A case of rib valve fixation using combined metal plates and steel wire in severe chest and abdomen combined explosive trauma

Abstract

The purpose of the study was to provide demonstration of chest and abdomen severe combined explosive trauma diagnosis and surgical treatment peculiarities with primary combined thoracoplasty using metal plates and steel wire. The clinical case concerns an injured L., 49 years, who received an explosive injury being in a bulletproof vest and helmet. 1 hr after the injury he was admitted for further examination and treatment. The diagnosis was established: severe combined explosive trauma of the chest and abdomen. Closed chest trauma. Multiple closed fractures of the III-X ribs on the right side. The following surgery was performed: thoracocentesis, drainage of the right pleural cavity by Buelau. Laparoscopy, the abdominal organs revision, conversive laparotomy, suturing of the diaphragm, “sandwich-type” liver tamponade. The following surgical intervention was performed next day: right-side thoracoplasty, bone fragments removal, reposition, the VII, VIII and XI ribs metal osteosynthesis with the help of adaptive titanium plates. A “Second Look” was performed on the third day together with abdominal organs revision, napkins removal, abdominal cavity sanitation and re-drainage and laparostomy closure. Authors suppose the use of adaptive titanium plates in combination with a metal thread is possible at the third and fourth levels of medical care