PAID EDITORIAL

Better Patient Outcomes Through Innovation in Chest Wall Injury Repair

Contributed by Peter A. Cole, MD

Respiratory failure, pneumonia and tracheotomies are common complications of severe chest wall trauma resulting from automotive, motorcycle and snow mobile accidents—but they don’t have to be. Thanks to innovations in the treatment of flail chest and fractured sternums, people can recover faster and with less pain. However, only a small fraction of indicated patients receive the surgery that could help because few specialists have the proper expertise. The orthopedic trauma team at Regions Hospital is working to elevate care for chest wall injury through continued research, and by creating awareness about ways to improve outcomes for these patients.

The role of surgical intervention in treating chest wall trauma

Surgical stabilization of rib fixation (SSRF) is a procedure that uses titanium plates and screws to stabilize the ribs and hold them in place while they heal. Without treatment, rib fractures may heal in a nonanatomic way, resulting in chest deformity, chronic pain and health comorbidities. Good candidates for SSRF are generally patients with multiple, consecutive, displaced fractures in ribs 3-10, especially when they are intubated, require respiratory support or have labored breathing because of pain. Findings from our experience and growing scientific evidence, show that SSRF is associated with shorter stays in the hospital and intensive care unit, lower pneumonia rates and a reduced need for a ventilator or tracheostomy. Some studies show a decrease in mortality, as well as better long-term outcomes with fewer chronic symptoms. Improvements are optimized when surgical intervention happens within the first three days—and may be even better if treated within the first 24 hours.

Bridging the gap in chest wall injury repair

Despite these impressive results, chest wall trauma is currently undertreated. It is estimated that less than 10% of indicated patients in North America receive SSRF, according to the Chest Wall Injury Society. A significant obstacle is the number of surgeons with expertise in chest wall repair. It’s still uncommon to find SSRF specialists even in many Level 1 Trauma Centers — and especially rare to find more than a couple at a single location. That’s not enough to ensure that patients get expeditious care for their injuries. After all, these types of injuries don’t take a day off. The orthopedic trauma team at Regions Hospital takes both a departmental and interdisciplinary approach to treating chest wall trauma with our general trauma surgery colleagues. By having an advanced team of six surgeons who treat rib fractures, flail chest trauma and chronic injury-related complications, we’re available to provide optimal treatment every day of the year.

Promising trends in chest wall repair

While there’s still work to be done to make this surgery accessible to patients who need it, we’re seeing progress. • More success stories — 10 years ago, our team did 5-10 operations per year. Now we treat a patient almost every week. • New tools—Thanks to instrumentation and implants specifically designed for different anatomical locations, the procedure is now an option for more patients. • Expanded training —More doctors are gaining expertise in SSRF, including about a dozen fellows trained at Regions Hospital, who are now practicing at centers across the country.

Partnering with the medical community to advance patient care

Working alongside the other members of the Chest Wall Injury Society, the team at Regions Hospital is advancing innovation in the treatment of chest wall injury. We’re also proud to partner with doctors across the Twin Cities metro area to improve outcomes for patients with chest wall injury. If you identify patients who have chest trauma with contiguous broken ribs, we can help. To learn more about HealthPartners and how we support ortho trauma, visit www.healthpartners.com/orthotrauma.

Peter A. Cole, MD is the Department Chair of Orthopedic Surgery at Regions Hospital. He is a recognized thought-leader, educator and researcher on numerous advanced trauma topics, including management of flail chest and rib malunions. He is the senior author of numerous publications and chapters about chest wall trauma.

Innovation in chest wall injury repair

Thanks to innovations in the treatment of flail chest and fractured sternums, we’re able to improve outcomes for patients, helping them recover faster and with less pain.

Bridging the gap in chest wall injury repair

We take a departmental approach to treating chest wall trauma. By having an advanced team of six surgeons who treat chest wall injury, we’re available to provide optimal treatment every day of the year.

This approach is working and we’re seeing promising trends:

• More success stories – 10 years ago, our team did 5-10 operations per year.

Now we treat a new patient almost every week.

• New tools – Thanks to instrumentation and implants specifically designed for different anatomical locations, chest wall repair is now an option for more patients.

• Expanded training – More doctors are gaining expertise in SSRF, including several fellows trained at Regions Hospital.

For more information, visit healthpartners.com/orthotrauma or call 651-254-8300.

640 Jackson St. St. Paul, MN 55101