title: The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure.
abstract: BACKGROUND
  Blunt chest injuries are usually combined with multiple rib fractures and severe lung contusions. This can occasionally induce acute respiratory failure and prolong ventilations. In order to reduce the periods of ventilator dependency, we propose a less invasive method of fixing multiple rib fractures.
  
  
  METHODS
  Since October 2009, we have developed a new method to fix fractured ribs caused by blunt trauma. Rib fixations were performed using 2.0- or 2.5-mm intramedullary titanium elastic nails (TEN), with the help of video-assisted thoracoscopic surgery (VATS) and minimal thoracic incisions. All the patients' demographics and postoperative data were collected.
  
  
  RESULTS
  From January 2010 to December 2012, a total of 65 patients presenting with multiple rib fractures resulting in acute respiratory failure were included in the study. Twelve patients received the new surgical fixation. Rib fixations were performed at an average of 4 days after trauma. Patients were successfully weaned off ventilators after an average of 3 days. The average length of stay in the hospital and the intensive care unit (ICU) was shorter for the patients with fixation than for nonsurgical patients. All twelve patients returned to normal daily activities and work.
  
  
  CONCLUSIONS
  In the reconstruction of an injured chest wall, the VATS with TENs fixation in multiple rib fractures is feasible. This method is also effective in decreasing the length of the surgical wound. Because the structure of the chest cage is protected, the period of mechanical ventilation is shortened and the length of stay in the hospital and the ICU can be reduced.
authors: Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.|Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan.
authors: Yih-Wen
authors: YW
authors: Tarng
authors: Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan.
authors: Yuan-Yuarn
authors: YY
authors: Liu
authors: Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan.
authors: Fong-Dee
authors: FD
authors: Huang
authors: Department of Emergency, Fooying University Hospital, Pingtung County, Taiwan.|Department of Medical Technology, Fooyin University, Kaohsiung City, Taiwan.|Department of Nursing, Tajen University, Yanpu Township, Pingtung County, Taiwan.
authors: Hsing-Lin
authors: HL
authors: Lin
authors: Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan. tcwu@csmu.edu.tw.|Division of Chest Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. tcwu@csmu.edu.tw.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan. tcwu@csmu.edu.tw.
authors: Tzu-Chin
authors: TC
authors: Wu
authors: Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan. chou2763e@yahoo.com.tw.|Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan. chou2763e@yahoo.com.tw.
authors: Yi-Pin
authors: YP
authors: Chou
mesh_terms: D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012253:Rib Fractures / Q000209:etiology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D014025:Titanium; D014193:Trauma Centers; D015300:Ventilator Weaning; D014949:Wounds, Nonpenetrating / Q000150:complications*
chemical_list: D014025:Titanium
keywords: Acute respiratory failure; Blunt chest trauma; Rib fracture; Surgical fixation; Titanium nail