Dr. Joe Forrester, director of Stanford Chest Wall Injury Center, and Acute Care Surgeon Dr. Jamie Tung discuss management of acute and chronic rib fractures.
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TRANSCRIPT
FORRESTER: Hello, My name is Dr. Joe Forrester and I am the medical director of the Stanford Chest Wall Injury center, here with Dr. Jamie Tung who is one of our acute care surgeons and fellow expert in chest wall injury.
TUNG: As leaders in the field of chest wall injury, we created this brief video to discuss the management of acute and chronic rib fractures. Rib fractures are common injuries – approximately 10% of people in the United States presenting to a hospital after trauma will have had a rib fracture. There is a good chance either you or someone you know has had a rib fracture.
FORRESTER: The pain from rib fractures comes from direct, mechanical injury to the intercostal nerve, which runs under the rib fracture. Repeated movement of the rib, every time someone breathes, causes aggravation and irritation of the nerve which can lead to the development of pneumonia, respiratory failure, and in severe cases require mechanical ventilatory support, or intubation.
TUNG: But there are opportunities to help stop this pain early before it leads to life-threatening complications or chronic pain.
TUNG: We treat the pain from rib fractures using many different techniques. We can use pain control given by mouth and by IV, blocks of the nerves, and for patients with severe chest wall injury, we can perform surgery to stabilize the ribs in place.
FORRESTER: Surgical stabilization of rib fractures, or SSRF, is a technique where we use a titanium plate and small screws to put the rib fractures back into their normal alignment and prevent them from moving and tugging on the intercostal nerve, which improves pain. Importantly, by performing this surgery early after injury, we can often reduce the acute pain associated with rib fractures, lower the risk of pneumonia, decrease the amount of opiate pain medication we prescribe, get people back to work earlier and help them do what they love to do faster.
TUNG: Additionally, for patients who require mechanical ventilatory support or ventilation, by performing SSRF early we can prevent ventilator-associated pneumonia, decrease the risk of needing a tracheostomy or surgical breathing tube, and liberate folks off the ventilator faster.
FORRESTER: Sometimes, after a rib is fractured and broken the rib fails to heal. This can result in popping, clicking, or chronic pain in the chest wall. This is called chronic non-union of a rib fracture. In some cases, we can also use SSRF to help treat the discomfort and pain associated with these fractures as well.
FORRESTER: We hope you have enjoyed this short video on rib fractures and their management. The Stanford Chest Wall Injury Center is a uniquely Stanford program striving to improve the care of patients with chest wall injury. Thank you so much.
