1.
Caitlyn Ryan, Summer Research Intern
Andrew R. Doben, M.D.

2.
 Flail Chest and how it is treated
 Background information on rib
fractures
 Surgical Rib Fixation (SRF) and how it
is utilized at Baystate
 Study methods and
results/conclusions
 Future of SRF?

3.
• A flail chest occurs when a segment of the
thoracic cage is separated from the rest of the
chest wall.
• Result of a crushing chest injury
• Paradoxical respiration
http://medical-dictionary.thefreedictionary.com/flail+segment
This image shows the
paradoxical movements
of the flail segments

4.
 Major source of morbidity in the U.S.
 Significant advances in pain control, no
improvement in the outcomes
 Various reports beginning in the 1950s and
sporadic attempts through the mid 80’s
 The safety and efficiency of SRF remains
uncertain (especially in age ≥ 65 population)

5.
 11,807 Deaths from Thoracic Trauma
 Mortality was 22% for the elderly versus 10%
for the young
 The most common complication of rib
fractures is pneumonia
 Up to 60% patients do not return to full time
employment

6.
 Surgical Rib Fixation is a surgery that allows
surgeons to apply artificial support to fractured
ribs
 There are different methods of support that can
be used during SRF; these include Rib Loc,
Synthes Rib Matrix, and Intramedullary Nail
 Here at Baystate, the Synthes Rib Matrix is
utilized

7.
Ribs are realigned and
osteosynthes plates are
bent/cut to fit specific ribs.
The ribs are held together by
the osteosynthes plate, which
is screwed into the ribs.
Important for restoration of
the integrity of the chest wall:
• Plate apposition
• tissue mobilization
• shape formation

8.
Baystate Medical Center has created a
multidisciplinary team approach to the care of rib
fracture patients.
 This includes specific pain regimens,
multimodality target respiratory therapy, and
surgical intervention
 The study conducted here at Baystate focused
on the concept of age restrictions within the
SRF patient population

9.
 Patients with flail chest or severe rib fractures who
were admitted to a Level 1 Trauma Center for SRF
between July 2010 and June 2014 were evaluated
 Patients age ≥ 65 and age ≤ 64 were evaluated and
compared in the outcome variables:
1. Injury Severity Score
2. Total number of Fractures
3. Hospital Length of Stay
4. ICU LOS
5. Ventilator Days
6. Fractures Repaired

10.
 Utilized REDCap Database, which is a
secure, web-based application for building
and managing online databases
 Research Electronic Data Capture
 Also provides automated export
procedures for easy statistical analysis

11.
The median number of
ventilator days, ISS, ICU
LOS, and Hospital LOS were
similar in both groups,
signaling that there should
not be age restrictions on
surgical rib fixations.

12.
 This project is intended
to improve the care and
outcomes of patients
with rib fractures.
 Presentation at EAST
(Eastern Association for
Aurgical Trauma) at end
of January 2015
 Creation of a national
registry
http://www.swedish.org/about/blog/august-2012/rib-fractures-
essentials-of-management-treatment

13.
Thank you to Andrew Doben, M.D., who is the
primary researcher of this project
Thank you to Jeffry Nahmias, M.D., who made
this internship opportunity possible
Thank you to Jane Sicard and the Summer
Scholars for giving me the opportunity to present
my research here today

14.
1. Flail chest. (n.d.). Medterms. Retrieved July 21, 2014, from
http://www.medterms.com/script/main/art.asp?articlekey=3473
2. flail segment. (n.d.). TheFreeDictionary.com. Retrieved July 16, 2014, from http://medical-
dictionary.thefreedictionary.com/flail+segment(flail segment image/definition)
3. M.D., A. D. (Director) (2014, July 21). Surgical Management of Traumatic Rib Fractures.
Lecture conducted from , Springfield, MA.
4. Operative management of rib fractures in the setting of flail chest: a systematic review and
meta-analysis. (0001, January 18). Operative management of rib fractures in the setting of flail chest: a
systematic review and meta-analysis. Retrieved July 16, 2014
5. REDCap. (n.d.). REDCap. Retrieved August 4, 2014, from
https://collaborate.tuftsctsi.org/redcap/
6. SRF Abstract by Dr. Andrew Doben, M.D.
7. Swedish Medical Center Seattle and Issaquah. (n.d.). Swedish. Retrieved July 16, 2014, from
http://www.swedish.org/about/blog/august-2012/rib-fractures-essentials-of-management-
treatment
8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. (n.d.). AccessMedicine.
Retrieved July 16, 2014, from
http://accessmedicine.mhmedical.com/content.aspx?bookid=348§ionid=40381746&jumpsect
ionID=40408000&Resultclick=2
9. TRAUMA.ORG: Thoracic Trauma. (n.d.). TRAUMA.ORG: Thoracic Trauma. Retrieved July 16,
2014, from http://www.trauma.org/archive/thoracic/CHESTflail.html(flail chest definition)