Preliminary Results of Rib Osteosynthesis at the Teaching Hospital Sylvanus Olympio in Lomé

Abstract

Introduction:  Flaps and rib fractures can be life-threatening due to disruption of hematosis. In certain “many” situations, it is important to quickly restore parietal rigidity by costal osteosynthesis. The objective of our work is to report the surgical results of a first Togolese series of rib osteosynthesis performed in the context of chest trauma.
Patients and methods: We proceed by a retrospective study on a series of patients treated for severe blunt chest trauma and who underwent osteosynthesis from 2020 to 2022. Epidemiological and clinical data, in particular the radiological lesion assessment clinic, the therapeutic measures as well as the immediate operative follow-up were collected.
Results: six patients with blunt chest trauma. They were four men and two women whose mean age was 44.4 years. Five patients were admitted for polytrauma and one patient for a serious thoracic trauma. All were admitted to intensive care unit  on day 0 of the trauma. The radioclinical assessment had noted staged fractures of ribs and/or thoracic flap with an average of six affected ribs. All the patients presented pleural effusions and benefited from pleural drainage on their admission to intensive care, often after a chest X-ray or after carrying out a chest CT scan or a whole-body CT scan. The indication for rib osteosynthesis was retained on the clinical criteria, in particular the existence of a pleural effusion, the instability of the wall and the impact on hematosis, by the drop in peripheral oxygen saturation (Sp02). Despite oxygen therapy above 6 l/min for more than 4 days, and according to the results of the chest CT scan and the evolution of the patient after the implementation of the means of resuscitation. The osteosynthesis material used was “third tube” orthopedic plates molded intraoperatively in three patients, pelvic plates in one patient. The average number of plates used was 4.5 and that of Vis was 18. Two patients underwent osteosynthesis by Judet staple.
Conclusion: rib osteosynthesis contributes to a regression of symptoms, in particular chest pain, to reduce the duration of hospitalization, morbidity and mortality, and then improves the functional respiratory prognosis in the short and long term. Despite our reduced technical platform, the results are generally good, reducing the hospital stay in intensive care. This encourages the practice of surgical management of multiple rib fractures associated or not with a rib flap.