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Multiple Rib Fractures

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Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.
Marasco SF, Davies AR, Cooper J, Varma D, Bennett V, Nevill R, Lee G, Bailey M, Fitzgerald M.
J Am Coll Surg. 2013 May;216(5):924-32.

Rationale for inclusion:  Prospective, randomized trial comparing operative rib fixation with mechanical ventilation  for flail chest injuries.  

Citations - 120 (as of July 2017)

Rib fracture repair: indications, technical issues, and future directions.
Nirula R, Diaz JJ Jr, Trunkey DD, Mayberry JC.
World J Surg. 2009 Jan;33(1):14-22.

Rationale for inclusion:  A widely cited and comprehensive review regarding operative rib fixation.

Citations - 247 (as of July 2017)

Epidural analgesia improves outcome after multiple rib fractures.
Bulger EM, Edwards T, Klotz P, Jurkovich GJ.
Surgery. 2004 Aug;136(2):426-30.

Rationale for inclusion: Prospective, randomized trial compared epidural analgesia versus IV opioids for rib fractures.  The use of epidural analgesia improved mechanical ventilation duration and pneumonia rates.

Citations - 205 (as of July 2017)

A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management.
Sirmali M, Türüt H, Topçu S, Gülhan E, Yazici U, Kaya S, Tastepe I.
Eur J Cardiothorac Surg. 2003 Jul;24(1):133-8.

Rationale for inclusion: Large retrospective study correlating age and number of rib fractures with outcomes.

Citations - 313 (as of July 2017)

Morbidity from rib fractures increases after age 45.
Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA.
J Am Coll Surg. 2003 Apr;196(4):549-55.

Rationale for inclusion: Retrospective cohort study of 171 patients with rib fractures that were compared with respect to number of rib fractures and age.

Citations - 189 (as of July 2017)

Elderly trauma patients with rib fractures are at greater risk of death and pneumonia.
Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, Lemaire J, Martin M.
J Trauma. 2003 Mar;54(3):478-85.

Rationale for inclusion: Mortality was greater (19%) in patients >65 years with multiple rib fractures.

Citations - 230 (as of July 2017)

Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.
Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S.
J Trauma. 2002 Apr;52(4):727-32; discussion 732.

Rationale for inclusion: Surgical rib fixation was compared with internal pneumatic stabilization in this prospective, randomized trial.

Citations - 377 (as of July 2017)

The morbidity and mortality of rib fractures.
Ziegler DW, Agarwal NN.
J Trauma. 1994 Dec;37(6):975-9.

Rationale for inclusion: An initial study documenting the morbidity and mortality associated with rib fractures.

Citations - 332 (as of July 2017)

Management of flail chest without mechanical ventilation.
Trinkle JK, Richardson JD, Franz JL, Grover FL, Arom KV, Holmstrom FM.
Ann Thorac Surg. 1975 Apr;19(4):355-63.

Rationale for inclusion: Challenged convention by comparing patient with flail chests who underwent intubation and mechanical ventilation versus treatment of the underlying pulmonary contusion alone.

Citations - 260 (as of July 2017)

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