NEPA Vital Signs - Winter 2019 Spring 2020 - 22

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LUZERNEMEDSOC.ORG

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INCORPORATION OF 3D PRINT MODELING
FOR SURGICAL STABILIZATION OF
TRAUMATIC RIB FRACTURES

eisinger Wyoming Valley (GWV) Medical Center, located in Wilkes-Barre,
Pennsylvania has been accredited as
a level II trauma center by the Pennsylvania
Trauma Systems Foundation (PTSF) since
2008. Our center provides high-quality,
state-of-the-art emergency and trauma care
to a 6 county, primarily rural area with a
full-time population of over 550,000 people. Like most non-urban trauma centers,
97% of our trauma patients present with
a blunt mechanism of injury mostly from
falling and motor vehicle accidents and 3%
from penetrating injuries such as knife or
gunshot wounds. Our population of geriatric
patients, defined by the PTSF as greater
than or equal to 65 has steadily increased
from 41% in 2016, to 46% in 2018 and this
patient population tends to present with
more medical comorbidities making their
outcomes worse than those in the traditional
trauma population which is often cited as
between 1-44 years of age.
Rib fractures are one of the most common
injuries following blunt trauma, occurring
in approximately 10% of all trauma patients
nationwide. Over 350,000 patients sustain
rib injuries annually in the Unites States,
and major trauma centers admit patients
with rib fractures daily. At GWV, we have
seen an increased trend in our rib fracture
patients. In 2016, there were 205 total
patients with rib fractures, in which 88 (43%)
were geriatric, in 2017, 219 total rib fracture
patients were seen with 96 of them (44%)
being geriatric and in 2018, there were 214
total patients with rib fractures, in which
118 (55%) were geriatric. Despite many
improvements in the care of rib fracture
patients, outcomes remain poor and have
not changed substantially over the last 15
years. Although surgical stabilization of
rib fractures (SSRF) has been practiced

A custom 3D print model is
fabricated of the patient's
injuries. Prints can take
anywhere from six to 60 hours
depending on the complexity
and size of the model as well as
the printer and its capabilities.
sporadically for nearly 100 years, there has
to ensure their nursing and monitoring
been a recent explosion in the technology
needs are met.
for, frequency of, and data addressing SSRF. * C: Comfort, specifically aggressive pain
management utilizing mixed multi-modal
Patients with rib fractures at GWV trauma
drug therapies to limit narcotic use. This
center are managed via an evidence-based
also incorporates ultrasound guided
protocol which utilizes a respiratory risk
regional nerve blocks and thoracic epiassessment (RRA) screening tool. Patients
dural catheters when needed.
are risk-stratified to how significant their * D: Disability, which encourages early
injuries are which helps determine if they are
mobilization, physical, occupational and
at risk for clinical deterioration and need for
physiatry evaluations to promote patient
a higher-level of care such as the progressive
mobility which decreases the risk of
care unit or intensive care unit on admission.
pneumonia, deep vein thrombosis and
Any patients who have an RRA score of 3 or
pulmonary embolism and improves healmore (0 being no risk and 6 being the highest
ing and overall outcomes by preventing
risk) undergo formal computed tomography
muscle deconditioning from laying in bed
(CT) scanning of their thorax and these
for a prolonged period of time.
images then are sent to the 3D lab to undergo * E: Evaluation for early operative repair
3D remodeling for possible operative repair.
with open reduction and internal
fixation or SSRF.
Next, all patients with rib fractures are managed utilizing a clinical
Patients are individually assessed with
mnemonic, ABCDE:
respect to the extent of their total injury
* A: Airway and aggressive respiratory burden and specifically to their thoracic
management in which deep breathing injury and how much pain and mobility limand coughing to promote pulmonary itations they have. They are also assessed for
toileting with baseline incentive spirom- their prior quality of life, activity level, hand
etry is performed.
dominance and occupation. Taking all of this
* B: Bed assignment to ensure that patients into account helps the surgeon determine
with a high risk of clinical deterioration if a patient would be considered a good
are admitted to the appropriate location candidate or not for SSRF. Traditionally, the
evidence-based indications for SSRF were to
N E PA

VITAL SIGNS

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NEPA Vital Signs - Winter 2019 Spring 2020

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