Dr. Anthony Tannous

    When Do We Plate Ribs?

    5/15/2018 12:00:00 AM

    Healthy Living – May 15, 2018
    Anthony Tannous – Eastern Maine Medical Center
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    Rib fractures are some of the most common injuries encountered in the hospital and Emergency Department. They can result from minor traumas such as falls or more major trauma such as motorcycle and motor vehicle accidents.

    The toll that rib fractures take is highly variable. It is dependent on a multitude of factors such as type, location and number of the rib fractures, associated injuries to the lung or to other organs, as well as patient factors such as age, medical comorbidities, general fitness, and previous use of narcotics.
    At the very least, rib fractures cause significant pain. Most patients describe the pain being at its worst when they move, cough, or deeply breathe. Of course, to protect themselves from pain, most patients start breathing shallowly. Aside from decreasing the amount of oxygen and carbon dioxide exchange, this pattern of breathing excludes certain areas of the lung from filling up with air. These areas then collapse, fill with mucus and become predisposed to infections, namely pneumonia. Therefore, the main therapeutic goal for a patient who is suffering from rib fractures is to treat his or her pain. This is usually achieved by a combination of pain medications, some with narcotic properties, some with muscle relaxant properties and some with anti-inflammatory properties. Patients with several rib fractures often are only adequately managed by three or four different medications. Patients are also encouraged to deep breathe and cough and they are given a device called an incentive spirometer which sets a goal of inspiration and expiration for them to achieve on a periodic basis during the day.

    More severe rib fractures are frequently associated with underlying lung injuries. When the lung is scratched it could leak air resulting in what we call a pneumothorax. Bleeding from the lung and the ribs themselves results in a collection of blood within the chest called a hemothorax. When the size of the hemo or pneumothorax is significant, they may require a drainage tube called a chest tube. These tubes are usually placed with the help of gentle sedation and local anesthetic at the bedside and they remain in place for several days depending on the severity of the lung injury.

    You may have heard of a new modality to treat rib fractures called rib plating. This procedure is indicated when the patient has suffered from several contiguous rib fractures with significant displacement. In these cases, the chances of success with medication alone are low. A trauma or thoracic surgeon would then intervene to place plates along the ribs with screws holding them in place, to realign the ribs. This is a surgical procedure done under general anesthesia. It is most useful when done early enough after the trauma as infection and associated medical issues may be contraindications to placing metallic plates in any patient. Furthermore, not all rib fracture locations are amenable to this procedure. Typically high or low rib fractures are not helped by this surgery and very posterior fractures may be too hard to reach surgically. It may be useful to ask your doctor if you are a candidate for this procedure in the event that you find yourself with broken ribs.

    In most cases, ribs heal by themselves. They take time to stop hurting completely, they may be incapacitating and they require patience but we have several modalities to treat them.
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