PREOPERATIVE PLANNING, OPERATIVE TECHNIQUES AND PITFALLS OF SURGICAL STABILIZATION OF RIB FRACTURES : OUR 81 CASES PRACTICE WITH A LITERATURE REVIEW

Abstract

　　Although reports on surgical stabilization of rib fractures (SSRF) have increased in foreign countries, the surgery is not yet widely performed in Japan. The main reason for this situation may be the lack of information on the SSRF method in Japanese literature. We present preoperative planning, operative techniques, and pitfalls of SSRF, through our 81 cases (87 sides) practice with a literature review. In preoperative planning, it is essential to select the ribs requiring osteosynthesis by the location, number and fracture type ; and to design the approach to the ribs intended for minimal incision and muscle-sparing. Volume-rendering CT images as well as traditional scans including 3D reconstruction are advantageous for this planning. Ultrasound examination in the operating room is also beneficial. Rib dislocation on CT is an important finding requiring osteosynthesis. In Japan, a threaded-type plate, a claw-type plate, and an intramedullary splint can be used for treatment. The implants to employ should be chosen depending on the location and type of the fractured ribs. Flexible claw-type plates are especially recommended for stabilizing costochondral fractures. Several pitfalls as well as where to and how to use should be considered. We are devising thoracic and subcutaneous drainage for effective management.