OP-Journal
DOI: 10.1055/a-2370-6869
Fachwissen

Indikationen, OP-Zeitpunkt und Technik der operativen Stabilisierung beim Thoraxtrauma

Indications, Timing and Technique for Surgical Stabilisation of Thoracic Trauma
Michael D. Hülskamp
,
Oliver Riesenbeck
,
Michael J. Raschke

Rippenserienfrakturen und Flail-Segmente (Stückfrakturen von Rippen mit paradoxem Atemmuster) können zu mechanischer respiratorischer Insuffizienz führen. Dies kann durch chirurgische Stabilisierung von Rippenfrakturen (SSRF) verhindert werden. In diesem narrativen Review werden morphologische und physiologische Kriterien zur Indikationsstellung der SSRF, Besonderheiten einzelner Patientengruppen sowie Techniken der SSRF betrachtet.



Publikationsverlauf

Artikel online veröffentlicht:
14. Mai 2025

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  • Literatur

  • 1 Majercik S, Pieracci FM. Chest Wall Trauma. Thorac Surg Clin 2017; 27: 113-121
  • 2 Peek J, Beks RB, Hietbrink F. et al. Epidemiology and outcome of rib fractures: a nationwide study in the Netherlands. Eur J Trauma Emerg Surg 2022; 48: 265-271
  • 3 Franssen AJPM, Daemen JHT, Luyten JA. et al. Treatment of traumatic rib fractures: an overview of current evidence and future perspectives. J Thorac Dis 2024; 16: 5399-5408
  • 4 Bemelman M, Poeze M, Blokhuis TJ. et al. Historic overview of treatment techniques for rib fractures and flail chest. Eur Trauma Emerg Surg 2010; 36: 407-415
  • 5 Jones EK, Ninkovic I, Bahr M. et al. A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures. J Trauma Acute Care Surg 2023; 95: 161-171
  • 6 Sermonesi G, Bertelli R, Pieracci FM. et al. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper. World J Emerg Surg 2024; 19: 33
  • 7 Delaplain PT, Schubl SD, Pieracci FM. et al. Chest Wall Injury Society Guideline for SSRF Indications, Contraindications and Timing. 2020 Zugriff am 22. November 2024 unter: https://cwisociety.org/wp-content/uploads/2020/05/CWIS-SSRF-Guideline-01102020.pdf
  • 8 Marasco SF, Davies AR, Cooper J. et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg 2013; 216: 924-932
  • 9 Liu T, Liu P, Chen J. et al. A Randomized Controlled Trial of Surgical Rib Fixation in Polytrauma Patients With Flail Chest. J Surg Res 2019; 242: 223-230
  • 10 Granetzny A, El-Aal MA, Emam ER. et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg 2005; 4: 583-587
  • 11 Tanaka H, Yukioka T, Yamaguti Y. et al. Surgical Stabilization of Internal Pneumatic Stabilization? A Prospective Randomized Study of Management of Severe Flail Chest Patients. J Trauma 2002; 52: 727-732
  • 12 Cataneo AJM, Cataneo DC, de Oliveira FH. et al. Surgical versus nonsurgical interventions for flail chest. Cochrane Database Syst Rev 2015; 2015: CD009919
  • 13 Sawyer E, Wullschleger M, Muller N. et al. Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis. J Surg Res 2022; 276: 221-234
  • 14 Beks RB, Peek J, de Jong MB. et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg 2019; 45: 631-644
  • 15 Long R, Tian J, Wu S. et al. Clinical efficacy of surgical versus conservative treatment for multiple rib fractures: A meta-analysis of randomized controlled trials. Int J Surg 2020; 83: 79-88
  • 16 Craxford S, Owyang D, Marson B. et al. Surgical management of rib fractures after blunt trauma: a systematic review and meta-analysis of randomised controlled trials. Ann R Coll Surg Engl 2022; 104: 249-256
  • 17 Pieracci FM, Leasia K, Bauman Z. et al. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg 2020; 88: 249-257
  • 18 Xiao X, Zhang S, Yang J. et al. Surgical fixation of rib fractures decreases intensive care length of stay in flail chest patients. Ann Transl Med 2020; 8: 216-216
  • 19 Pieracci FM, Lin Y, Rodil M. et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg 2016; 80: 187-194
  • 20 Prins JTH, Van Lieshout EMM, Ali-Osman F. et al. Outcome after surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures and moderate to severe traumatic brain injury (CWIS-TBI). J Trauma Acute Care Surg 2021; 90: 492-500
  • 21 Lagazzi E, de Roulet A, Proaño-Zamudio JA. et al. Is severe traumatic brain injury no longer a contraindication for surgical stabilization of rib fractures in patients with multiple rib fractures? A propensity-matched analysis. J Trauma Acute Care Surg 2023; 94: 823-830
  • 22 Prins JTH, Van Lieshout EMM, Ali-Osman F. et al. Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury. Eur J Trauma Emerg Surg 2022; 48: 3327-3338
  • 23 Van Wijck SFM, Pieracci FM, Smith EF. et al. Rib fixation in patients with severe rib fractures and pulmonary contusions: Is it safe?. J Trauma Acute Care Surg 2022; 93: 721-726
  • 24 Jiang Y, Wang X, Teng L. et al. Comparison of the effectiveness of surgical versus nonsurgical treatment for multiple rib fractures accompanied with pulmonary contusion. Ann Thorac Cardiovasc Surg 2019; 25: 185-191
  • 25 Polycarpou A, Kim BD. Pediatric surgical rib fixation: A collected case series of a rare entity. J Trauma Acute Care Surg 2021; 91: 947-950
  • 26 Hoepelman RJ, Beeres FJP, Heng M. et al. Rib fractures in the elderly population: a systematic review. Arch Orthop Trauma Surg 2023; 143: 887-893
  • 27 Zhang D, Jiao C, Xi S. et al. Evaluation of surgical outcomes in elderly patients with rib fractures: A single-centre propensity score matching study. Front Surg 2023; 10: 1-9
  • 28 Jensen S, Sanderfer VC, Porter K. et al. Surgical stabilization of rib fractures in the geriatric trauma population is associated with equivalent outcomes to a younger cohort: A propensity matched analysis. Injury 2024; 55: 111593
  • 29 Prins JTH, Van Lieshout EMM, Eriksson EA. et al. Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: An international, retrospective matched case-control study. J Trauma Acute Care Surg 2022; 93: 727-735
  • 30 DeVoe WB, Abourezk M, Goslin BJ. et al. Surgical stabilization of severe chest wall injury following cardiopulmonary resuscitation. J Trauma Acute Care Surg 2022; 92: 98-102
  • 31 Forrester JD, Bauman ZM, Cole PA. et al. Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma. J Trauma Acute Care Surg 2023; 95: 943-950
  • 32 Pieracci FM, Coleman J, Ali-Osman F. et al. A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures. Journal of Trauma and Acute Care Surgery 2018; 84: 1-10
  • 33 Forrester JD, Sarani B, Forssten MP. et al. Time to surgical stabilization of rib fractures: does it impact outcomes?. Trauma Surg Acute Care Open 2024; 9: 1-5
  • 34 Becker L, Schulz-Drost S, Spering C. et al. Impact of Time of Surgery on the Outcome after Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma—A Matched-Pairs Analysis of the German Trauma Registry. Front Surg 2022; 9: 1-7
  • 35 Becker L, Schulz-Drost S, Spering C. et al. Effect of surgical stabilization of rib fractures in polytrauma: an analysis of the TraumaRegister DGU. Eur J Trauma Emerg Surg 2022; 48: 2773-2781
  • 36 Prins JTH, Van Wijck SFM, Leeflang SA. et al. Biomechanical characteristics of rib fracture fixation systems. Clin Biomech (Bristol) 2023; 102: 105870
  • 37 Bottlang M, Walleser S, Noll M. et al. Biomechanical rationale and evaluation of an implant system for rib fracture fixation. Eur J Trauma Emerg Surg 2010; 36: 417-426
  • 38 Tay-Lasso E, Alaniz L, Grant W. et al. Prospective single-center paradigm shift of surgical stabilization of rib fractures with decreased length of stay and operative time with an intrathoracic approach. J Trauma Acute Care Surg 2023; 94: 567-572
  • 39 Tichenor M, Reparaz LB, Watson C. et al. Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique. Trauma Surg Acute Care Open 2023; 8: e001201
  • 40 Choi J, Kaghazchi A, Sun B. et al. Systematic Review and Meta-Analysis of Hardware Failure in Surgical Stabilization of Rib Fractures: Who, What, When, Where, and Why?. J Surg Res 2021; 268: 190-198