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Year : 2019  |  Volume : 4  |  Issue : 1  |  Page : 1-2

Necessity is the mother of invention: Rib fixation with pediatric ankle plates and screws after successful thoracoabdominal damage control surgery

Editor-In-Chief, The Journal of Cardiothoracic Trauma, Gothenburg, Sweden

Date of Web Publication30-Dec-2019

Correspondence Address:
Moheb A Rashid
Editor-In-Chief, The Journal of Cardiothoracic Trauma, Gothenburg
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jctt.jctt_20_19

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How to cite this article:
Rashid MA. Necessity is the mother of invention: Rib fixation with pediatric ankle plates and screws after successful thoracoabdominal damage control surgery. J Cardiothorac Trauma 2019;4:1-2

How to cite this URL:
Rashid MA. Necessity is the mother of invention: Rib fixation with pediatric ankle plates and screws after successful thoracoabdominal damage control surgery. J Cardiothorac Trauma [serial online] 2019 [cited 2023 Jun 1];4:1-2. Available from: https://www.jctt.org/text.asp?2019/4/1/1/274207

Yes, it is truly said “necessity is the mother of invention.” This proverb is well reflected in this unique case. Almost a decade ago, while I was the attending surgeon on call, in Lillehammer Hospital, Norway, where we received a 57-year old multitraumatized man after falling from a huge horse (crushed between his horse and a stone). He fell first on his left side, and this has been repeated a few minutes later with transient fainting. He was transported to our hospital with a helicopter, stable in all vital signs. Primary survey revealed, body temperature at 34°, lactate 9, and trauma room chest X-ray showed massive left-sided hemothorax. Hence, he was already in the deadly triad of bleeding, hypothermia, and acidosis. A chest tube was inserted in the trauma bay, and over 1000 ml blood was drained immediately. The patient collapsed hemodynamically immediately after the primary survey. He was taken directly to the operation room (OR) for a resuscitative thoracotomy and laparotomy. Massive damage control surgery was performed both in the chest and abdomen. Severe bleeding from several intercostal arteries was stopped. Splenectomy of a damaged “mashed” spleen was done. Quick ligations of many other vessels in the chest and abdomen were performed. The thoracoabdominal damage control operations were done in <1 h with ten procedures performed including Mattox maneuver. The patient was sent to the intensive care unit (ICU) for physiological corrections. Few hours later, he was still in the deadly triad with no progress with bleeding from the tubes and wounds. The patient was taken back to the OR for exploration without finding any major bleeders, and we found just oozing everywhere. Quick closure of the chest and abdomen was done, and the patient was sent back to the ICU. Fortunately, he became more stable, and the hypothermia and acidosis were corrected, and the bleeding from the tubes and the wounds was minimal. The patient was taken to the OR for definitive surgery after taking a whole-body computed tomography where he was damaged in all his 12 ribs on the left side with massive damage of the wall that was flailing. During surgery, all organs in the chest and abdomen were checked and lesions left were repaired including five lung lesions. During closure of the chest, I found that it was impossible to close such a severely damaged and unstable chest wall. During this time, there were no available specific rib plates and screws. The crushed rib edges were acting as shrapnels penetrating the lung in many places. The most damaged ribs were repositioned in place and “we got what we had,” so I used the available plates and screws for pediatric ankle fractures with modifications and cautions [Figure 1]. We achieved a stable chest wall that could be closed safely with no more risk for damage to the lung. The postoperative course was lengthy, but the patient recovered well with no major complications except for a posttraumatic pseudoaneurysm of an intercostal artery that was successfully coiled later on in Oslo University Hospital. One year later, I saw the patient in my office living a happy and normal life.
Figure 1: Pediatric plates and screws for ankle fractures were modified and fixed to stabilize a severely damaged chest wall during the definitive surgery after previous two resuscitative thoracotomies and laparotomies with damage control surgery

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To the best of our knowledge, this case was the first of its kind in the literature in many aspects. It was unique to be the first in using plates and screws of pediatric ankle fractures for surgical stabilization of rib fractures (SSRF) [Figure 2] after successful resuscitative thoracotomy and resuscitative laparotomy with massive damage control both in the chest and abdomen. The lesson learned in this case is that we have been in urgent need of modern and specifically designed devices to fix a damaged chest wall that could be encountered in any hospital. Yes, indeed, necessity is the mother of invention. Technology has taken now a great step forward in developing specific titanium rib plates and screws that are compatible to the magnetic resonance imaging and have no significant obstacles in airport checkpoint controls. Good-quality studies on this matter are on progress. Some studies have already published their results as shown in this volume. We in the World Society for Cardiothoracic Trauma (www.wsctt.com) are pleased to have a special and unique edition in this issue of the official journal of the society on this evolving surgical technology for the best care of our patients.
Figure 2: A postoperative reconstruction skeletal view showing how the plates and screws are fixing the flailed ribs in place

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This volume is authored by the majority of the world's experts on the subject of SSRF. The manuscripts were orally presented in the Summit of the Chest Wall Injury Society (www.cwisociety.org) held in Santa Fee, New Mexico, May 28–30, 2019. It is a great pleasure having such a scientific cooperation between the Chest Wall Injury Society and the World Society for Cardiothoracic Trauma. This fruitful cooperation will be definitely of great benefit for the best care of our patients through establishing powerful educational platforms for surgeons, nurses, and all coworkers in this evolving technology. For that reason, we will have also a special course of excellence on SSFR developed and designed for this purpose. Such a course will be given by the World's authorities on the subject and will be held in conjunction with the second International Congress for the World Society for Cardiothoracic Trauma that will be held in the stunning archipelago Lofoten, Svolvær in the beautiful Norway, September 2–4, 2020 (www.wsctt-congress.com). I wish welcoming you there to be part of this unique congress with its powerful and credited continuing Medical Education (CME) educational event.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to b'e reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


  [Figure 1], [Figure 2]


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