NEPA Vital Signs - Winter 2019 Spring 2020 - 24

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LUZERNEMEDSOC.ORG

unit post-operative day number 1 and
then transferred to the trauma dedicated
medical-surgical floor (Trauma-5) at GWV
where they continue to receive their care
from specialty trained trauma nursing staff.
Usually patients are discharged depending
on their other injuries and medical comorbidities within 3-5 days post-operation.
SSRF utilizes these custom plates which
remain in the patient for their lifetime and
rarely need to be removed unless there is
an infection involving the plate, hardware
failure or chronic pain felt to be from the
plate or screw itself. All of these have been
discussed in the current literature and have
been found to occur very rarely.
Utilization and integration of new technological advances such as 3D print modeling
to better define and treat pathoanatomic
abnormalities adds significant value to the
healthcare system. In patients with severe
traumatic rib fractures, incorporation of this
technology has allowed for the pre-fabrication of custom plating which can be used
for fracture repair. Pre-fabrication saves
significant operative time which is both
financially costly as well as costly to the
patient as they will require less time under
general anesthesia, less fluid requirements
and less time lying on the operating room
table which can lead to pressure injury or
worsening of their pulmonary function in
the non-injured lung. Patients who have
undergone SSRF have been found overall
to utilize less narcotic medication, have
improved pulmonary toilet requiring less
supplemental oxygen, require less days
in the intensive care unit and less days on
mechanical ventilation, are able to mobilize faster decreasing the risk of bedsores
and deep vein thrombosis and pulmonary
embolism as well as have decreased hospital length of stay and a quicker return
to work and their baseline functional
pre-injury status.
RICHARD A. LOPEZ, D.O.,
F.A.C.S., F.A.C.O.S., Director
of Trauma and Surgical Critical Care,
Geisinger Health System, Geisinger
Wyoming Valley Medical Center
SARAH A. FLORA, BS, RT (R) (MR) (AART)
Program Lab Director, 3D Imaging and Printing,
Geisinger Medical Center, Danville

Top: 3D model with completed prefabricated custom plates for rib fractures and sternal fracture.
Bottom: Customized plates, labeled and placed into container for sterilization.
REFERENCES:
Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the
elderly. J Trauma 2000;48:1040-6 discussion 1046-1047.
Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A.
Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care
Surg 2014;76:462-8.
Bemelman M, Poeze M, Blokhuis TJ, Leenen LP. Historic overview
of treatment techniques for rib fractures and flail chest. Eur J
Trauma Emerg Surg 2016;36:407-15.
Mayberry JC, Ham LB, Schipper PH, Ellis TJ, Mullins RJ. Surveyed
opinion of American trauma, orthopedic, and thoracic surgeons
on rib and sternal fracture repair. J Trauma 2009;66:875-9.
Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward 3rd T, et
al. Association for the Surgery of, Management of pulmonary
contusion and flail chest: an Eastern Association for the Surgery
of Trauma practice management guideline. J Trauma Acute Care
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Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal
fixation versus endotracheal intubation and ventilation. J Thorac
Cardiovasc Surg 1995;110:1676-80.
Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, et
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Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP. Operative chest wall stabilization in flail chest-outcomes
of patients with or without pulmonary contusion. J Am Coll Surg
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Marasco SF, Davies AR, Cooper J, Varma D, Bennett V, Nevill R, et al.
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SM, et al. Surgical rib fixation for flail chest deformity improves
liberation from mechanical ventilation. J Crit Care 2014;29:139-43.
Pieracci FM, Lin Y, Rodil M, Synder M, Herbert B, Tran DK, et al. A
prospective, controlled clinical evaluation of surgical stabilization
of severe rib fractures. J Trauma Acute Care Surg 2016;80:187-94.
Leinicke JA, Elmore L, Freeman BD, Colditz GA. Operative management
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and meta-analysis. Ann Surg 2013;258:914-21.
Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM.
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Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest:
what is the benefit. J Am Coll Surg 2012;215:201-5.

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NEPA Vital Signs - Winter 2019 Spring 2020

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