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

BMC Research Notes

Theodore G Liou¹  Don H Van Boerum²  Nathan C Dean¹ 

[1] Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, Utah, USA;University of Utah, Salt Lake City, USA

关键词: Pain control;    Bronchiectasis;    Rib plating;    Rib fracture;    Cystic fibrosis;   

Others  :  1127394
DOI  :  10.1186/1756-0500-7-681

 received in 2014-03-07, accepted in 2014-09-26,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Dean et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Aris RM, Renner JB, Winders AD, Bucli HE, Riggs DB, Lester GE, David A, Ontjes DA: Increased rate of fractures and severe kyphosis: sequelae of living into adulthood with cystic fibrosis. Ann Intern Med 1998, 128:186-193.
• [2]Liou TG, Adler FR, Fitzsimmons SC, Cahill BC, Hibbs JR, Marshall BC: Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol 2001, 153:345-52.
• [3]Bottlang M, Long WB, Phelan D, Fielder D, Madey SM: Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury 2013, 44(2):232-8.
• [4]Billè A, Okiror L, Campbell A, Simons J, Routledge T: Evaluation of long-term results and quality of life in patients who underwent rib fixation with titanium devices after trauma. Gen Thorac Cardiovasc Surg 2013, 61(6):345-9.
• [5]Matrix rib, DePuy Synthes, Johnson and Johnson North America [http://sites.synthes.com/na/matrixrib/ webcite]
• [6]McCaffery M, Pasero C: Pain: Clinical Manual. St. Louis: Mosby, Inc; 1999. P. 16