Three-point Bending Test of Two Methods for Rib Internal Fixation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGui-bin ¹ ,  LIULi-jun ¹ , SONGYong-bin ¹ , ZHOUShao-hui ¹ , LIGuo-lei ²

1. Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang 050051, P. R. China;
2. Department of Thoracic Surgery, Hebei Traditional Chinese Medical Hospital, Shijiazhuang 050051, P. R. China;

Corresponding?author：

LIULi-jun, Email: hbghxiongwaike@126.com

Keywords：

Rib fracture; Flail chest; Internal fixation; Cross section; Three-point bending test

DOI：

10.7507/1007-4848.20140191

Video：

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Objective To use claw-shaped blade plate and self-made 'titanium clip' blade plate for rib fracture fixation, and compare outcomes of these two internal fixation methods through mechanical tests. Methods Thoracic cage specimens of six adults (male)corpses were numbered. Bilateral 4th, 6th and 8th thoracic ribs of each corpse were taken from the rib nodules (0%)to costal cartilage junction (CJJ points, 100%)along the long axis of the ribs. Rib fragments about 130 mm in length with 50% locus were selected for mechanical tests of the lateral area. A total of 36 rib fragments were sampled and numbered. Each rib fragment was placed on electronic universal mechanical tester. A span of 100 mm and a loading speed of 2.5 mm/min were set to perform a three-point bending test until specimens fractured. The loads at displacement of 2, 4, 6, 8, 10, 15 and 20 mm respectively and maximum load were recorded, then the load-displacement curve was drawn. Above rib fragments were randomly divided into 2 groups, which were fixed using 'titanium clip' blade plate (titanium plate group)and claw-shaped blade plate (claw-shape group)respectively. Three-point bending test was performed under above loading conditions until the fixed specimens fractured again, and relevant data were recorded. Results Before fixation, there was no statistical difference in maximum load and peak deformation of the 4th, 6th and 8th ribs between the 2 groups (P > 0.05). Maximum load and peak deformation of the 4th, 6th and 8th ribs in the claw-shape group after fixation were statistically different from those before fixation (P < 0.05). Maximum load and peak deformation of the 4th, 6th and 8th ribs in the titanium plate group after fixation were also statistically different from those before fixation (P < 0.05). After fixation, maximum loads of the 4th, 6th and 8th ribs in the claw-shape group were statistically different from those in the titanium plate group (P < 0.05), but there was no statistical difference in peak deformation between the 2 groups (P > 0.05). Conclusions Fractured ribs fixed with 'titanium clip' blade plates are more stable and stronger than those fixed with claw-shaped blade plates.

Citation： ZHANGui-bin, LIULi-jun, SONGYong-bin, ZHOUShao-hui, LIGuo-lei. Three-point Bending Test of Two Methods for Rib Internal Fixation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 658-662. doi: 10.7507/1007-4848.20140191 Copy

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2.	Granetzny A, Abd El-Aal M, Emam E, et al. Surgical versus conserva-tive treatment of flail chest. Evaluation of the pulmonary status.Interact Cardiovasc Thorac Surg, 2005, 4(6):583-587.
3.	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.
4.	Campbell N, Conaglen P, Martin K, et al. Surgical stabilization of rib fractures using Inion OTPS wraps-techniques and quality of life follow-up. J Trauma, 2009, 67(3):596-601.
5.	王洪斌, 張明, 劉海林, 等.微創小切口肋骨內固定術治療多根多處肋骨骨折及連枷胸.中國胸心血管外科臨床雜志, 2012, 19(4):449-450.
6.	Ahmed Z, Mohyuddin Z. Management of flail chest injury:internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg, 1995, 110(6):1676-1680.
7.	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.
8.	Bottlang M, Helzel I, Long W, et al. Less-invasive stabilization of rib fractures by intramedullary fixation:a biomechanical evaluation. J Trauma, 2010, 68(5):1218-1224.
9.	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.
10.	Collins RL, Cornely W, Grella C, et al. Response:the new enivoronment of accountability for OTPS. Sci Pract Perspect, 2002, 1(1):28-29.
11.	Schultz AB, Benson DR, Hirsch C. Force-deformation properties of human ribs. J Biomech, 1974, 7(3):303-309.
12.	Granik G, Stein I. Human ribs:static testing as a promising medical application. J Biomech, 1973, 6(3):237-240.
13.	Yoganandan N, Pintar FA. Biomechanics of human thoracic ribs. J Biomech Eng, 1998, 120(1):100-104.
14.	Stitzel JD, Cormier JM, Barretta JT, et al. Defining regional variation in the material properties of human rib cortical bone and its effect on fracture prediction. Stapp Car Crash J, 2003, 47:243-265.
15.	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.
16.	Kemper AR, McNally C, Pullins CA, et al. The biomechanics of human ribs:material and structural properties from dynamic tension and bending test. Stapp Car Crash J, 2007, 51:235-273.
17.	Campbell N, Richardson M, Antippa P, et al. Biomechanical testing of two devices for internal fixation of fractured ribs. J Trauma, 2010, 68(5):1234-1238.

1. Bastos R, Calhoon JH, Baisden CE. Flail chest and pumlonary contu-sion. Sem in Thorac Cardiovasc Surg, 2008, 20(1):39-45.
2. Granetzny A, Abd El-Aal M, Emam E, et al. Surgical versus conserva-tive treatment of flail chest. Evaluation of the pulmonary status.Interact Cardiovasc Thorac Surg, 2005, 4(6):583-587.
3. 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.
4. Campbell N, Conaglen P, Martin K, et al. Surgical stabilization of rib fractures using Inion OTPS wraps-techniques and quality of life follow-up. J Trauma, 2009, 67(3):596-601.
5. 王洪斌, 張明, 劉海林, 等.微創小切口肋骨內固定術治療多根多處肋骨骨折及連枷胸.中國胸心血管外科臨床雜志, 2012, 19(4):449-450.
6. Ahmed Z, Mohyuddin Z. Management of flail chest injury:internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg, 1995, 110(6):1676-1680.
7. 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.
8. Bottlang M, Helzel I, Long W, et al. Less-invasive stabilization of rib fractures by intramedullary fixation:a biomechanical evaluation. J Trauma, 2010, 68(5):1218-1224.
9. 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.
10. Collins RL, Cornely W, Grella C, et al. Response:the new enivoronment of accountability for OTPS. Sci Pract Perspect, 2002, 1(1):28-29.
11. Schultz AB, Benson DR, Hirsch C. Force-deformation properties of human ribs. J Biomech, 1974, 7(3):303-309.
12. Granik G, Stein I. Human ribs:static testing as a promising medical application. J Biomech, 1973, 6(3):237-240.
13. Yoganandan N, Pintar FA. Biomechanics of human thoracic ribs. J Biomech Eng, 1998, 120(1):100-104.
14. Stitzel JD, Cormier JM, Barretta JT, et al. Defining regional variation in the material properties of human rib cortical bone and its effect on fracture prediction. Stapp Car Crash J, 2003, 47:243-265.
15. 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.
16. Kemper AR, McNally C, Pullins CA, et al. The biomechanics of human ribs:material and structural properties from dynamic tension and bending test. Stapp Car Crash J, 2007, 51:235-273.
17. Campbell N, Richardson M, Antippa P, et al. Biomechanical testing of two devices for internal fixation of fractured ribs. J Trauma, 2010, 68(5):1234-1238.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Three-point Bending Test of Two Methods for Rib Internal Fixation

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