This seems crazy that people will still go through this when there's an alternative to getting someone off the breathing machine and out of the hospital sooner —Dr. Don Van Borum
SALT LAKE CITY — A new surgical technique being used at a Utah hospital aims to be a quicker, less painful way to heal broken ribs.
Rib plating, as it is called, has been implemented at Intermountain Medical Center, among other hospitals nationwide.
The procedure works by making small incisions at the break sites, spanning the broken ribs with titanium plates, and holding them in place with locking screws that go just through the outside of the bone on both sides of the rib.
The technique is similar to those used in the mending of legs or arms, said Intermountain trauma surgeon Dr. Don Van Borum, but the novel rib plates mimic the ribs. The plates move while the patient breathes but hold firm at the site of the break.
Van Borum said rib plating, intended for patients with multiple fractures, heals patients faster and causes less pain than the conventional rib fracture treatments.
"For years … treatment was primarily pain medication and encouragement to keep breathing deep and coughing," he said, explaining that the primary issue with rib fractures is pain while breathing.
Patients oftenwon't breathe as deeply due to pain, and that can lead to a lung collapsing, Van Borum said. With traditional methods, there was a delicate balance between too much pain medication that depresses breathing versus too little medicine and the patient having too much pain to breathe, he said.
"The goal has always been to try to get enough … pain relief so the patient can keep breathing," Van Borum said.
Also, he said, people could be on a breathing machine from a few days to two weeks after an operation.
With rib plating, which typically involves four to five ribs, the majority of patients are not on a breathing machine afterward, Van Borum said.
Rib plating was first attempted in the 1970s and '80s, using plates that were intended for mandible fractures, he said. This was unsuccessful because the plates were not flexible and would break when placed on the constantly moving ribs. The practice was abandoned for years, Van Borum said.
About five years ago, a group of doctors and engineers in Portland, Ore., sought to develop rib plates that were flexible enough to move with the ribs as the patient breathed but stable enough to hold the fractured area together while it healed.
Ken Manzanares opted for the procedure after he broke five ribs when he fell off his horse and slammed against an embankment in a canyon.
"They were displaced in such a way that I risked losing my breathing capacity," Manzanares said. "And the mending may not be what I wanted."
Immediately following the surgery, Manzanares said he felt no rib pain. And he was back to work within a few weeks.
"I feel no pain. I have no issues," he said. "I do hard labor now, pouring concrete as part of my job with Salt Lake County."
Manzanares also is now fully involved with the hobby he loves: rebuilding classic saddles. And he said he was back in the saddle "within a month."
"This seems crazy that people will still go through this when there's an alternative to getting someone off the breathing machine and out of the hospital sooner," Van Borum said.
"Recovery is rapid. Most patients are out of the hospital in four to five days," he said. "We've had people get back to work within a week, whereas traditionally they could be out about six weeks."
According to data from the American Association of Surgery for Trauma, a survey of about 150 patients reported on average a nine out of 10 in terms of satisfaction with rib plating surgery, Van Borum said.
Surgeons at Intermountain Medical Center are working with other hospitals around the country, sharing what could be the most comprehensive data collected so far on rib plating.
They're also refining the technology, hoping to make it even less invasive than it is now.