Geometry of Human Ribs Pertinent to Chest-wall Reconstruction and Internal Rib Fixation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIGuo-lei ¹ ,  LIULi-jun ¹ , SONGYong-bin ¹ , ZHANGGui-bin ¹ , ZHOURu-ming ² , XINGXu-ran ²

1. Department of Thoracic Surgery, Hebei Province General Hospital, Shijiazhuang 050051, Hebei, P. R. China;
2. Medical Imaging Center, Hebei Province General Hospital, Shijiazhuang 050051, Hebei, P. R. China;

Corresponding?author：

LIULi-jun, Email: lljdoctor@yahoo.com.cn

Keywords：

Rib; Geometry; Computed tomography; Fracture; Internal fixation

DOI：

10.7507/1007-4848.20140013

Video：

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Objective To provide geometric morphometric parameters for anatomical plate design by measuring the geometry of the 3rd to 9th ribs of adults using X-ray computed tomography (CT). Methods Twenty patients receiving chest CT scan in Hebei Province General Hospital from May to July of 2012 were recruited in this study. There were 10 Han males and 10 Han females with their height of 167-180 (173±8) cm and age of 16-58 (37±18) years. None of the patients had thoracic trauma history or other disease which might influence the shape or density of ribs. After general chest CT scan, three-dimensional images of thoracic bones were constructed. The geometric shape of the ribs was analyzed and measured. Results The ribs were divided into 3 sections as followed, from rib head to-37.5% of rib (section 1), 25%-75% (section 2), and 50%-100% (section 3). The maximum curvature of general curved ribs on long axis occurred in section 1 of the ribs. The third rib had the largest curvature (20.24±2.86/m). Section 2 of the 8th rib had the smallest curvature (6.14±0.96/m). The curvature of section 2 of 7th to 9th ribs was smaller than that of other 2 sections. The smallest curvature appeared in section 3 of 3rd to 6th ribs. Each rib had a retroversion angle along its longitudinal axis, and its numerical value was 30-50 degrees. The rib unrolled angle decreased firstly and then increased gradually. The cross-sectional area of marrow cavity ranged from 27.59 mm2 at the rear to 55.91 mm2 in the front. Conclusion Multi-slice spiral CT three-dimensional reconstruction of ribs can accurately measure the morphological characteristics of ribs, and provide a practical method for designing internal rib fixation plates.

Citation： LIGuo-lei, LIULi-jun, SONGYong-bin, ZHANGGui-bin, ZHOURu-ming, XINGXu-ran. Geometry of Human Ribs Pertinent to Chest-wall Reconstruction and Internal Rib Fixation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 41-46. doi: 10.7507/1007-4848.20140013 Copy

1.	Richardson JD, Franklin GA, Heffley S, et al.Operative fixation of chest wall fractures:an underused procedure? Am Surg, 2007, 73 (6):591-597.
2.	Rcmeron P, Dziukas L, Hadj A, et al.Rib fractures in major trauma.Aust N Z J Surg, 1996, 66 (8):530-534.
3.	Lardinois D, Krueger T, Dusmet M, et al.Pulmonary function testing after operative stabilisation of the chest wall for flail chest.Eur J.Cardiothorac Surg, 2001, 20 (3):496-501.
4.	Rccchione RN, Richardson JD, Seligson D.Painful nonunion of multiple rib fractures managed by operative stabilization.J Trauma, 2000, 48 (2):319-321.
5.	Pinczewski LA, Lyman J, Salmon LJ, et al.A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft.A controlled, prospective trial.Am J Sports Med, 2007, 35 (4):564-574.
6.	OtsuboH, Shino K, Nakamura N, et al.Arthroscopic evaluation of ACL grafts reconstructed with the anatomical two-bundle technique using hamstring tendon autograft.Knee Surg Sports Traumatol Arthrosc, 2007, 15 (6):720-728.
7.	Granetzy A, Abd El-Aal M, Emam E, et al.Surgical versus conservative treatment of flail chest.Evaluation of the pulmonary status.Interact Cardiovasc Thorac Surg, 2005, 4 (6):583-587.
8.	Tanaka H, Yukioka T, Yamaguti Y, et al.Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.J Trauma, 2002, 52 (4):727-732.
9.	Ahmed Z, Mohyuddin Z.Management of flail chest injury:internal fixation versus endotracheal intubation and ventilation.J Thoracic Cardiovasc Surg, 1995, 110 (6):1676-1680.
10.	Reber PU, Ris HB, Inderbitzi R, et al.Osteosynthesis of the injured chest wall.Use of the AO (Arbeitsgemeinschaft für Osteosynthese) technique.Scand J Thorac cardiovasc Surg, 1993, 27 (3-4):137-142.
11.	Mouton W, Lardinois D, Furrer M, et al.Long-term follow-up of patients with operative stabilization of a flail chest.Thoracic and Cardiovasc Surg, 1997, 45 (5):242-244.
12.	Oyarzun JR, Bush AP, McCormick JR, et al.Use of 3.5-mm acetabular reconstruction plates for internal fixation of flail chest injuries.Ann Thorac Surg, 1998, 65 (5):1471-1474.
13.	張繼軍, 高聲甫, 程曉斌, 等.電視胸腔鏡在急性胸部創傷中的應用.中華創傷雜志, 1997, 13 (5):288-290.
14.	Mohr M, Abrams E, Engel C, et al.Geometry of human ribs pertinent to orthopedic chest-wall reconstruction.J Biomech, 2007, 40 (6):1310-1317.
15.	Bottlang M, Helzel I, Long WB, et al.Anatomically contoured plates for fixation of rib fractures.J Trauma, 2010, 68 (3):611-615.
16.	李錦青, 王健, 唐康來.多層螺旋CT后處理技術測量國人離體肩胛盂扭轉角.中國醫學影像技術, 2010, 26 (1):161-163.
17.	李錦青, 王健, 唐康本.多層螺旋CT后處理測量肱骨頭扭轉角的實驗研究.中國骨與關節損傷雜志, 2009, 24 (5):393-395.
18.	Engel C, Krieg JC, Madey SM, et al.Operative chest wall fixation with osteosynthesis plates.J Trauma, 2005, 58 (1):181-186.
19.	Kaneko K.Thoracoscopic surgery.J Kyobu Geka, 2009, 62 (8 Suppl):718-722.
20.	Dansereau J, Stokes IA.Measurements of the threedimensional shape of the rib cage.J Biomech, 1988, 21 (11):893-901.
21.	Cormier JM, Stitzel JD, Duma SM, et al.Regional variation in the structural response and geometrical properties of human ribs.Annu Proc Assoc Adv Automot Med, 2005, 49:153-170.
22.	Bottlang M, Walleser S, Noll M, et al.Biomechanical rationale and evaluation of an implant system for rib fracture fixation.Eur J Trauma Emerg Surg, 2010, 36 (5):417-426.
23.	Yoganandan N, Pintar FA.Biomechanics of human thoracic ribs.J Biomech Engin, 1998, 120 (1):100-104.

1. Richardson JD, Franklin GA, Heffley S, et al.Operative fixation of chest wall fractures:an underused procedure? Am Surg, 2007, 73 (6):591-597.
2. Rcmeron P, Dziukas L, Hadj A, et al.Rib fractures in major trauma.Aust N Z J Surg, 1996, 66 (8):530-534.
3. Lardinois D, Krueger T, Dusmet M, et al.Pulmonary function testing after operative stabilisation of the chest wall for flail chest.Eur J.Cardiothorac Surg, 2001, 20 (3):496-501.
4. Rccchione RN, Richardson JD, Seligson D.Painful nonunion of multiple rib fractures managed by operative stabilization.J Trauma, 2000, 48 (2):319-321.
5. Pinczewski LA, Lyman J, Salmon LJ, et al.A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft.A controlled, prospective trial.Am J Sports Med, 2007, 35 (4):564-574.
6. OtsuboH, Shino K, Nakamura N, et al.Arthroscopic evaluation of ACL grafts reconstructed with the anatomical two-bundle technique using hamstring tendon autograft.Knee Surg Sports Traumatol Arthrosc, 2007, 15 (6):720-728.
7. Granetzy A, Abd El-Aal M, Emam E, et al.Surgical versus conservative treatment of flail chest.Evaluation of the pulmonary status.Interact Cardiovasc Thorac Surg, 2005, 4 (6):583-587.
8. Tanaka H, Yukioka T, Yamaguti Y, et al.Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.J Trauma, 2002, 52 (4):727-732.
9. Ahmed Z, Mohyuddin Z.Management of flail chest injury:internal fixation versus endotracheal intubation and ventilation.J Thoracic Cardiovasc Surg, 1995, 110 (6):1676-1680.
10. Reber PU, Ris HB, Inderbitzi R, et al.Osteosynthesis of the injured chest wall.Use of the AO (Arbeitsgemeinschaft für Osteosynthese) technique.Scand J Thorac cardiovasc Surg, 1993, 27 (3-4):137-142.
11. Mouton W, Lardinois D, Furrer M, et al.Long-term follow-up of patients with operative stabilization of a flail chest.Thoracic and Cardiovasc Surg, 1997, 45 (5):242-244.
12. Oyarzun JR, Bush AP, McCormick JR, et al.Use of 3.5-mm acetabular reconstruction plates for internal fixation of flail chest injuries.Ann Thorac Surg, 1998, 65 (5):1471-1474.
13. 張繼軍, 高聲甫, 程曉斌, 等.電視胸腔鏡在急性胸部創傷中的應用.中華創傷雜志, 1997, 13 (5):288-290.
14. Mohr M, Abrams E, Engel C, et al.Geometry of human ribs pertinent to orthopedic chest-wall reconstruction.J Biomech, 2007, 40 (6):1310-1317.
15. Bottlang M, Helzel I, Long WB, et al.Anatomically contoured plates for fixation of rib fractures.J Trauma, 2010, 68 (3):611-615.
16. 李錦青, 王健, 唐康來.多層螺旋CT后處理技術測量國人離體肩胛盂扭轉角.中國醫學影像技術, 2010, 26 (1):161-163.
17. 李錦青, 王健, 唐康本.多層螺旋CT后處理測量肱骨頭扭轉角的實驗研究.中國骨與關節損傷雜志, 2009, 24 (5):393-395.
18. Engel C, Krieg JC, Madey SM, et al.Operative chest wall fixation with osteosynthesis plates.J Trauma, 2005, 58 (1):181-186.
19. Kaneko K.Thoracoscopic surgery.J Kyobu Geka, 2009, 62 (8 Suppl):718-722.
20. Dansereau J, Stokes IA.Measurements of the threedimensional shape of the rib cage.J Biomech, 1988, 21 (11):893-901.
21. Cormier JM, Stitzel JD, Duma SM, et al.Regional variation in the structural response and geometrical properties of human ribs.Annu Proc Assoc Adv Automot Med, 2005, 49:153-170.
22. Bottlang M, Walleser S, Noll M, et al.Biomechanical rationale and evaluation of an implant system for rib fracture fixation.Eur J Trauma Emerg Surg, 2010, 36 (5):417-426.
23. Yoganandan N, Pintar FA.Biomechanics of human thoracic ribs.J Biomech Engin, 1998, 120 (1):100-104.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Geometry of Human Ribs Pertinent to Chest-wall Reconstruction and Internal Rib Fixation

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