Name of the Procedure:

Open Treatment of Rib Fracture(s) with Internal Fixation, including Thoracoscopic Visualization when performed, Unilateral; 4-6 Ribs
Common Name: Rib Fracture Surgery

Summary

This procedure involves surgically fixing broken ribs using internal fixation devices, with the aid of a thoracoscope (a special instrument to view inside the chest). It is performed on one side of the chest and typically addresses fractures in 4-6 ribs.

Purpose

This surgery aims to stabilize multiple broken ribs, alleviate pain, and allow for better breathing and quicker recovery. It is typically performed when non-surgical treatments are ineffective.

Indications

• Severe rib fractures causing instability in the chest wall (flail chest)
• Persistent pain despite conservative treatment
• Difficulty breathing due to rib fractures
• Displaced rib fractures
• Multiple rib fractures (4-6 ribs on one side)

Preparation

• Fasting for 6-8 hours prior to surgery
• Adjusting any regular medications as advised by the doctor
• Pre-op imaging (X-rays, CT scans) to assess the extent of the fractures
• Blood tests and general health evaluation

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incision: An incision is made in the chest over the fractured ribs.
3. Exposure: The muscles and tissues are carefully separated to expose the broken ribs.
4. Thoracoscopic Visualization: A thoracoscope may be used for a clear view of the chest cavity.
5. Internal Fixation: Metal plates, screws, or other fixation devices are attached to the broken ribs to stabilize them.
6. Closure: The incision is closed with sutures, and a drain may be placed to remove any fluid buildup.
7. Recovery: The patient is monitored as they wake up from anesthesia.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic or thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Scrub technologists

Risks and Complications

• Infection
• Bleeding
• Reaction to anesthesia
• Damage to surrounding organs or tissues
• Hardware irritation or failure
• Persistent pain
• Pneumothorax (collapsed lung)

Benefits

• Stabilized rib fractures
• Reduced pain
• Improved ability to breathe
• Shorter recovery time compared to non-surgical treatment for severe fractures

Recovery

• Hospital stay of 2-5 days
• Pain management with prescribed medications
• Breathing exercises and physical therapy
• Restrictions on heavy lifting and strenuous activities
• Follow-up appointments to monitor healing and hardware integrity
• Complete recovery typically takes 6-8 weeks

Alternatives

• Conservative management with pain medications, rest, and physical therapy
• External fixation
• Pros:
  • Non-invasive options may avoid surgical risks.
  • Suitable for less severe fractures.
  • Cons:
  • Longer recovery time.
  • Persistent pain or difficulty breathing may be unresolved.

Patient Experience

• During the Procedure: Under anesthesia, so the patient will be unconscious and feel no pain.
• After the Procedure: Pain at the incision site, managed with medications. Temporary discomfort from chest tubes and hardware. Gradual improvement in pain and mobility with ongoing care.

Pain and discomfort can be managed with medication, and patients are encouraged to follow breathing exercises to facilitate lung function and decrease the risk of pneumonia.