title: An assessment of outcomes with intramedullary fixation of fractured ribs.
abstract: BACKGROUND
  Surgical management of fractured ribs with internal fixation is an increasingly accepted therapy. Concurrently, specific rib fixation prostheses are being developed which should improve results and minimise hardware and rib/splint construct failures. The Synthes titanium intramedullary splint lends itself to difficult to access areas such as posterior rib fractures and fractures under the scapula. We analyse a case series of patients in whom this rib fixation prosthesis has been used.
  
  
  METHODS
  Fifteen patients received 35 intramedullary splints. Follow up at 3 and 6 months was performed with three dimensional computed tomography scanning to assess for bone alignment, callus formation and healing, residual deformity, hardware failure or cut through. Computerized finite element analysis (FEA) was used to model forces acting on a posterior fracture with and without an intramedullary fixation splint in situ.
  
  
  RESULTS
  Complete healing (bony union) was noted in only 3 (9 %) of the fractures fixed with splints by 3 months. Partial healing (cartilaginous union) was noted in 28 of the 33 fractures (85 %), and non healing was noted in only 2 (6 %). In both those two patients, failure at the rib / splint interface was noted after both patients reported sneezing. No hardware failures were noted. By 6 months the fractures which had shown partial healing, had all completely healed. There were no late failures (between 3 and 6 months) of either hardware or rib/splint interfaces. FEA modelling identified sites of increased stress in the rib at the rib / splint interface and in a modelled intramedullary splint where it spans the fracture.
  
  
  CONCLUSIONS
  Further analysis of outcomes with intramedullary splints is warranted as well as further development of intramedullary rib fixation solutions.
authors: Cardiothoracic Surgery Department, the Alfred Hospital, 55 Commercial Rd, Prahran, 3181, Australia. s.marasco@alfred.org.au.|Department of Surgery, Monash University, Melbourne, VIC, Australia. s.marasco@alfred.org.au.
authors: Silvana
authors: S
authors: Marasco
authors: Cardiothoracic Surgery Department, the Alfred Hospital, 55 Commercial Rd, Prahran, 3181, Australia.
authors: Margaret
authors: M
authors: Quayle
authors: Cardiothoracic Surgery Department, the Alfred Hospital, 55 Commercial Rd, Prahran, 3181, Australia.
authors: Robyn
authors: R
authors: Summerhayes
authors: Faculty of Science, Monash University, Melbourne, VIC, Australia.
authors: Ilija D
authors: ID
authors: Šutalo
authors: Commonwealth Scientific and Industrial Research Organisation (CSIRO), Mathematics Informatics and Statistics, Melbourne, VIC, Australia.
authors: Petar
authors: P
authors: Liovic
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D020342:Finite Element Analysis; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D021621:Imaging, Three-Dimensional; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: FEA modelling; Intramedullary; Rib fixation; Rib fracture