Caitlyn Ryan, Summer Research Intern Andrew R. Doben, M.D.

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Presentation transcript:

Caitlyn Ryan, Summer Research Intern Andrew R. Doben, M.D.

 Flail Chest and how it is treated  Background information on rib fractures  Surgical Rib Fixation (SRF) and how it is utilized at Baystate  Study methods and results/conclusions  Future of SRF?

A flail chest occurs when a segment of the thoracic cage is separated from the rest of the chest wall. Result of a crushing chest injury Paradoxical respiration This image shows the paradoxical movements of the flail segments

 Major source of morbidity in the U.S.  Significant advances in pain control, no improvement in the outcomes  Various reports beginning in the 1950s and sporadic attempts through the mid 80’s  The safety and efficiency of SRF remains uncertain (especially in age ≥ 65 population)

 11,807 Deaths from Thoracic Trauma  Mortality was 22% for the elderly versus 10% for the young  The most common complication of rib fractures is pneumonia  Up to 60% patients do not return to full time employment

 Surgical Rib Fixation is a surgery that allows surgeons to apply artificial support to fractured ribs  There are different methods of support that can be used during SRF; these include Rib Loc, Synthes Rib Matrix, and Intramedullary Nail  Here at Baystate, the Synthes Rib Matrix is utilized

Ribs are realigned and osteosynthes plates are bent/cut to fit specific ribs. The ribs are held together by the osteosynthes plate, which is screwed into the ribs. Important for restoration of the integrity of the chest wall: Plate apposition tissue mobilization shape formation

Baystate Medical Center has created a multidisciplinary team approach to the care of rib fracture patients.  This includes specific pain regimens, multimodality target respiratory therapy, and surgical intervention  The study conducted here at Baystate focused on the concept of age restrictions within the SRF patient population

 Patients with flail chest or severe rib fractures who were admitted to a Level 1 Trauma Center for SRF between July 2010 and June 2014 were evaluated  Patients age ≥ 65 and age ≤ 64 were evaluated and compared in the outcome variables: 1.Injury Severity Score 2.Total number of Fractures 3.Hospital Length of Stay 4.ICU LOS 5.Ventilator Days 6.Fractures Repaired

 Utilized REDCap Database, which is a secure, web-based application for building and managing online databases  Research Electronic Data Capture  Also provides automated export procedures for easy statistical analysis

The median number of ventilator days, ISS, ICU LOS, and Hospital LOS were similar in both groups, signaling that there should not be age restrictions on surgical rib fixations.

 This project is intended to improve the care and outcomes of patients with rib fractures.  Presentation at EAST (Eastern Association for Aurgical Trauma) at end of January 2015  Creation of a national registry essentials-of-management-treatment

Thank you to Andrew Doben, M.D., who is the primary researcher of this project Thank you to Jeffry Nahmias, M.D., who made this internship opportunity possible Thank you to Jane Sicard and the Summer Scholars for giving me the opportunity to present my research here today

1. Flail chest. (n.d.). Medterms. Retrieved July 21, 2014, from 2. flail segment. (n.d.). TheFreeDictionary.com. Retrieved July 16, 2014, from dictionary.thefreedictionary.com/flail+segment(flail segment image/definition) 3. M.D., A. D. (Director) (2014, July 21). Surgical Management of Traumatic Rib Fractures. Lecture conducted from, Springfield, MA. 4. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. (0001, January 18). Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Retrieved July 16, REDCap. (n.d.). REDCap. Retrieved August 4, 2014, from 6. SRF Abstract by Dr. Andrew Doben, M.D. 7. Swedish Medical Center Seattle and Issaquah. (n.d.). Swedish. Retrieved July 16, 2014, from treatment 8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. (n.d.). AccessMedicine. Retrieved July 16, 2014, from ionID= &Resultclick=2 9. TRAUMA.ORG: Thoracic Trauma. (n.d.). TRAUMA.ORG: Thoracic Trauma. Retrieved July 16, 2014, from chest definition)