Use of Pain Scale and Arterial Oxygen Partial Pressure as Screening Internal Fixation Indications for Patients with Multiple Rib Fractures_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIONGJian ,  XUYong-dong , WANGChang-tao , LIZhi-cheng , WANGDong-dong

Department of Thoracic Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201300, P. R. China;

Corresponding author：

XUYong-dong, Email: xyd927927@163.com

Keywords：

Rib fracture; Internal fixation; Pain scale; Arterial oxygen partial pressure

DOI：

10.7507/1007-4848.20140011

Video：

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Objective To explore the feasibility to use pain scale and arterial oxygen partial pressure(PaO₂)as screening internal fixation indications for patients with multiple rib fractures. Methods Clinical data of 48 patients with multiple rib fractures who were admitted to Shanghai Pudong Hospital from September 2010 to February 2013 were retrospectively analyzed. Visual analogue scale (VAS) was used for pain assessment. Twenty-four patients whose VAS was greater than or equal to 6 and PaO₂ was less than 60 mm Hg 3 days after injury were chosen as the experimental group, including 16 males and 8 females with their age of 49.29±15.73 years. Another 24 patients whose VAS was less than or equal to 5 and PaO₂ was greater than 60 mm Hg 3 days after injury were chosen as the control group, including 19 males and 5 females with their age of 48.63±13.49 years. Patients in both groups received rib internal fixation with steel plates. Three days and 1 week after surgery respectively, VAS and PaO₂ were compared between the 2 groups. Results In the experimental group, VAS 3 days after surgery was significantly lower than preoperative VAS (4.09±0.93 vs. 8.21±1.18, P < 0.05), and VAS 1 week after surgery was significantly lower than preoperative VAS (3.20±0.98 vs. 8.21±1.18, P < 0.05). In the control group, there was no statistical difference between VAS 3 days after surgery and preoperative VAS (P > 0.05), and there was no statistical difference between VAS 1 week after surgery and preoperative VAS (P > 0.05). Three days after surgery, PaO₂ of the experimental group was significantly higher than preoperative PaO₂ (61.00±3.47 mm Hg vs. 53.00±3.97 mm Hg, P < 0.05). There was no statistical difference between PaO₂ 3 days after surgery and preoperative PaO₂ in the control group (66.71±5.15 mm Hg vs. 66.00±5.00 mm Hg, P > 0.05). Three days after surgery, pneumonia occurred in 4 patients in the experimental group and 2 patients in the control group (χ²=0.762, P > 0.05). Three days after surgery, pain scale reduction of the experimental group was significantly higher than that of the control group (4.13±1.45 vs. 0.00±0.42, P < 0.05). One week after surgery, pain scale reduction of the experimental group was significantly higher than that of the control group (5.04±1.23 vs. 0.08±0.28, P < 0.05). Three days after surgery, PaO₂ increase of the experimental group was significantly higher than that of the control group (7.42±3.59 mm Hg vs. 0.21±0.98 mmHg, P < 0.05). Conclusion It's reasonable and feasible to use pain scale greater than or equal to 6 and PaO₂ less than 60 mm Hg as internal fixation indications for patients with multiple rib fractures.

Citation： XIONGJian, XUYong-dong, WANGChang-tao, LIZhi-cheng, WANGDong-dong. Use of Pain Scale and Arterial Oxygen Partial Pressure as Screening Internal Fixation Indications for Patients with Multiple Rib Fractures. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 36-40. doi: 10.7507/1007-4848.20140011 Copy

1.	Khandelwal G, Mathur RK, Shukla S, et al.A prospective single center study to assess the impact of surgical stabilization in patients with rib fracture.Int J Surg, 2011, 9 (6):478-481.
2.	Althausen PL, Shannon S, Watts C, et al.Early surgical stabilization of flail chest with locked plate fixation.J Orthop Trauma, 2011, 25 (11):641-647.
3.	Ramponi F, Meredith GT, Bendinelli C, et al.Operative management of flail chest with anatomical locking plates (MatrixRib).ANZ J Surg, 2012, 82 (9):658-659.
4.	Karmakar MK, Ho AM.Acute pain management of patients with multiple fractured ribs.J Trauma, 2003, 54 (3):615-625.
5.	Konstantinov IE, Saxena P, Wood DJ.Stabilisation of chronic flail chest:a novel approach of surgical fixation and osteogenesis.Thorax, 2009, 64 (3):265-266.
6.	Vyhnánek F.Principles of the thoracic wall injury management.Rozhl Chir, 2011, 90 (11):637-641.
7.	Bhatnagar A, Mayberry J, Nirula R.Rib fracture fixation for flail chest:what is the benefit? J Am Coll Surg, 2012, 215 (2):201-205.
8.	Yang HC, Hyun KK, Kang DY.Reoperative surgical stabilization of a painful nonunited rib fracture using bone grafting and a metal plate.J Orthop Trauma, 2009, 23 (8):605-606.
9.	黄国胜.可吸收固位钉治疗多发性肋骨骨折.中国组织工程研究与临床康复, 2011, 15 (4):725-728.
10.	Mayberry J.Early stabilization of flail chest with locked plate fixation.J Orthop Trauma, 2011, 25 (11):648.
11.	Campbell N, Conaglen P, Martin K, et al.Surgical stabilization of rib fractures using Inion OTPS wraps-techniques and quality of Life follow-up.J Trauma, 2009, 67 (3):596-601.
12.	Mayberry JC, Terhes JT, Ellis TJ, et al.Absorbable plates for rib fracture repair:preliminary experience.J Trauma, 2003, 55 (5):835-839.
13.	Beelen R, Rumbaut J, De G.Surgical stabilization of a rib fracture using an angle stable plate.Trauma, 2007, 63 (5):1159-1160.
14.	Engel C, Krieg JC, Madey SM, et al.Operative chest wall fixation with osteosynthesis plates.J Trauma, 2005, 58 (1):181-186.
15.	Bottlang M, Walleser S, Noll M.Biomechanical rationale and evaluation of an implant system for rib fracture fixation.Eur J Trauma Emerg Surg, 2010, 36 (5):417-426.
16.	Bottlang M, Long WB, Phelan D, et al.Surgical stabilization of flail chest injuries with MatrixRIB implants:a prospective observational study.Injury, 2013, 44 (2):232-238.
17.	Igai H, Kamiyoshihara M, Nagashima T, et al.Rib fixation for severe chest deformity due to multiple rib fractures.Ann Thorac Cardiovasc Surg, 2012, 18 (5):458-461.
18.	de Moya M, Bramos T, Agarwal S, et al.Pain as an indication for rib fixation:a bi-institutional pilot study.J Trauma, 2011, 71 (6):1750-1754.
19.	Nirula R, Mayberry JC.Rib fracture fixation:controversies and technical challenges.Am Surg, 2010, 76 (8):793-802.
20.	Nirula R, Diaz J, Trunkey D.Rib fracture repair:indications, technical issues, and future directions.World J Surg, 2009, 33 (1):14-22.
21.	熊健, 王长涛, 吴蕾, 等.疼痛和动脉血二氧化碳分压作为肋骨骨折患者手术指征的临床分析.中国胸心血管外科临床杂志, 2011, 18 (5):474-475.
22.	Slobogean GP, MacPherson CA, Sun T, et al.Surgical fixation vs nonoperative management of flail chest:a meta-analysis.J Am Coll Surg, 2013, 216 (2):302-311.
23.	Marasco SF, Davies AR, Cooper J, et al.Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.J Am Coll Surg, 2013, 216 (5):924-932.
24.	Simon B, Ebert J, Bokhari F.Management of pulmonary contusion and flail chest:an eastern association for the surgery of trauma practice management guideline.J Trauma Acute Care Surg, 2012, 73 (5):351-361.
25.	肖接承, 华菲, 朱江, 等.采用镍钛合金环抱器微创重点肋骨内固定治疗连枷胸的临床应用.苏州大学学报:医学版, 2007, 27 (5):775-776, 779.
26.	Voggenreiter G, Neudeck F, Aufmkolk M.Operative chest wall stabilization in flail chest--outcomes of patients with or without pulmonary contusion.J Am Coll Surg, 1998, 187 (2):130-138.

1. Khandelwal G, Mathur RK, Shukla S, et al.A prospective single center study to assess the impact of surgical stabilization in patients with rib fracture.Int J Surg, 2011, 9 (6):478-481.
2. Althausen PL, Shannon S, Watts C, et al.Early surgical stabilization of flail chest with locked plate fixation.J Orthop Trauma, 2011, 25 (11):641-647.
3. Ramponi F, Meredith GT, Bendinelli C, et al.Operative management of flail chest with anatomical locking plates (MatrixRib).ANZ J Surg, 2012, 82 (9):658-659.
4. Karmakar MK, Ho AM.Acute pain management of patients with multiple fractured ribs.J Trauma, 2003, 54 (3):615-625.
5. Konstantinov IE, Saxena P, Wood DJ.Stabilisation of chronic flail chest:a novel approach of surgical fixation and osteogenesis.Thorax, 2009, 64 (3):265-266.
6. Vyhnánek F.Principles of the thoracic wall injury management.Rozhl Chir, 2011, 90 (11):637-641.
7. Bhatnagar A, Mayberry J, Nirula R.Rib fracture fixation for flail chest:what is the benefit? J Am Coll Surg, 2012, 215 (2):201-205.
8. Yang HC, Hyun KK, Kang DY.Reoperative surgical stabilization of a painful nonunited rib fracture using bone grafting and a metal plate.J Orthop Trauma, 2009, 23 (8):605-606.
9. 黄国胜.可吸收固位钉治疗多发性肋骨骨折.中国组织工程研究与临床康复, 2011, 15 (4):725-728.
10. Mayberry J.Early stabilization of flail chest with locked plate fixation.J Orthop Trauma, 2011, 25 (11):648.
11. Campbell N, Conaglen P, Martin K, et al.Surgical stabilization of rib fractures using Inion OTPS wraps-techniques and quality of Life follow-up.J Trauma, 2009, 67 (3):596-601.
12. Mayberry JC, Terhes JT, Ellis TJ, et al.Absorbable plates for rib fracture repair:preliminary experience.J Trauma, 2003, 55 (5):835-839.
13. Beelen R, Rumbaut J, De G.Surgical stabilization of a rib fracture using an angle stable plate.Trauma, 2007, 63 (5):1159-1160.
14. Engel C, Krieg JC, Madey SM, et al.Operative chest wall fixation with osteosynthesis plates.J Trauma, 2005, 58 (1):181-186.
15. Bottlang M, Walleser S, Noll M.Biomechanical rationale and evaluation of an implant system for rib fracture fixation.Eur J Trauma Emerg Surg, 2010, 36 (5):417-426.
16. Bottlang M, Long WB, Phelan D, et al.Surgical stabilization of flail chest injuries with MatrixRIB implants:a prospective observational study.Injury, 2013, 44 (2):232-238.
17. Igai H, Kamiyoshihara M, Nagashima T, et al.Rib fixation for severe chest deformity due to multiple rib fractures.Ann Thorac Cardiovasc Surg, 2012, 18 (5):458-461.
18. de Moya M, Bramos T, Agarwal S, et al.Pain as an indication for rib fixation:a bi-institutional pilot study.J Trauma, 2011, 71 (6):1750-1754.
19. Nirula R, Mayberry JC.Rib fracture fixation:controversies and technical challenges.Am Surg, 2010, 76 (8):793-802.
20. Nirula R, Diaz J, Trunkey D.Rib fracture repair:indications, technical issues, and future directions.World J Surg, 2009, 33 (1):14-22.
21. 熊健, 王长涛, 吴蕾, 等.疼痛和动脉血二氧化碳分压作为肋骨骨折患者手术指征的临床分析.中国胸心血管外科临床杂志, 2011, 18 (5):474-475.
22. Slobogean GP, MacPherson CA, Sun T, et al.Surgical fixation vs nonoperative management of flail chest:a meta-analysis.J Am Coll Surg, 2013, 216 (2):302-311.
23. Marasco SF, Davies AR, Cooper J, et al.Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.J Am Coll Surg, 2013, 216 (5):924-932.
24. Simon B, Ebert J, Bokhari F.Management of pulmonary contusion and flail chest:an eastern association for the surgery of trauma practice management guideline.J Trauma Acute Care Surg, 2012, 73 (5):351-361.
25. 肖接承, 华菲, 朱江, 等.采用镍钛合金环抱器微创重点肋骨内固定治疗连枷胸的临床应用.苏州大学学报:医学版, 2007, 27 (5):775-776, 779.
26. Voggenreiter G, Neudeck F, Aufmkolk M.Operative chest wall stabilization in flail chest--outcomes of patients with or without pulmonary contusion.J Am Coll Surg, 1998, 187 (2):130-138.

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Use of Pain Scale and Arterial Oxygen Partial Pressure as Screening Internal Fixation Indications for Patients with Multiple Rib Fractures

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