From the Department of Surgery (J.S.V.), Department of Surgery (A.S., J.H., J.A.B., W.B.D.V.), and Department of Trauma Surgery (A.C., M.M.), OhioHealth Riverside Methodist Hospital, Columbus, Ohio.
J Trauma Acute Care Surg. 2024 Mar 1;96(3):471-475. doi: 10.1097/TA.0000000000004145. Epub 2023 Oct 13.
Often missed in blunt chest wall injury, costal cartilage injuries can cause chest wall instability, refractory pain, and deformity. Notably, there is only a small amount of evidence regarding hardware performance when applied to costal cartilage. In a prior multicenter study, hardware failure rate was found to be approximately 3% following surgical stabilization of rib fractures (SSRFs) for all fracture locations. The aim of the current study was to evaluate hardware performance for costal cartilage injuries.
All patients undergoing SSRF performed at our institution from 2016 to 2022 were queried, including both acute and chronic injuries. Both radiographic and clinical follow-up were retrospectively reviewed to evaluate for hardware failure defined as plate fracture, malposition, or screw migration following cartilage fixation.
After screening 359 patients, 43 were included for analysis. Mean age was 64 years, and 67% of patients were male. Median number of fractures per patient was 7 with 60% of patients sustaining a flail chest injury pattern. Median total plates per operation was 6 and median costal cartilage plates was 3. In total, 144 plates were applied to the costal cartilage for the group. Mean follow-up was as follows: clinical 88 days, two-view plain radiography 164 days, and chest computed tomography 184 days. Hardware failure was observed in 3 of 144 plates (2.1%), in three separate patients. Two cases were asymptomatic and did not require intervention. One patient required revisional operation in the acute setting.
In our institution, hardware failure for costal cartilage fractures was observed to be 2.1%. This aligns with prior reports of hardware failure during SSRF for all injury locations. Surgical stabilization of anterior and cartilaginous chest wall injury with appropriate plate contouring and fixation technique appears to provide adequate stabilization with a relatively low rate of hardware malfunction.
Therapeutic/Care Management; Level V.
钝性胸壁损伤常被漏诊，肋软骨损伤可导致胸壁不稳定、顽固性疼痛和畸形。值得注意的是，关于应用于肋软骨的内固定物性能的证据很少。在先前的多中心研究中，发现所有骨折部位的肋骨骨折手术固定（SSRF）后，内固定物的失败率约为 3%。本研究旨在评估肋软骨损伤的内固定物性能。
对我院 2016 年至 2022 年期间行 SSRF 的所有患者进行了查询，包括急性和慢性损伤。回顾性分析影像学和临床随访资料，以评估软骨固定后出现的内固定物失败，定义为钢板骨折、位置不当或螺钉迁移。
经过筛选 359 例患者，43 例纳入分析。平均年龄 64 岁，67%为男性。每位患者骨折中位数为 7 处，60%为连枷胸损伤模式。手术中平均每例使用的钢板总数为 6 块，肋软骨钢板中位数为 3 块。共有 144 块钢板应用于该组患者的肋软骨。该组患者的平均随访时间如下：临床随访 88 天，双平面 X 线平片随访 164 天，胸部 CT 随访 184 天。在 144 块钢板中，有 3 块（2.1%）出现内固定物失败，发生在 3 位患者中。其中 2 例患者无症状，无需干预。1 例患者在急性发作时需要进行翻修手术。
在我院，肋软骨骨折的内固定物失败率为 2.1%。这与所有损伤部位 SSRF 中内固定物失败的先前报告一致。采用适当的钢板塑形和固定技术对前侧和软骨性胸壁损伤进行手术固定，似乎能够提供充分的稳定性，且内固定物故障的发生率相对较低。
治疗/护理管理；等级 V。
