Search Our Scientific Publications & Authors

Front Surg 2022 9;9:845494. Epub 2022 Jun 9.

Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany.

Introduction: Management of traumatic rib fractures is subject of controversial discussions. Rib fractures are common, especially after traffic accidents and falls. There is no consensus on whether and how many rib fractures need reconstruction. Read More

Gen Thorac Cardiovasc Surg 2022 Jun 3. Epub 2022 Jun 3.

Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands.

Objectives: Early surgical stabilization of flail chest has been shown to improve chest wall stability and diminish respiratory complications. The addition of video‑assisted thoracoscopic surgery (VATS) can diagnose and manage intrathoracic injuries and evacuate hemothorax. This study analyzed the outcome of our 7-year experience with VATS-assisted surgical stabilization of rib fractures (SSRF) for flail chest. Read More

Bone Joint J 2022 Jun;104-B(6):729-735

University of Nottingham, Nottingham, UK.

Aims: The last decade has seen a marked increase in surgical rib fracture fixation (SRF). The evidence to support this comes largely from retrospective cohorts, and adjusting for the effect of other injuries sustained at the same time is challenging. This study aims to assess the impact of SRF after blunt chest trauma using national prospective registry data, while controlling for other comorbidities and injuries. Read More

Emerg Radiol 2022 May 21. Epub 2022 May 21.

Department of Radiology and Imaging Sciences, Division of Emergency and Trauma Imaging, Emory University School of Medicine, Atlanta, GA, USA.

In the setting of acute trauma where identification of critical injuries is time-sensitive, a portable chest radiograph is broadly accepted as an initial diagnostic test for identifying benign and life-threatening pathologies and guiding further imaging and interventions. This article describes chest radiographic findings associated with various injuries resulting from blunt chest trauma and compares the efficacy of the chest radiograph in these settings with computed tomography (CT). Common chest radiographic findings in blunt thoracic injuries will be reviewed to improve radiologic identification, expedite management, and improve trauma morbidity and mortality. Read More

J Surg Res 2022 Sep 6;277:310-318. Epub 2022 May 6.

Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia.

Introduction: Damage to the thoracic cage is common in the injured patient, both when the injuries are confined to this single cavity and as part of the overall injury burden of a polytraumatized patient. In a subset of these patients, the severity of injury to the intrathoracic viscera is either underappreciated at admission or blossom over the following 48-72 h. The ability to promptly identify these patients and abrogate complications therefore requires triage of such at-risk patients to close monitoring in a critical care environment. Read More

Surg Infect (Larchmt) 2022 May;23(4):321-331

Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.

Surgical stabilization of rib fractures is recommended in patients with flail chest or multiple displaced rib fractures with physiologic compromise. Surgical stabilization of rib fractures (SSRF) and surgical stabilization of sternal fractures (SSSF) involve open reduction and internal fixation of fractures with a plate construct to restore anatomic alignment. Most plate constructs are composed of titanium and presence of this foreign, non-absorbable material presents opportunity for implant infection. Read More

Injury 2022 Apr 25. Epub 2022 Apr 25.

Adult Critical care Unit, The Royal London hospital, Barts Health NHS Trust, United Kingdom; William Harvey Research Institute, Queen Mary University London, United Kingdom. Electronic address:

Background: Severe chest injuries are associated with significant morbidity and mortality. Surgical rib fixation has become a more commonplace procedure to improve chest wall mechanics, pain, and function. The aim of this study was to characterise the epidemiology and long-term functional outcomes of chest trauma patients who underwent rib fixation in a major trauma centre (MTC). Read More

Pediatr Pulmonol 2022 Jul 14;57(7):1818-1819. Epub 2022 May 14.

Pediatric ICU and Trauma Center, A. Gemelli Hospital, Fondazione Policlinico Gemelli IRCCS, Rome, Italy.

Blunt chest injury is commonly observed in the Pediatric Emergency Department and Intensive Care Unit since up to 30% of children with traumatic injury sustain injury to the thorax. Differently from adults, who present with concomitant rib or sternoclavicular fractures in 70% of cases, more than half of childhood chest injuries occur without any bone fracture, mostly causing lung contusions. This lower rate of rib fractures and near absence of flail chest in children may be due to greater elasticity of the pediatric cartilaginous and bony skeleton. Read More

Port J Card Thorac Vasc Surg 2022 Apr 11;29(1):57-59. Epub 2022 Apr 11.

Department of Cardiothoracic Surgery, Centro Hospitalar Universitário São João, Porto, Portugal.

We report a case of a 32-year-old male patient who sustained an isolated stab injury to the left chest wall. He was initially treated with emergency surgery for right ventricular free wall rupture, with an uneventful postoperative course. During follow-up, the patient complained of exercise intolerance and dyspnea on effort. Read More

Am J Surg 2022 Apr 7. Epub 2022 Apr 7.

Scripps Mercy San Diego Trauma. 4077 Fifth Ave, San Diego, CA, 92103, USA. Electronic address:

Introduction: There has been increasing use of surgical stabilization of rib fractures (SSRF), but most literature demonstrate outcomes of single centers during the index hospitalization. We sought to analyze statewide patterns and longer-term outcomes after SSRF.

Methods: Adult patients with >1 rib fracture in the 2016-2018 California Office of Statewide Health Planning Database were identified. Read More

J Clin Med 2022 Apr 7;11(8). Epub 2022 Apr 7.

Department of Visceral, Transplant, Thoracic and Vascular Surgery, Division of Thoracic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany.

Chest compressions during cardiopulmonary resuscitation (CPR) may be associated with iatrogenic chest wall injuries. The extent to which these CPR-associated chest wall injuries contribute to a delay in the respiratory recovery of cardiac arrest survivors has not been sufficiently explored. In a single-center retrospective cohort study, surviving intensive care unit (ICU) patients, who had undergone CPR due to medical reasons between 1 January 2018 and 30 June 2019, were analyzed regarding CPR-associated chest wall injuries, detected by chest radiography and computed tomography. Read More

Am Surg 2022 Jul 14;88(7):1459-1466. Epub 2022 Apr 14.

21823The University of Tennessee Medical Center, Mountain Home, TN, USA.

Background: Rib fracture (RF) pain management provides analgesia while reducing opioids. We postulated: (1) Prescriber factors affect opiate duration, and (2) lidocaine infusion curtails dependency.

Materials And Methods: Retrospective study of RF patients undergoing multimodal analgesia at ACS-verified Level 1 Trauma Center April 2018-February 2020. Read More

J Trauma Acute Care Surg 2022 Apr 8. Epub 2022 Apr 8.

Introduction: Surgical stabilization of rib fractures has gained popularity as both metal and resorbable plates have been approved for fracture repair. Is there a difference between metal and resorbable plate rib fixation regarding rib fracture alignment, control of pain, and quality-of-life scores (Rand SF-36 survey)?

Methods: Eligible patients (pts) included ≥18 years with one or more of the following: flail chest, one or more bi-cortical displaced fractures (3 -10), non-displaced fractures with failure of medical management. Pts were randomized to either metal or resorbable plate fixation. Read More

J Surg Res 2022 08 4;276:221-234. Epub 2022 Apr 4.

Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Medicine, Griffith University, Southport, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

Background: Multiple rib fractures and flail chest are common in trauma patients and may result in significant morbidity and mortality. While rib fractures have historically been treated conservatively, there is increasing interest in the benefits of surgical fixation. However, strong evidence that supports surgical rib fixation and identifies the most appropriate patients for its application is currently sparse. Read More

BMC Cardiovasc Disord 2022 04 6;22(1):151. Epub 2022 Apr 6.

Departments of Cardiac Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.

Background: Papillary muscle rupture is a rare condition. Its clinical presentation, diagnosis and management can be very challenging for the clinician.

Case Presentation: A 73-year-old woman with hypertension presented with chest pain, ST-segment changes, and elevated serum troponin levels. Read More

Medicina (Kaunas) 2022 Feb 24;58(3). Epub 2022 Feb 24.

Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua 500, Taiwan.

: Flail chest typically results from major trauma to the thoracic cage and is accompanied by multiple rib fractures. It has been well documented that surgical fixation of rib fractures can decrease both morbidity and mortality rates. This study aimed to evaluate the effectiveness of a dedicated APS Rib Fixation System, which features a pre-contoured design based on anatomical rib data of the Asian population. Read More

Sisli Etfal Hastan Tip Bul 2021 29;55(4):495-502. Epub 2021 Dec 29.

Depatment of Anaesthesiology and Reanimation, University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.

Objectives: In this study, the effect of multi-trauma on treatment results in flail chest patients who underwent chest wall stabilization was investigated.

Methods: The data of thirty-six flail chest cases between the ages of 18-79 who were consulted for thoracic surgery were retrospectively analyzed in the study. The presence of flail chest in the patients was confirmed by thoracic surgeons, and the multi-traumas were confirmed through the diagnoses made by specialist physicians reexamining clinical methods. Read More

Crit Care Res Pract 2022 1;2022:6547849. Epub 2022 Mar 1.

Intensive Care Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.

Background: Chest injury with multiple rib fractures is the most common injury among major trauma patients in New South Wales (23%) and is associated with a high rate of mortality and morbidity. The aim of this study was to determine the intensive care unit (ICU) length of stay (LOS) among major trauma patients with multiple rib fractures and to identify factors associated with a prolonged ICU LOS.

Materials And Methods: Single-centre, retrospective observational cohort study of adult patients with 3 or more traumatic rib fractures, who were admitted to ICU between June 2014 and June 2019. Read More

Respirol Case Rep 2022 Apr 27;10(4):e0914. Epub 2022 Feb 27.

First Department of Surgery Hamamatsu University School of Medicine Hamamatsu Japan.

The claw-type titanium plate has been successfully applied to manage a flail chest. However, rare and life-threatening organ injury occurs due to an insufficient claw bend. We report an ingenuity of surgical fixation using KANI® plates (USCI Japan, Tokyo, Japan) in a flail chest. Read More

J Chest Surg 2022 Apr;55(2):183-187

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Flail chest is a critical medical condition in which multiple segmentally fractured adjacent ribs cause paradoxical movement of the thoracic cage in patients with severe blunt trauma injury. Surgical stabilization is considered essential in patients who require mechanical ventilation. However, there is no consensus on which surgical procedure to choose among the various available techniques or when to perform surgery. Read More

Eur J Trauma Emerg Surg 2022 Feb 22. Epub 2022 Feb 22.

Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.

Purpose: Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients.

Methods: A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. Read More

Arch Orthop Trauma Surg 2022 Feb 8. Epub 2022 Feb 8.

Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 16, 6000, Lucerne, Switzerland.

Background: Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patients (older than 60 years) with multiple rib fractures. Read More

Interact Cardiovasc Thorac Surg 2022 05;34(5):768-774

Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Objectives: Blunt chest trauma after mechanical resuscitation manoeuvres appears to have a significant impact on the often complicated course. Due to a lack of data in the literature, the purpose of this study was to investigate the feasibility and immediate outcome of chest wall stabilization for flail chest in this vulnerable patient population.

Methods: We retrospectively reviewed the medical records of patients after cardiopulmonary resuscitation between January 2014 and December 2018 who were diagnosed with flail chest. Read More

J Trauma Acute Care Surg 2022 Jun 4;92(6):967-973. Epub 2022 Feb 4.

From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.

Introduction: The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or intensive care unit (ICU) and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study was to evaluate triage effectiveness and health care resources utilization following RIG implementation. Read More

J Trauma Acute Care Surg 2022 Jun 25;92(6):1047-1053. Epub 2022 Jan 25.

From the Cardiothoracic Surgery Unit (S.F.M., R.S.), The Alfred Hospital; Department of Surgery (S.F.M., M.F., K.M.) and Department of Epidemiology and Preventative Medicine (M.B.), Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria; Department of Traumatology (Z.J.B.), John Hunter Hospital; Discipline of Surgery (Z.J.B.), University of Newcastle, Newcastle, New South Wales; National Trauma Research Institute (M.F.); Trauma Service (M.F., K.M.), The Alfred Hospital, Melbourne, Victoria; Trauma Service (M.E.W., B.P.), Gold Coast University Hospital; School of Medicine (M.E.W.), Griffith University, Southport, Queensland; Trauma Service (J.H.), Westmead Hospital, Westmead; and Westmead Clinical School (J.H.), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Background: The aim of this study was to assess pain and quality of life (QoL) outcomes in patients with multiple painful displaced fractured ribs with and without operative fixation. Rib fractures are common and can lead to significant pain and disability. There is minimal level 1 evidence for rib fixation in non-ventilator-dependent patients with chest wall injuries. Read More

Trauma Case Rep 2022 Feb 23;37:100596. Epub 2021 Dec 23.

Department of cardiothoracic surgery, Soroka University Medical Center, Israel.

Flail chest is a common injury in blunt trauma which is usually treated with analgesia, oxygen, and other conservative measures. In more severe cases mechanical ventilation and surgical stabilization of rib fractures (SSRF) may be warranted. Penetrating injury to the heart or great vessels due to rib fractures however, is much less common. Read More

Am Surg 2022 May 2;88(5):984-985. Epub 2022 Jan 2.

Department of Surgery, Division of Trauma & Acute Care Surgery, 5557University of South Alabama College of Medicine, Mobile, AL, USA.

Respiratory failure secondary to rib fractures is a major source of morbidity and mortality in trauma patients, particularly in older populations. Management of pain in these patients is complex due to the nature of the injuries. We present 3 patients who underwent a video-assisted thoracoscopic cryoablation of intercostal nerves for pain control after chest trauma. Read More

J Med Case Rep 2021 Dec 28;15(1):614. Epub 2021 Dec 28.

Cardiovascular Research Center, Shafa Hospital, Kerman University of Medical Sciences, Shafa Avenue, Kerman, Iran.

Background: Aortic regurgitation is attributed to congenital and acquired abnormalities of the aortic valve or aortic valve supporting structures. The most common cause of aortic regurgitation is atherosclerotic degeneration of the valve, especially in the presence of a bicuspid aortic valve. A 25-year-old Persian man with no past medical history, developed dyspnea since 1 week before his first visit to the physician. Read More

Ann R Coll Surg Engl 2022 Apr 20;104(4):249-256. Epub 2021 Dec 20.

The University of Nottingham, UK.

Introduction: Multiple traumatic rib fractures are associated with significant morbidity and mortality. The last decade has seen a significant increase in rates of surgical fixation for both flail and non-flail rib fractures; the evidence for this has come from largely retrospective studies. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management. Read More

J Clin Med 2021 Nov 9;10(22). Epub 2021 Nov 9.

Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.

Background: The coexistence of thoracic fractures and blunt aortic injury (BAI) is potentially catastrophic and easy to be missed in acute trauma settings. Data regarding patients with thoracic fractures complicated with BAI are limited.

Methods: The authors conducted a prospective, observational, single-center study including patients with thoracic burst fractures. Read More