Easy and Effective Method for the Treatment of Rib Fracture by Using Chrisofix-Technique

L. Zsiros1, Z. Záborszky2, A. Petri2, Z. Gergely3 and K. Bolla4

 

1MH KHK Traumatológia Budapest, 2DEOTEC Traumatológiai Tanszék Debrecen, 3Bács-Kuskun megyei Kórház Traumatológia Kecskemét, 4Chrisofix AG., Svájc

 

 

 

Summary

   The Chrisofix Chest Orthosis (rib splint) is an effective and easy to use device for the treatment of rib fractures. It immediately ameliorates pain and in the same time increases FVC. It decreases the paradox thoracic movement - if such developes - and reduces the risk of late complications.


Introduction

    Rib fracture was considered a life threatening injury even in the XVI. to XVIII. century. (Shakespeare: As you like it: “and broke three of his ribs, that there is little hope of life in him). Rib fracture is still a common form of injury in modern age. In Hungary in line with European statistics 10% of all injuries involve the thorax. 80% of thoracic injuries are followed by damage to the bones of the thorax. Pain follows every form of thoracic injury. Rib fractures disrupt the static of the chest wall, decrease the respiratory area, thus cause restrictive and later obstructive breathing difficulty with unforeseeable consequences due to the increase of bronchial excretion. Injury of the ribs and the following pain are triggering mechanisms in this cascade. Ameliorating the pain stops or reduces disease progression.
    There have been attempted to stop the pathologic progression of this cascade ever since the beginnings. Malgaigne proposed a thorax fixing bandage in his book already in 1851. Several other adhesive bandaging methods have been advocated, which are today rather not accepted, as they do more harm in elderly and COPD patients than good.

    The idea of the chest orthosis (Bolla K.), the “partial immobilisation of the chest” has been per analogy developed to the spontaneous defense mechanismos, during which the rib fracture patient tries to decrease the pain by pressingwith his hand on the site of the injury (Fig. 1).

Fig.1:Spontaneous defense mechanismos a rib fracture patient

Fig.2:The Chrisofix Chest Orthosis

The rib-splint is easy to adjust and continuously secure in the requested
position, hypoallergenic and X-ray penetrable. It is available in two diffe-rent
sizes (12x17 and 17x17 cm, respectively (Fig. 2). To proof the hypo-thesis on
the beneficial effect of the chest orthosis in rib fracture patients, we started
a placebo-controlled single blind multicenter clinical study.


Patients and Methods
   106 hospitalised patients between the age of 16 and 92 with 1-7 fractured ribs were involved into this non-randomised, placebo-controlled, multicenter explorative clinical study. Pain level was evaluated by visual analog scale 1,24, 48 and 72 hours after application of the rib-splint or similar sized abdominal sponge as sham treated control. Spontaneous pain level and cough induced pain were both recorded.

   Pulmonary functional tests were conducted in the case of 29 patients who received rib-splint and in 19 sham treated patients.Change in forced vital capacity (FVC) was measured directly after treatment and then 1, 24, 48 and 72 hours later. Statistical evaluation: t-test, paired ttest,Wilcoxon-Mann-Whitney-U-test, and Omnibus test were used.


Results

   The missing of randomisation resulted in two “positive bias”. The “Chrisofix patients” were older (55.8 vs. 44.7 p=0.015) and had more fractured ribs (2.8vs. 2.2; p<0.01). Compared to the controls (18 pats.), the chest orthosis significantly(p< 0.05) reduced the pain in rest (Fig. 3) and also at forced inspiration(p<0,01) in the 72 patients(Fig.4). While after the admission, the forced vital capacity (FVC) became first further reduced (-154, -134, -31 ml) and only slightly improved by day 3 (+164ml) in the 12 controls, it continuously increased (+161, +301, +410 and +616ml) in the 29 “Chrisofix” patients (Fig.5; p< 0.001). Similar trend was also seen in FEV1 and PEF.

Fig.3:Comparison of pain intensity registered in rest

Fig.4:Comparison of pain intensity registered by coughing

Fig.5:Change in the FVC during the first days of hospitalization

 


Conclusions

    The use of the Chrisofix Chest Orthosis resulted in a significantly accelerated improvement of the respiratory functions. This improvement, as the consequence of the registered pain reduction, started within one hour after the application of the splints. Based on this observation in a other investigation- presented also in this congress (G514C0281) – we showed that the use of chest orthesis can significantly reduce also the duraton of hospitalisation in this pation population.


References

Bolla K., Bolla O.: Medical splint and method of its manufacturing. European Patent Office: EP 0874607 B1 Internat. Public. No.: WO 97/022312 (26.06.1997 Gazette1997/27).

Bolla K.: Vorrichtung zur Schmerzlinderden Immobilisierung von gebrochenen Rippen. PCT/PCT/CH 2004/00109, 2004.

Mészáros T, Sárváry A, Petri A, Záborszky Z, Bolla K.: Use of chest or-thosis can significantly shorten the hospitalisation of rib fracture patients Proceeding of the 7th. European Trauma Congress; Code: G514C0281.

Anderson TM, Mansour KA, Miller JJ.: Thoracic approaches to anterior spinal operations:Anterior thoracic approaches. Ann. Thorac. Surg. 55: 1447. 1993.

Bay V.: Dringliche Operationsindikationen beim Thoraxtrauma. Zbl. Chir; 113: 73-84,1988.

Galan G, et al.: Blunt chest injuries in 1696 patients. Eur. J. Cardiothorac Surg. 6:284-287, 1992.

Rehm KE. Die Osteosynthese der Throraxwandinstabilitaten. Hefte Unfallheik. 175.1985.

Szabó GJ.: Therapeutische Strategie bei offenen Thoraxverletzungen. Hefte Unfallheik 223: 373-376, 1992.

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Use of Chest Orthosis Can Significantly Shorten the Hospitalisation of Rib Fracture Patients

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