burns and Surgical Critical Care,
Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA, USA
Raminder Nirula, MD, MPH Acute Care Surgery Section, Department of
Surgery, University of Utah, Salt Lake City, UT, USA
Barbara U. Okafor, BS Division of Trauma, Burns and Surgical Critical Care,
Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
Fredric M. Pieracci, MD, MPH Department of Surgery, Denver Health Medical
Center, University of Colorado School of Medicine, Denver Health Medical Center,
Denver, CO, USA
Richard M. Pino, MD, PhD, FCCM Department of Anesthesia, Critical Care and
Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston,
MA, USA
Noelle N. Saillant, MD Division of Trauma, Emergency Surgery and Surgical
Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, USA
Jeffrey J. Skubic, DO Division of Trauma, Burns and Surgical Critical Care,
Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA, USA
Abraham Sonny, MD Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
S. Rob Todd, MD, FACS, FCCM Michael E. DeBakey Department of Surgery,
Baylor College of Medicine, Houston, TX, USA
Thomas W. White, MD, FACS, CNSC Intermountain Trauma and General
Surgery, Murray, UT, USA
Tiffany Zens, MD Department of Surgery, University of Wisconsin, UW Hospital
and Clinics, Madison, WI, USA
Frank Zhao, MD Acute Care Surgery, The Queen’s Medical Center, Honolulu,
Honolulu, HI, USA
Department of Surgery, John A. Burns School of Medicine, University of Hawaii,
Honolulu, HI, USA
