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Jaishankar Raman, MBBS MMed, FRACS, PhD

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Plating the rib?

August 8, 2018

Yes, why not? Every other bone that is broken in the body is internally fixed with plates and screws.  

I am sure the medical members of the audience will remember mention of flail chest or painful rib fractures. In the "old days", the standard treatment for both was conservative with some shaking of the head and trying to control the pain.

Both of these can be addressed very effectively with plating of the ribs. Dr Sylvana Marasco, from the Alfred Hospital, Melbourne is a very innovative surgeon who was a trainee when I first was in practice in Melbourne. She conducted a randomized study which showed the benefit of fixing multiple ribs in patients with flail chest. I have personal experience with this approach with excellent results, over the years.  Incidentally, this is still not standard of care, yet...

One could extend this practice to painful rib fractures also. This approach definitely saves the patients from  unnecessary opioid use and use of other painkillers.

 

What about when we cause the fractures or rib osteotomies? This type of rib break is caused to improve visualization - in minimally invasive cardiac surgery, thoracotomy for lung surgery, thoracotomy for aortic reconstruction, etc.  

I first discovered to my delight , one day in 2005 that one could get very dramatic relief from thoracotomy pain if the broken rib was aligned well and plated, in a patient who underwent a lung resection. I then started using small straight titanium plates with multiple holes to fix these rib breaks, with very encouraging results. The current experience with this approach is over 750 patients in my personal practice.  

 

As experience with this approach expands, there are at least 3 orthopedic companies that provide rib plating systems. There is greater awareness of the benefits of rib plating in the trauma surgery realm.

 

So, the next time you are confronted with someone who has had a fractured rib or a thoracotomy, please remember that rib plating is a very good option to address the broken rib.

 

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