Limits...
Rib plating of acute and sub-acute non-union rib fractures in an adult with cystic fibrosis: a case report.

Dean NC, Van Boerum DH, Liou TG - BMC Res Notes (2014)

Bottom Line: Under general anesthesia, he had open reduction and internal fixation of the right 5th, 6th and 7th rib fractures with a Synthes Matrix rib set.In our case report, rib plating with bone grafting improved rib pain and allowed healing of the fractures and recovery, although the immediate post-op period required close attention and care.We believe repair may be of benefit in selected cystic fibrosis patients, such as our patient who had suffered multiple rib fractures that were healing poorly.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, Utah 84107, USA. Nathan.Dean@imail.org.

ABSTRACT

Background: Rib fractures associated with osteoporosis have been reported to occur ten times more frequently in adults with cystic fibrosis. Fractures cause chest pain, and interfere with cough and sputum clearance leading to worsened lung function and acute exacerbations which are the two main contributors to early mortality in cystic fibrosis. Usual treatment involves analgesics and time for healing; however considerable pain and disability result due to constant re-injury from chronic repetitive cough. Recently, surgical plating of rib fractures has become commonplace in treating acute, traumatic chest injuries. We describe here successful surgical plating in a White cystic fibrosis patient with multiple, non-traumatic rib fractures.

Case presentation: A-37-year old White male with cystic fibrosis was readmitted to Intermountain Medical Center for a pulmonary exacerbation. He had developed localized rib pain while coughing 2 months earlier, with worsening just prior to hospital admission in conjunction with a "pop" in the same location while bending over. A chest computerized tomography scan at admission demonstrated an acute 5th rib fracture and chronic non-united 6th and 7th right rib fractures. An epidural catheter was placed both for analgesia and to make secretion clearance possible in preparation for the surgery performed 2 days later. Under general anesthesia, he had open reduction and internal fixation of the right 5th, 6th and 7th rib fractures with a Synthes Matrix rib set. After several days of increased oxygen requirements, fever, fluid retention, and borderline vital signs, he stabilized. Numerical pain rating scores from his ribs were lower post-operatively and he was able to tolerate chest physical therapy and vigorous coughing.

Conclusions: In our case report, rib plating with bone grafting improved rib pain and allowed healing of the fractures and recovery, although the immediate post-op period required close attention and care. We believe repair may be of benefit in selected cystic fibrosis patients, such as our patient who had suffered multiple rib fractures that were healing poorly.

Show MeSH

Related in: MedlinePlus

Chest computerized tomography rib reconstruction shows 2 non-union subacute fractures, and the acute fracture in the adjacent 5th rib.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4197343&req=5

Fig1: Chest computerized tomography rib reconstruction shows 2 non-union subacute fractures, and the acute fracture in the adjacent 5th rib.

Mentions: A 37-year-old White male with CF identified at 3½ months, mutations F508del and R560T, was readmitted to Intermountain Medical Center for a pulmonary exacerbation. One week following discharge from his previous hospitalization 3 months earlier, he coughed hard and developed immediate focal pain in his right chest, mid to anterior axillary line at the 6th and 7th thoracic levels. He was seen in the emergency department and chest x-rays showed no abnormalities. He was treated symptomatically with oral analgesics; the pain waxed and waned but never resolved. A month later he had a particularly vigorous cough, and he felt a pop in the same area with even more pain. The pain worsened further just prior to readmission when his chest “popped” again while tying his shoe. A chest computerized tomography scan at admission (Figure 1) demonstrated an acute 5th rib fracture and chronic non-united 6th and 7th right rib fractures. He was taking chronic Vitamin D and calcium supplements and had a 25 hydroxyvitamin D2 and D3 level in the normal range (33 nanograms per milliliter). Forced expiratory volume in 1 second on admission was 0.66 liter (19% of predicted), and forced vital capacity 2.59 liters (61% of predicted), decreased from 0.80 (23% of predicted) and 2.73 (64% of predicted) at the end of his prior admission. His lungs are chronically infected with mucoid Pseudomonas aeruginosa. His body mass index at admission was 23; he had taken only a few short courses of corticosteroids over his lifetime.Figure 1


Rib plating of acute and sub-acute non-union rib fractures in an adult with cystic fibrosis: a case report.

Dean NC, Van Boerum DH, Liou TG - BMC Res Notes (2014)

Chest computerized tomography rib reconstruction shows 2 non-union subacute fractures, and the acute fracture in the adjacent 5th rib.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197343&req=5

Fig1: Chest computerized tomography rib reconstruction shows 2 non-union subacute fractures, and the acute fracture in the adjacent 5th rib.
Mentions: A 37-year-old White male with CF identified at 3½ months, mutations F508del and R560T, was readmitted to Intermountain Medical Center for a pulmonary exacerbation. One week following discharge from his previous hospitalization 3 months earlier, he coughed hard and developed immediate focal pain in his right chest, mid to anterior axillary line at the 6th and 7th thoracic levels. He was seen in the emergency department and chest x-rays showed no abnormalities. He was treated symptomatically with oral analgesics; the pain waxed and waned but never resolved. A month later he had a particularly vigorous cough, and he felt a pop in the same area with even more pain. The pain worsened further just prior to readmission when his chest “popped” again while tying his shoe. A chest computerized tomography scan at admission (Figure 1) demonstrated an acute 5th rib fracture and chronic non-united 6th and 7th right rib fractures. He was taking chronic Vitamin D and calcium supplements and had a 25 hydroxyvitamin D2 and D3 level in the normal range (33 nanograms per milliliter). Forced expiratory volume in 1 second on admission was 0.66 liter (19% of predicted), and forced vital capacity 2.59 liters (61% of predicted), decreased from 0.80 (23% of predicted) and 2.73 (64% of predicted) at the end of his prior admission. His lungs are chronically infected with mucoid Pseudomonas aeruginosa. His body mass index at admission was 23; he had taken only a few short courses of corticosteroids over his lifetime.Figure 1

Bottom Line: Under general anesthesia, he had open reduction and internal fixation of the right 5th, 6th and 7th rib fractures with a Synthes Matrix rib set.In our case report, rib plating with bone grafting improved rib pain and allowed healing of the fractures and recovery, although the immediate post-op period required close attention and care.We believe repair may be of benefit in selected cystic fibrosis patients, such as our patient who had suffered multiple rib fractures that were healing poorly.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, Utah 84107, USA. Nathan.Dean@imail.org.

ABSTRACT

Background: Rib fractures associated with osteoporosis have been reported to occur ten times more frequently in adults with cystic fibrosis. Fractures cause chest pain, and interfere with cough and sputum clearance leading to worsened lung function and acute exacerbations which are the two main contributors to early mortality in cystic fibrosis. Usual treatment involves analgesics and time for healing; however considerable pain and disability result due to constant re-injury from chronic repetitive cough. Recently, surgical plating of rib fractures has become commonplace in treating acute, traumatic chest injuries. We describe here successful surgical plating in a White cystic fibrosis patient with multiple, non-traumatic rib fractures.

Case presentation: A-37-year old White male with cystic fibrosis was readmitted to Intermountain Medical Center for a pulmonary exacerbation. He had developed localized rib pain while coughing 2 months earlier, with worsening just prior to hospital admission in conjunction with a "pop" in the same location while bending over. A chest computerized tomography scan at admission demonstrated an acute 5th rib fracture and chronic non-united 6th and 7th right rib fractures. An epidural catheter was placed both for analgesia and to make secretion clearance possible in preparation for the surgery performed 2 days later. Under general anesthesia, he had open reduction and internal fixation of the right 5th, 6th and 7th rib fractures with a Synthes Matrix rib set. After several days of increased oxygen requirements, fever, fluid retention, and borderline vital signs, he stabilized. Numerical pain rating scores from his ribs were lower post-operatively and he was able to tolerate chest physical therapy and vigorous coughing.

Conclusions: In our case report, rib plating with bone grafting improved rib pain and allowed healing of the fractures and recovery, although the immediate post-op period required close attention and care. We believe repair may be of benefit in selected cystic fibrosis patients, such as our patient who had suffered multiple rib fractures that were healing poorly.

Show MeSH
Related in: MedlinePlus