BIG T Trauma Series Ep. 18 – Rib Plating Update

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 16 October 2023

⏱️ 30 minutes

🔗️ Recording | iTunes | RSS

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Summary

Has the pendulum swung too far? Is it time to put the drill down?? Or, drill, baby, drill! While the number of rib plating cases has exploded the data supporting the practice is less-than-stellar. On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill bring you up to speed on rib plating.

If you haven’t already, we recommend you listen to Behind the Knife episode 298, published in May 2020. (https://behindtheknife.org/podcast/big-t-trauma-series-ep-10-rib-fractures/) This episode covers comprehensive management of rib fractures, including multimodal pain control, regional blocks, pulmonary toilet, BiPAP, etc.

REFERENCES:
GUIDELINES
EAST PMG Rib Plating (2017): https://www.east.org/education-resources/practice-management-guidelines/details/rib-fractures-open-reduction-and-internal-fixation-of-update-in-process
EAST PMG Rib Fracture Non-Surgical Management (2022): https://www.east.org/education-resources/practice-management-guidelines/details/nonsurgical-management-and-analgesia-strategies-for-older-adults-with-multiple-rib-fractures-a-systematic-review-metaanalysis
Chest Wall Injury Society Guidelines (2020): https://cwisociety.org/wp-content/uploads/2020/05/CWIS-SSRF-Guideline-01102020.pdf

FLAIL/UNSTABLE CHEST
Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries: A Randomized Clinical Trial, JAMA 2022: https://jamanetwork.com/journals/jamasurgery/fullarticle/2796556
Prospective randomized controlled trial of operative rib fixation in traumatic flail chest, JACS 2013: https://pubmed.ncbi.nlm.nih.gov/23415550/
Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status, Interact Cardiovasc Thoracic Surg 2005: https://pubmed.ncbi.nlm.nih.gov/17670487/
Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients, J Trauma 2002: https://pubmed.ncbi.nlm.nih.gov/11956391/
Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis, J Surg Research 2022: https://pubmed.ncbi.nlm.nih.gov/35390577/
Surgical versus nonsurgical interventions for flail chest, Cochrane Review 2015: https://pubmed.ncbi.nlm.nih.gov/26222250/

NON-FLAIL CHEST
Randomized Controlled Trial of Surgical Rib Fixation to Nonoperative Management in Severe Chest Wall Injury, Ann Surgery 2023: https://pubmed.ncbi.nlm.nih.gov/37317861/
Rib fixation in non-ventilator-dependent chest wall injuries: A prospective randomized trial, J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/35081599/
A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (NONFLAIL), J Trauma 2020: https://pubmed.ncbi.nlm.nih.gov/31804414/
Operative versus nonoperative treatment of multiple simple rib fractures: A systematic review and meta-analysis, Injury 2020: https://pubmed.ncbi.nlm.nih.gov/32650981/

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out the rest of the BIG T Trauma episodes here: https://behindtheknife.org/podcast-series/big-t-trauma/

Transcript

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0:00.0	Behind the Night, the surgery podcast, relevant and engaging content to sign to help you dominate
0:12.5	the day.
0:22.2	Welcome back to Big Tea Trauma on Behind the Night, today we have an update on Replayed
0:26.5	and this is Patrick Georgeoff, I'm joined by two of my former co-fells at the home of
0:30.7	Big Tea Trauma, the University of Texas, and Houston.
0:33.7	We have Dr. Teddy Puzio, who is currently faculty at UT and assistant program director
0:38.0	for the Acute Care Fellowship, and Dr. and Commander Jason Burrell, who is trauma medical
0:42.7	director of the U.S. Indo-Pacific, command welcome gentlemen.
0:46.8	Hey Patrick, thanks for having us back.
0:49.9	Before we go on, I think you have some exciting news that you need to share.
0:53.8	I, in fact, do, I'm very happy to announce my new position at Duke University, I'm thrilled
0:58.2	to be here, and truly excited to be working with such an amazing team.
1:02.2	Oh Patrick, as a former Tar Heal training, it really hurts my heart, you say that, but
1:07.4	I am back, you're going to get over it, Teddy, when the half of these swear to you.
1:11.4	Alright, so today we're going to talk about reading fractures and the latest data to help
1:15.7	us decide whether or not we should lay our pension.
1:18.8	This is a fairly deep dive into a pretty nuanced topic, and if you haven't already, we highly
1:23.2	recommend you take a listen to podcast episode 298, which was published in May of 2020.
1:28.8	If you go to behind the knife data work, you can search by topic or series.
1:33.4	And in a month or two, we expect to have a brand new cutting edge websites and apps, which
1:37.7	include both Android and iOS out and ready for use.
1:41.6	This will make accessing all types of BDK content even easier.
	...

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