Pain Management of Multiple Rib Fractures based on Early Reduction and Fixation in Patients without Intensive Care Unit

Objective: Blunt thoracic traumas are often complicated with rib fractures. The decision-making process of the treatment approaches not clear for clinicians. So, we aim to investigate the effect of surgical intervention on pain management of patients as treatment indication. Methods: Cases with 3 or more rib fractures were evaluated in our study. Between 2014-2018, 367 patients with multiple rib fractures were admitted to our hospital. Of the 367 patients, 238 were included in this study. Among them 84 cases with multiple rib fractures that underwent surgery within fist 36 hours, 27 cases were operated after the 7th day 127 patients were managed conservatively. The results of hospitalization time, pneumonia, rates, thoracic deformity rates on 6.month thorax computerized tomography, intercostal blockage requirement, postoperative 6.month quality of life questionnaire for pain and clinical outputs were retrospectively analyzed. Results: The average hospitalization was found that it was significantly different in favor of the surgical group (z = 6.674; p

Kaynakça

[1] Özkan S, Tetik GB, Tahtacı R, et al. Retrospective Analysis of 513 Cases Diagnosed with Rib Fracture Secondary to Blunt Thorax Trauma. J Clin Anal Med 2017;8(3):181-4.

[2] Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization?: a prospective randomized study of management of severe flail chest patients. J Trauma 2002;52:727-32.

[3] Soderlund T, Ikonen A, Pyhalto T, et al. Factors associated with in-hospital outcomes in 594 consecutive patients suffering from severe blunt chest trauma. Scand J Surg 2015;104:115–20.

[4] Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surgery & Acute Care Open 2017;2:1–7.

[5] Pape HC, Remmers D, Rice J, et al. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 2000;49:496–504.

[6] Todd SR, McNally MM, Holcomb JB, et al. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg 2006;192:806-11.

[7] Elie G, Pierre EF, Nicola S, et al. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures? Interactive CardioVascular and Thoracic Surgery 2012;14 :312–315.

[8] Jaap S, J. C. Goslings, T. Schepers. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg 2017;43:163–68.

[9] Martin TJ, Eltorai AS, Dunn R, et al. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury 2019 ;50(6):1159-65.

[10] Eun Gu Hwang, Yunjung Lee. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil 2014; 10(4): 241–44.

[11] Khosa AH, Durrani HD, Wajid W et al. Choice of Analgesia in Patients with Critical Skeletal Trauma. Cureus 2019 ;11(5): e4694.

[12] Kerr VMA, Arthur M, Mullins RJ, et al. Rib fracture pain and disability: Can we do better? J Trauma 2003;54(6):1058-63.

[13] Richardson JD, Miller FB, Carrillo EH, et al. Complex thoracic injuries. Surg Clin North Am 1996;76(4):725-48.

[14] Mayberry JC, Kroeker AD, Ham LB, et al. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg 2009;75(5):389-94.

[15] Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg 1995;110(6):1676-80.

[16] [Nirula R, Diaz JJ, Trunkey DD, et al. Rib fracture repair: indications, technical issues, and future directions World J Surg. 2009 ;33(1):14-22.

[17] Ciraulo DL, Elliott D, Mitchell KA, et al. Flail chest as a marker for significant injuries. J Am Coll Surg 1994;178(5):466-70.

[18] Lee RB, Bass SM, Morris JA, et al. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma 1990;30(6):689-94.

[19] Girsowicz E, Falcoz PE, Santelmo N, et al. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures? Interact Cardiovasc Thorac Surg 2012;14:312–5.

[20] Granetzny A, AbdEl-Aal M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardio Vasc Thorac Surg 2005;4(6):583-7.

[21] Unsworth A, Curtis K, Asha SE. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scand J Trauma Resusc Emerg Med 2015;23:17.

[22] Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs non-operative management of flail chest: a meta-analysis. J Am Coll Surg 2013;216:302–11.e1.

[23] Rauchwerger JJ, Candido KD, Deer TR, et al. Thoracic epidural steroid injection for rib fracture pain. Pain Practice 2013;13:416–21.

[24] Baker EJ, Lee GA. A Retrospective Observational Study Examining the Effect of Thoracic Epidural and Patient Controlled Analgesia on Short-term Outcomes in Blunt Thoracic Trauma Injuries. Medicine (Baltimore) 2016 ;95(2):e2374.

[25] Beks RB, Peek J, de Jong MB, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg.2019 ;45(4):631-44.

[26] Liang YS, Yu KC, Wong CS, et al. Does Surgery Reduce the Risk of Complications Among Patients with Multiple Rib Fractures? A Meta-analysis. Clin Orthop Relat Res 2019 ;477(1):193-205.

[27] Cheema FA, Chao E, Buchsbaum J, et al. State of Rib Fracture Care: A NTDB Re-view of Analgesic Management and Surgical Stabilization. Am Surg 2019 ;85(5):474-78.

[28] Marasco SF, Martin K, Niggemeyer L, et al. Impact of rib fixation on quality of life after major trauma with multiple rib fractures. Injury 2019 ;50(1):119-24.

Kaynak Göster

65 32

Arşiv
Sayıdaki Diğer Makaleler

Mid-Term Outcomes of Percutaneous Treatment of Superficial Femoral Artery Total Occlusions: Single Center Experience

AHMET HAKAN ATEŞ, AYSU BAŞAK ÖZBALCI, Selim KUL, Mustafa YENERÇAĞ, Metin OKŞUL, UĞUR ARSLAN

Better Outcomes with Minimally Invasive Thyroidectomy than Conventional Thyroidectomy

Nilda SÜTAY SÜSLÜ, Çağrı KÜLEKÇİ, Selçuk DAĞDELEN, Nafiye YILDIZ, AYŞE TOMRİS ERBAŞ

Biliary Atresia Splenic Malformation Syndrome: A Single Center Experience

Önder ÖZDEN, Şeref Selçuk KILIÇ, Murat ALKAN, Gökhan TÜMGÖR, Recep TUNCER

Pain Management of Multiple Rib Fractures based on Early Reduction and Fixation in Patients without Intensive Care Unit

İsmail AĞABABAOĞLU, ÖZGÜR ÖMER YILDIZ, Filiz Banu ÇETİNKAYA ETHEMOGLU, Yavuz Selim SANİOĞLU

The Difference in Clinical and Prognostic Features Between De Novo and Recurrent Her2-Positive Metastatic Breast Cancer Patients

Yusuf ACIKGOZ, Yakup ERGÜN, Gökhan UÇAR, Merve DİRİKOÇ, Doğan UNCU

Pretibial Edema Strain Ratio Obtained by Elastography Can Be Used in Differential Diagnosis of Patients with Chronic Heart Failure and Nephrotic Syndrome

DERYA DEMİRTAŞ, Burçak ÇAKIR PEKÖZ, Mehmet KÜÇÜKOSMANOĞLU

Infant Acute Lymphoblastic Leukemia with Atypical Presentation

İnci YAMAN BAJİN, Yılmaz YILDIZ, Şenol AKIN, Selin AYTAÇ, Şule ÜNAL, Barış KUŞKONMAZ, Mualla ÇETİN, Serap SİVRİ, FATMA GÜMRÜK

Pathways and Inborn Errors of Bile Acid Synthesis

UFUK BOZKURT OBUZ, İNCİLAY LAY

Evaluation of cancer related missense mutations in CENPH

CEREN SUCULARLI