Malkoc Aldin, Mamoun Lana, Vignaroli Kendall, Gill Harpreet, Barmanwalla Amira, Phan Alexander, Daoud Amanda, Nguyen Alexandra, Woodward Brandon
Arrowhead Regional Medical Center, Colton, CA 92324, USA.
California University of Science and Medicine, Colton, CA 92324, USA.
J Med Cases. 2024 Sep;15(9):215-221. doi: 10.14740/jmc4267. Epub 2024 Aug 10.
Rib plating is a recommended intervention for patients with multiple rib fractures or flail chest to improve shortness of breath, significantly reduce pain, and shorten the length of hospital stay. Here, we report a unique and extremely rare finding in a patient with empyema following intrathoracic rib fixation. A 32-year-old male with a history of alcohol use disorder presented to the emergency department trauma bay after a motor vehicle accident. Computed tomography (CT) showed right hemopneumothorax and fourth to ninth rib fractures with displacement. The right fifth and sixth ribs were then plated using a titanium RibFix bridge, implanted intrathoracically along the posterior surface of the ribs. On postoperative day 11, the patient developed an empyema and a CT-guided drainage catheter was placed into the collection. The patient was given a 3-day course of tissue plasminogen activator (tPA) and DNase for the treatment of his empyema. On postoperative day 15, a repeat CT scan demonstrated significant improvement in the empyema with evidence of abscess resolution. Antibiotics were discontinued after a total of 7 days and the patient was discharged on postoperative day 20. This case report contributes information to the management of complications in intrathoracic rib fixation.
肋骨接骨板固定术是针对多根肋骨骨折或连枷胸患者的一种推荐干预措施，可改善呼吸急促症状，显著减轻疼痛，并缩短住院时间。在此，我们报告了1例胸腔内肋骨固定术后并发脓胸患者的独特且极为罕见的发现。一名有酒精使用障碍病史的32岁男性在机动车事故后被送至急诊科创伤区。计算机断层扫描（CT）显示右侧血气胸以及第4至第9肋骨骨折并移位。随后使用钛制RibFix桥接板对右侧第5和第6肋骨进行接骨板固定，沿肋骨后表面植入胸腔内。术后第11天，患者发生脓胸，并在积液处放置了CT引导下引流导管。给予患者为期3天的组织纤溶酶原激活剂（tPA）和脱氧核糖核酸酶治疗脓胸。术后第15天，重复CT扫描显示脓胸有显著改善，有脓肿消退迹象。总共7天后停用抗生素，患者于术后第20天出院。本病例报告为胸腔内肋骨固定术并发症的处理提供了信息。
