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CASE REPORT
Figure 1
tenth ribs on the left side, and fractures of the second through seventh ribs in at least two places each. Despite the number and wide distribution of these rib fractures, the chest wall was stable and the left lung was fully expanded after insertion of the chest tube. The patient was taken to the surgical intensive care unit (SICU) for further care.
The patient remained on assist control (AC) mode on the ventilator until hospital day two, when she was switched to pressure support (PS) mode. On the morning of hospital day three, the patient’s morning chest X-ray portion of the chest wall. Thoracic surgery was consulted and the patient was scheduled for the operating room the following day.
During the operation, a posterolateral incision was made with an extending vertical incision just medial to the spine to encompass the more posterior rib fractures (see Figure 2). As noted previously, there was a severe 10, with most ribs having multiple fractures. Ribs three through 10 were plated using
the Synthes titanium rib-plating system. At
REFERENCES
Figure 2
the conclusion of the case, the chest wall appeared stable. Two intrathoracic chest tubes were placed and a subcutaneous drain was also placed.
On post-operative day two, the patient was weaned from AC mode to PS mode on
the ventilator. All chest tubes and drains The patient remained on PS mode over
the subsequent days due to airway edema and underlying pulmonary contusion. She underwent a percutaneous tracheostomy on post-operative day 11 and was transitioned to trach collar the same day. On post- operative day 15, she was transferred out of the SICU and on day 26, she was discharged from the hospital.
DISCUSSION
Our case illustrates an example of severe left-sided rib fractures following blunt trauma with a delayed collapse of the chest plating. While rib plating is certainly not new in the context of trauma, this case is
notable for both the severity of the patient’s
was performed. The patient was able to be transitioned to pressure support mode after the rib plating and was successfully weaned off the ventilator after 11 days.
the length of stay in the ICU, decrease rates of pneumonia, and decrease the need for tracheostomy. As demonstrated by our effective means of treatment for patients with multiple rib fractures, especially those extubation process and overall recovery of these patients.
CONTRIBUTORS
■ RYANC.BANNING,MDisathird-yeargeneral surgery resident at ChristianaCare in Newark.
■ BRIAN T. NAM, MD is a thoracic surgeon at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute in Newark.
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