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rib instability

David B Seder, Christine Lord, David J Gagnon
The postresuscitation period after a cardiac arrest is characterized by a wide range of physiological derangements. Variations between patients include preexisting medical problems, the underlying cause of the cardiac arrest, presence or absence of hemodynamic and circulatory instability, severity of the ischemia-reperfusion injury, and resuscitation-related injuries such as pulmonary aspiration and rib or sternal fractures. Although protocols can be applied to many elements of postresuscitation care, the widely disparate clinical condition of cardiac arrest survivors requires an individualized approach that stratifies patients according to their clinical profile and targets specific treatments to patients most likely to benefit...
November 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Khaled M Mohamed, Michael M Murphy, Heather E Lawson, Ted Klemetti
Design of rib support systems in U.S. coal mines is based primarily on local practices and experience. A better understanding of current rib support practices in U.S. coal mines is crucial for developing a sound engineering rib support design tool. The objective of this paper is to analyze the current practices of rib control in U.S. coal mines. Twenty underground coal mines were studied representing various coal basins, coal seams, geology, loading conditions, and rib control strategies. The key findings are: (1) any rib design guideline or tool should take into account external rib support as well as internal bolting; (2) rib bolts on their own cannot contain rib spall, especially in soft ribs subjected to significant load-external rib control devices such as mesh are required in such cases to contain rib sloughing; (3) the majority of the studied mines follow the overburden depth and entry height thresholds recommended by the Program Information Bulletin 11-29 issued by the Mine Safety and Health Administration; (4) potential rib instability occurred when certain geological features prevailed-these include draw slate and/or bone coal near the rib/roof line, claystone partings, and soft coal bench overlain by rock strata; (5) 47% of the studied rib spall was classified as blocky-this could indicate a high potential of rib hazards; and (6) rib injury rates of the studied mines for the last three years emphasize the need for more rib control management for mines operating at overburden depths between 152...
January 2016: International Journal of Mining Science and Technology
Christian Liebsch, Nicolas Graf, Hans-Joachim Wilke
PURPOSE: The influence of the anterior rib cage on the stability of the human thoracic spine is not completely known. One of the most common surgical interventions on the anterior rib cage is the longitudinal median sternotomy and its fixation by wire cerclage. Therefore, the purpose of this in vitro study was to examine, if wire cerclage can restore the stability of the human thoracic spine after longitudinal median sternotomy. METHODS: Six fresh frozen human thoracic spine specimens (C7-L1, 56 years in average, range 50-65), including the intact rib cage without intercostal muscles, were tested in a spinal loading simulator and monitored with an optical motion tracking system...
September 17, 2016: European Spine Journal
John K Hillier, Ioannis A Kougioumtzoglou, Chris R Stokes, Michael J Smith, Chris D Clark, Matteo S Spagnolo
Sediments beneath modern ice sheets exert a key control on their flow, but are largely inaccessible except through geophysics or boreholes. In contrast, palaeo-ice sheet beds are accessible, and typically characterised by numerous bedforms. However, the interaction between bedforms and ice flow is poorly constrained and it is not clear how bedform sizes might reflect ice flow conditions. To better understand this link we present a first exploration of a variety of statistical models to explain the size distribution of some common subglacial bedforms (i...
2016: PloS One
Umesh Srikantha, Kiran S Khanapure, Aniruddha T Jagannatha, Krishna C Joshi, Ravi G Varma, Alangar S Hegde
OBJECTIVE Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion. MATERIALS Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases...
December 2016: Journal of Neurosurgery. Spine
S Schulz-Drost, S Grupp, M Pachowsky, P Oppel, S Krinner, A Mauerer, F F Hennig, A Langenbach
PURPOSE: Stabilizing techniques of flail chest injuries usually need wide approaches to the chest wall. Three main regions need to be considered when stabilizing the rib cage: median-anterior with dissection of pectoral muscle; lateral-axillary with dissection of musculi (mm) serratus, externus abdominis; posterior inter spinoscapular with division of mm rhomboidei, trapezius and latissimus dorsi. Severe morbidity due to these invasive approaches needs to be considered. This study discusses possibilities for minimized approaches to the shown regions...
March 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Gerard P Slobogean, Hyunchul Kim, Joseph P Russell, David J Stockton, Adam H Hsieh, Robert V O'Toole
BACKGROUND: Multiple rib fractures cause significant pain and potential for chest wall instability. Despite an emerging trend of surgical management of flail chest injuries, there are no studies examining the effect of rib fracture fixation on respiratory function. OBJECTIVES: Using a novel full thorax human cadaveric breathing model, we sought to explore the effect of flail chest injury and subsequent rib fracture fixation on respiratory outcomes. PATIENTS AND METHODS: We used five fresh human cadavers to generate negative breathing models in the left thorax to mimic physiologic respiration...
December 2015: Archives of Trauma Research
Marco Castori, Francesca Servadei, Luigi Laino, Giulia Pascolini, Romano Fabbri, Anna Elisabetta Cifani, Giovanna Scassellati Sforzolini, Evelina Silvestri, Paola Grammatico
Autosomal aneuploidies associate with multiple minor skeletal defects, which, in fetuses, are best appreciated post-mortem after specific anatomic preparations. The present study was aimed to define patterns of skeletal anomalies in autosomal aneuploidies at standard radiology in second trimester fetuses by comparing findings in and among genotypes and gestational ages. Aneuploid fetuses were selected for availability of radiographs of various axial and non-axial structures, mainly homeotic transformations, vertebral clefts, vertebral segmentation and ossification defects, absent/hypoplastic nasal bone, premature talar calcifications, and selected appendicular anomalies...
March 2016: American Journal of Medical Genetics. Part A
Martin Kaláb, Jan Karkoška, Milan Kamínek, Eva Matějková, Zuzana Slaměníková, Aleš Klváček, Petr Šantavý
OBJECTIVES: Deep sternal wound infection poses a serious problem in cardiac surgery, with an up to 40% risk of mortality. Massive loss of sternum bone tissue and adjacent ribs results in major chest wall instability causing respiratory insufficiency and defects of soft tissue healing. Proposals for managing the situation have been published but the complexity of the issue precludes unequivocal resolution. Capitalizing on orthopaedic experience, we used allogeneic bone graft of sternum as a viable option...
March 2016: Interactive Cardiovascular and Thoracic Surgery
B Stoica, S Paun, I Tanase, I Negoi, A Runcanu, M Beuran
INTRODUCTION: Despite the high frequency of thoracic injuries secondary to traffic related accidents, the blunt cardiac valve rupture is extremely rare. METHOD: Case report and review of the literature using PubMed/MEDLINE and EMBASE databases. RESULT: A 38 year old female patient, victim of car accident was admitted. On primary survey the patient was conscious, cooperative and hemodynamic and respiratory stable. On secondary survey was found a bilateral open leg fracture and a seat belt sign...
September 2015: Chirurgia
F Vyhnánek, D Jirava, M Očadlík, D Škrabalová
PURPOSE OF THE STUDY: Multiple rib fractures with segmental chest wall instability are caused by high-energy chest trauma and are associated with significant morbidity and mortality. Flail chest injuries are mostly combined with lung injury (contusion, rupture, laceration) and subsequent pneumothorax or haemothorax. Early mechanical ventilation with internal pneumatic splinting is a conservative treatment for flail chest in patients with respiratory insufficiency. The surgical stabilisation of a flail chest is an effective method of treatment and is beneficial for selected patients...
2015: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Catherine E Ferland, Zeeshan M Sardar, Fahad Abduljabbar, Vincent Arlet, Jean A Ouellet
BACKGROUND CONTEXT: Sacral agenesis is a rare congenital disorder that may have spinopelvic instability due to sacroiliac joint malformation. Surgical indication in patients with sacral agenesis is to improve their sitting balance and protect the visceral organs. Achieving solid arthrodesis across this congenital malformation is challenging and prone to non-union. PURPOSE: The purpose of this study was to describe a novel surgical technique with vascularized ribs for management of sacral agenesis and complex spinopelvic dissociation...
December 1, 2015: Spine Journal: Official Journal of the North American Spine Society
Giuseppe Talamonti, Giuseppe D'Aliberti, Alberto Debernardi
PURPOSE: The aim of this paper is to discuss the problems of craniocervical instability and craniocervical fusion in infancy. Despite the relative frequency of carniovertebral joint malformations, actual instability is quite rare in infancy. METHODS: An infant 8 months of age presented with tetraparesis and sleep apnea due to a complex malformation of her craniovertebral joint. An initial attempt at conservative treatment using a rigid neck collar failed, so the patient was surgically managed by the onlay placement of two autologous rib grafts...
April 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Haitang Yang, Jicheng Tantai, Heng Zhao
OBJECTIVES: To present our experience of reconstructing wide defects with porously titanium mesh after radical resection of malignant chest wall tumors. METHODS: A retrospective review of surgical reconstruction for large chest wall resections with titanium mesh was conducted from January 2009 to August 2014 in Shanghai Chest Hospital. RESULTS: A total of 27 patients underwent major chest wall reconstructions with titanium mesh, following oncological resections...
July 2015: Journal of Thoracic Disease
Tomasz Darocha, Sylweriusz Kosiński, Anna Jarosz, Rafal Drwila
The use of extracorporeal membrane oxygenation is a new approach to rewarming patients with severe hypothermia and hemodynamic instability. There are, however, many questions regarding qualification for this technique in case of suspected or confirmed trauma.A male with confirmed accidental hypothermia (25°C) and after successful cardiopulmonary resuscitation from in-hospital cardiac arrest was subjected to a protocol of extracorporeal rewarming from profound hypothermia. Because of unclear history, a full trauma computed tomography was performed that showed pericerebral hematoma and signs of previously undergone right craniotomy, multiple right-sided rib fractures and the presence of intraperitoneal fluid...
July 2015: Medicine (Baltimore)
Andrés Jiménez-Quijano, Juan Carlos Varón-Cotés, Luis Gerardo García-Herreros-Hellal, Beatriz Espinosa-Moya, Oscar Rivero-Rapalino, Michelle Salazar-Marulanda
BACKGROUND: Fractures of the chest wall include sternum and rib fractures. Traditionally they are managed conservatively due to the anatomy of the rib cage that allows most of them to remain stable and to form a callus that unites the fractured segments. In spite of this management, some patients present with chronic pain or instability of the wall which makes them require some type of fixation. The present article performs a literature review based on 4 cases. CLINICAL CASES: The first case was a 61 year-old man with blunt chest trauma, with a great deformity of the chest wall associated with subcutaneous emphysema, and pneumothorax...
July 2015: Cirugia y Cirujanos
Claudia Kruger, Claudia Kappen
OBJECTIVE: Homeobox genes of the Hox class are required for proper patterning of skeletal elements and play a role in cartilage differentiation. In transgenic mice with overexpression of Hoxc8 and Hoxd4 during cartilage development, the authors observed severe defects, namely, physical instability of cartilage, accumulation of immature chondrocytes, and decreased maturation to hypertrophy. To define the molecular basis underlying these defects, the authors performed gene expression profiling using the Affymetrix microarray platform...
July 2010: Cartilage
Andrew T Healy, Prasath Mageswaran, Daniel Lubelski, Benjamin P Rosenbaum, Virgilio Matheus, Edward C Benzel, Thomas E Mroz
OBJECT The degenerative process of the spinal column results in instability followed by a progressive loss of segmental motion. Segmental degeneration is associated with intervertebral disc and facet changes, which can be quantified. Correlating this degeneration with clinical segmental motion has not been investigated in the thoracic spine. The authors sought to determine if imaging-determined degeneration would correlate with native range of motion (ROM) or the change in ROM after decompressive procedures, potentially guiding clinical decision making in the setting of spine trauma or following decompressive procedures in the thoracic spine...
August 2015: Journal of Neurosurgery. Spine
J Šafránek, V
PURPOSE OF THE STUDY: Sternal fractures occur most frequently in vehicle accidents, then due to falls from a height and by other blunt chest trauma. Most of these injuries are simple, non-displaced fractures only rarely requiring surgical management. Based on a retrospective analysis, the authors present their experience with the treatment of sternal fractures, emphasizing the use of osteosynthesis. MATERIAL AND METHODS: A group of 293 patients treated for fresh sternal fractures in the period from 2004 to 2013 were evaluated...
2015: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Loutfi S Aboussouan
Sleep-disordered breathing in neuromuscular diseases is due to an exaggerated reduction in lung volumes during supine sleep, a compromised physiologic adaptation to sleep, and specific features of the diseases that may promote upper airway collapse or heart failure. The normal decrease in the rib cage contribution to the tidal volume during phasic REM sleep becomes a critical vulnerability, resulting in saw-tooth oxygen desaturation possibly representing the earliest manifestation of respiratory muscle weakness...
May 1, 2015: American Journal of Respiratory and Critical Care Medicine
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