Aim of the work: To present indications, surgical technique, complications and mid-term results on a set of prospectively monitored patients with performed osteosynthesis of multiple rib fractures. Material and methods: In the period from January 2018 to May 2019, we performed osteosynthesis in 15 patients who were followed for at least 6 months. The indication was a multiple rib fracture with instability of the chest wall, a serial fracture of 3 and more ribs with a gross deformity of the chest wall and intrathoracic pathology requiring surgical procedure, in combination with one or more broken ribs. We used an innovated system of rib splints of a Czech manufacturer for the osteosynthesis. The average age of patients was 58. The most frequent mechanism of injury was a high-energy injury (in 10 cases). Out of the associated injuries, skeleton fractures in the area of chest and upper limbs in a total of eight patients were the most frequent ones. Traumatic hemothorax was present in 13 patients, pneumothorax in seven. Contusion of the lungs was reported in seven patients, and six multiple rib fractures were present in the set. Bilateral rib fractures occurred in six patients. Results: The time from injury to operating procedure ranged from 2 hours to 13 days. Most often, we performed osteosynthesis of 3 ribs using 4 splints. The ave­rage length of stay at the intensive care unit was 5.2 days. Surgical wounds healed primarily. As to early postoperative complications, we reported hemothorax in one case and fluidothorax in one case. Two patients were treated postoperatively for bronchopneumonia. Bone healing was achieved in all patients after 24 weeks. Discussion: The advantage of surgical stabilization is reduction of the time of artificial pulmonary ventilation including reduction in the incidence of related complications. In a complex chest injury, we consider it important to combine surgical stabilization of the ribs with the shoulder girdle osteosynthesis. Conclusion: We recommend surgical treatment of multiple rib fractures in multiple rib fractures, serial fractures with chest wall deformity, and in procedures associated with the treatment of an intrathoracic pathology. Splint osteosynthesis with innovated Judet-type rib splints is comfortable and safe and results in bone healing achieved.

Department of Chest Surgery Masaryk Hospital Ústí nad Labem

Department of Trauma Surgery Masaryk Hospital Ústí nad Labem

Institute of Anatomy 2nd Faculty of Medicine Charles University Prague

Masaryk Hospital o z Krajská zdravotní a s Regional Hospital Type 1 Trauma Center