Intraoperative evaluation by ultrasound of multiple rib fractures in trauma patients

Abstract

Introduction: Increased interests in surgical approaches for multiple rib fractures in trauma patients have emerged lately. A novel strategy based on intraoperative ultrasound (US) assessment to locate these fractures has been proposed to perform smaller incisions for thoracic wall reconstructions. We aimed to describe variations of site, size, and direction of surgical incisions before and after US use intraoperatively for localization of rib fractures. Materials and Methods: In this pilot study, ten trauma patients with multiple rib fractures requiring thoracic wall reconstruction were prospectively included during a 9-month period. Computer tomography of the thorax was used for determining surgical incisions. Before surgical incision, US was used for the identification of rib fractures and for marking a different surgical incision. In each patient, qualitative comparisons of surgical incision marks before and after US were performed. Results: The qualitative analysis demonstrated that five patients (5/10) had a change in the direction of the incision and also in five patients (5/10) there was a change in the size of the incision. In those five patients in whom the length and size of the incision changed, there was a median length reduction of the incision of 3 cm (interquartile range 2–3). Conclusions: In this pilot study, we observed that trauma patients with multiple rib fractures requiring thoracic wall reconstruction may benefit from intraoperative assessment of US for targeted surgical planning. US might offer advantages for surgical planning before defining the final surgical approach.