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The purpose of this study is to assess the outcome of a muscle sparing, minimally invasive open surgical technique for unstable ribcage injuries after trauma. The investigators will compare the results from the study participants to a historical cohort who were operated with a different surgical technique with large incisions and simultaneous thoracotomy.
This is a prospective follow-up study where the investigators aim to study patients who have undergone surgery with a muscle sparing, minimally invasive technique for unstable ribcage after trauma. The investigators plan on seeing the participants as out patients 6 months and 1 year after surgery. The results will be compared to results from a historical cohort with patients who participated in earlier studies with a different surgical method with large incisions and simultaneous thoracotomy. The investigators plan on including 50 patients since a preliminary analysis has suggested this should be enough to notice statistically significant differences between the groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Minimally invasive | Patients who underwent surgery with a muscle sparing, minimally invasive technique for unstable chest wall after trauma. |
| |
| Historical control | Patients who underwent surgery with large incisions and simultaneous thoracotomy for unstable chest wall after trauma. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Minimally invasive surgical fixation of unstable rib cage | Procedure | Minimally invasive and muscle sparing surgical fixation of ribs and/or sternum in an unstable segment of the chest wall (flail chest) with titan plates or medullary nails (MatrixRib Fixation System, DepuySynthes). |
| Measure | Description | Time Frame |
|---|---|---|
| Vital capacity of the lungs. | Vital capacity (VC) measured with spirometry. | One year after surgery. |
| Forced vital capacity of the lungs. | Forced vital capacity (VC) measured with spirometry. | One year after surgery. |
| Forced expiratory volume of the lungs. | Forced expiratory volume in 1 second (FEV1) measured with spirometry. | One year after surgery. |
| Forced expiratory volume percent of the lungs. | Forced expiratory volume in 1 second divided with forced vital capacity, measured with spirometry. | One year after surgery. |
| Peak expiratory flow of the lungs. | Peak expiratory flow measured with spirometry. | One year after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Disability | Degree of disability assessed with Disability Rating Index (DRI) scale ranging from 0-100 where higher scores indicate more disability. | Six months and one year after surgery. |
| Physical activity |
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Inclusion Criteria:
Exclusion Criteria:
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Patients surgically treated at our trauma ward for unstable chest wall due to trauma. Consecutive sampling.
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| Name | Affiliation | Role |
|---|---|---|
| Erik Westin, MD | Sahlgrenska University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sahlgrenska University Hospital | Gothenburg | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26889439 | Background | Bemelman M, van Baal M, Yuan JZ, Leenen L. The Role of Minimally Invasive Plate Osteosynthesis in Rib Fixation: A Review. Korean J Thorac Cardiovasc Surg. 2016 Feb;49(1):1-8. doi: 10.5090/kjtcs.2016.49.1.1. Epub 2016 Feb 5. | |
| 27307787 | Background | Caragounis EC, Fagevik Olsen M, Pazooki D, Granhed H. Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study. World J Emerg Surg. 2016 Jun 14;11:27. doi: 10.1186/s13017-016-0085-2. eCollection 2016. |
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Sharing data with other researchers will be considered by request.
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| ID | Term |
|---|---|
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
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|
| Large incision surgical fixation of unstable rib cage. | Procedure | Surgical fixation of ribs and/or sternum in an unstable segment of the chest wall (flail chest) with titan plates or medullary nails (MatrixRib Fixation System, DepuySynthes). Large non muscle sparing incision with simultaneous thoracotomy. |
|
Physical activity assessed with Grimby activity scale ranging from 1-6 where 6 indicates the highest level of activity.
| Six months and one year after surgery. |
| Shoulder mobility | Shoulder mobility assessed with Boström index, a scale ranging from 5-30 for each shoulder where 30 represents the greatest range of movement. | Six months and one year after surgery. |
| Respiratory movement | Movement of chest wall during respiration measured with Respiratory Movement Measuring Instrument (RMMI). | Six months and one year after surgery. |
| Strength of respiratory muscles | Strength of respiratory muscles measured with Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP). | Six months and one year after surgery. |
| Quality of life EQ-5D-5L | Quality of life assessed with the EuroQol (European Quality of Life) Five Dimension Five Level Scale (EQ-5D-5L). A 5-dimensional scale in which each dimension has 5 levels where 1 represents the best outcome and 5 represents the worst outcome. | Six months and one year after surgery. |
| Radiological healing | Radiological signs of healing of the participants rib fractures assessed with CT scan. Fractures will be denoted as healed, partially healed or with no signs of healing. | One year after surgery. |
| 17670487 | Background | Granetzny A, Abd El-Aal M, Emam E, Shalaby A, Boseila A. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005 Dec;4(6):583-7. doi: 10.1510/icvts.2005.111807. Epub 2005 Sep 15. |
| 25642282 | Background | Granhed HP, Pazooki D. A feasibility study of 60 consecutive patients operated for unstable thoracic cage. J Trauma Manag Outcomes. 2014 Dec 30;8(1):20. doi: 10.1186/s13032-014-0020-z. eCollection 2014. |
| 23415550 | Background | Marasco SF, Davies AR, Cooper J, Varma D, Bennett V, Nevill R, Lee G, Bailey M, Fitzgerald M. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013 May;216(5):924-32. doi: 10.1016/j.jamcollsurg.2012.12.024. Epub 2013 Feb 13. |
| 11956391 | Background | Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002 Apr;52(4):727-32; discussion 732. doi: 10.1097/00005373-200204000-00020. |
| 40392360 | Derived | Westin EO, Olsen MF, Caragounis EC. Comparison of long-term outcome between muscle sparing and non-muscle sparing surgical techniques in rib plating. Eur J Trauma Emerg Surg. 2025 May 20;51(1):212. doi: 10.1007/s00068-025-02881-z. |