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Rib Fracture Management A Practical Manual

:	Marc de Moya, John Mayberry
:	Rib Fracture Management A Practical Manual
:	Springer-Verlag
:	9783319916446
:	1
:	CHF 99.50
:

:	Klinische Fächer
:	English

:	197
:	Wasserzeichen/DRM
:	PC/MAC/eReader/Tablet
:	PDF

In recent years the approach towards rib fractures has evolved. Abandoned in the past, due to inadequate instrumentation and lack of evidence, rib fixation has recently re-emerged as a treatment option for trauma patients. There have been a number of advances over the last 25 years that now allow surgeons to internally fix rib fractures that otherwise may have not had other options. However, as a result there has been a rapid increase in literature and many institutions interested in initiating rib fixation programs. Due to a variety of practitioners involved namely, trauma surgeons, orthopedic surgeons, and thoracic surgeons there has been no comprehensive guide to patient selection, technique, and post-operative care.

The purpose of this text is to fill the educational gap for those trauma, orthopedic, and thoracic surgeons interested in learning the cutting edge evidence-based approaches to treatment of rib fractures. This topic has caught the interest of many and has been a recurrent theme at surgical meetings over the last two years. Although there has been ever increasing levels of interest and experience nationally there are many questions which remain.

< iv>This text will provide not only the theoretical background for improving outcomes in those with rib fractures but also serve as a practical guide to those interested in starting new programs. The text will include tips and tricks that can be used in the OR or at the bedside to improve patient care. Therefore, the focus will be on a comprehensive review but also including tips and tricks from the most experienced surgeons around the country who are performing internal fixation for rib fractures.

Marc de Moya, MD

Associate Professor of Surgery

Division of Trauma, Emergency Surgery

Massachuset s General Hospital

Harvard Medical School

165 Cambridge Street

Suite 810

Boston, MA 02114

< div>

John Mayberry, MD

Saint Alphonsus Regional Medical Center

999 North Curtis Road, Suite 407

Boise, Idaho 83706

	Foreword	5
	Preface	6
	Contents	7
	Contributors	9
	1: History of Rib Fracture Management	11
	The Ancients	11
	The Indians and Greeks	14
	The Romans	14
	Islamic Surgeons	15
	Medieval Surgeons	16
	Eighteenth- and Nineteenth-Century Surgeons	18
	Awakenings	19
	Mechanical Ventilation Slows Rib Fracture ORIF Development	21
	The Recognition That Rib Fractures Are a Marker for Non-thoracic Injuries	23
	Resurgence of Chest Wall ORIF	23
	Acceptance of ORIF	29
	Minimally Invasive Approach	29
	References	31
	2: Chest Wall Anatomy	35
	Surface Anatomy	35
	Bony Thorax	37
	Sternum	37
	The Rib Cage	38
	The Spine	39
	The Musculature of the Chest Wall	40
	Primary Respiratory Muscles	40
	Accessory Muscles of Inspiration	40
	Accessory Muscles of Expiration	41
	Nerves	42
	Vasculature of the Chest Wall	43
	References	43
	3: Pathophysiology of Rib Fractures and Lung Contusion	44
	Anatomy and Physiology	44
	Anatomy of the Chest Wall	44
	Ribs	44
	Sternum	45
	Muscles	45
	Respiratory Physiology	46
	Pathophysiology	46
	Rib Fractures	46
	Flail Chest	47
	Pulmonary Contusion	47
	Pneumothorax	49
	Hemothorax	50
	Special Considerations	50
	Geriatric Patients	50
	Pediatric Patients	51
	References	51
	4: Scoring Systems of Blunt Thoracic Trauma and Rib Fractures	53
	General Properties of Scoring Systems	53
	Ideal Characteristics of a Chest Wall Scoring System	55
	Current Chest Wall Injury Scoring Systems	56
	Chest Wall Organ Injury Scale	56
	Rib Fracture Score	58
	Chest Trauma Score	58
	RibScore	58
	Clinical Rib Score	59
	Future Directions	60
	References	61
	5: Medical Management of Rib Fractures	63
	Initial Evaluation	63
	Management	64
	Patient Disposition	64
	Pulmonary Care	66
	Fluid Management	67
	Pain Management	67
	Multimodal Pain Regimen	67
	Regional Anesthesia	70
	Venous Thromboembolism Prophylaxis	71
	Nutritional Support	71
	Complications	72
	References	73
	6: Lung Contusion Management: Invasive and Noninvasive	76
	History	76
	Epidemiology	76
	Pathophysiology	77
	Diagnosis	77
	Initial Chest Radiograph	78
	Lung Ultrasonography	78
	Thoracic CT Scan Imaging	78
	Lung Contusion Management	82
	Lung Contusion Management: Noninvasive	82
	Clinical Guidelines and Protocols	83
	Lung Contusion Management: Invasive	84
	Lung Contusion and CT Scan Predictors of Need for Mechanical Ventilation	86
	Thoracic Trauma Severity Score on Admission to Predict ARDS	86
	Measurement of Lung Contusion Volume by CT Imaging to Predict ARDS	87
	Measurement of Lung Contusion Volume by Lung Ultrasonography to Predict ARDS	88
	Management of ARDS Due to Lung Contusion	88
	References	89
	7: Rib Fracture and Lung Contusion: Impact on Pulmonary Function Tests	92
	Pathophysiology	92
	Acute Impact	94
	Risk Stratification Based on Pulmonary Function Tests	95
	Long-Term Impact	96
	References	98
	8: Indications for Rib Fixation	100
	Guidelines for Rib Fixation	100
	Indications for Rib Fixation: Anatomical Considerations	101
	Flail Chest	101
	Chest Wall Deformity	102
	Symptomatic Rib Fracture Nonunion or Chronic Malunion	103
	Open Rib Fracture	103
	Acute Pulmonary Herniation	103
	Number of Rib Fractures or Severely Displaced Fractures	103
	Indications for Rib Fixation: Physiologic Considerations	104
	Failure to Wean from the Ventilator	104
	Poor Pulmonary Mechanics	104
	Indications for Rib Fixation: Quality of Life	105
	Pain Control	105
	Reduced Long-Term Pain and Disability	105
	Indications for Rib Fixation: Other	106
	Thoracotomy for Other Indications	106
	Age	106
	Contraindications for Rib Fixation and Special Considerations	106
	Location of Fractures	107
	Pulmonary Contusion	107
	Traumatic Brain Injury	107
	Timing of Fixation	107
	References	108
	9: Slipping Rib Syndrome and Other Causes of Chest Wall Pain	112
	Anatomy	112
	Slipping Rib	114
	History	114
	Pathophysiology	115
	Prevalence	115
	Symptoms	116
	Diagnosis	116
	Treatment	117
	Costochondritis	117
	Tietze’s Syndrome	118
	Xiphodynia	119
	References	120
	10: Rib Fracture Management Algorithm for the Traumatically Injured, Non-intubated Patient	124
	References	127