title: Rib plating of acute and sub-acute non-union rib fractures in an adult with cystic fibrosis: a case report.
abstract: BACKGROUND
  Rib fractures associated with osteoporosis have been reported to occur ten times more frequently in adults with cystic fibrosis. Fractures cause chest pain, and interfere with cough and sputum clearance leading to worsened lung function and acute exacerbations which are the two main contributors to early mortality in cystic fibrosis. Usual treatment involves analgesics and time for healing; however considerable pain and disability result due to constant re-injury from chronic repetitive cough. Recently, surgical plating of rib fractures has become commonplace in treating acute, traumatic chest injuries. We describe here successful surgical plating in a White cystic fibrosis patient with multiple, non-traumatic rib fractures.
  
  
  METHODS
  A-37-year old White male with cystic fibrosis was readmitted to Intermountain Medical Center for a pulmonary exacerbation. He had developed localized rib pain while coughing 2 months earlier, with worsening just prior to hospital admission in conjunction with a "pop" in the same location while bending over. A chest computerized tomography scan at admission demonstrated an acute 5th rib fracture and chronic non-united 6th and 7th right rib fractures. An epidural catheter was placed both for analgesia and to make secretion clearance possible in preparation for the surgery performed 2 days later. Under general anesthesia, he had open reduction and internal fixation of the right 5th, 6th and 7th rib fractures with a Synthes Matrix rib set. After several days of increased oxygen requirements, fever, fluid retention, and borderline vital signs, he stabilized. Numerical pain rating scores from his ribs were lower post-operatively and he was able to tolerate chest physical therapy and vigorous coughing.
  
  
  CONCLUSIONS
  In our case report, rib plating with bone grafting improved rib pain and allowed healing of the fractures and recovery, although the immediate post-op period required close attention and care. We believe repair may be of benefit in selected cystic fibrosis patients, such as our patient who had suffered multiple rib fractures that were healing poorly.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, Utah 84107, USA. Nathan.Dean@imail.org.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Dean
authors.forename: Don H
authors.initials: DH
authors.lastname: Van Boerum
authors.forename: Theodore G
authors.initials: TG
authors.lastname: Liou
mesh_terms: D000208:Acute Disease; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001860:Bone Plates; D003371:Cough / Q000175:diagnosis / Q000209:etiology*; D003550:Cystic Fibrosis / Q000150:complications* / Q000175:diagnosis; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D012253:Rib Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000700:Analgesics