Zusammenfassung
Für die Versorgung von Rippenfrakturen existiert keine deutsche Leitlinie. Die Therapie ist uneinheitlich und die Diskussion darüber oft polemisch geführt. Dieser Artikel soll die Therapiemöglichkeiten und die Erfahrung eines großen Traumazentrums mit einer Thoraxchirurgie vorstellen.
Abstract
The therapy of rib fractures is controversially discussed. Neither does an osteosynthesis have to be performed for each individual rib fracture, nor is the internal splinting by ventilation or respiratory therapy sufficient for each patient. Rib fractures are common in polytrauma patients after car and motorcycle accidents or falls from great heights. However, rib fractures are also increasingly occurring in older patients with falls from low heights. Anamnesis and clinical examination are groundbreaking for the diagnosis and therapy decision of rib fractures. In radiological diagnostics, projection radiography comes first, followed by sonography and CT. Computed tomography should be required for planning an operation. Accompanying injuries must be taken into account when deciding on therapy. We see a complicated organ injury, dislocated rib serial fractures, flail chest and respiratory insufficiency as indications for rib stabilization. As a relative indication for rib stabilization, we see a high suffering pressure due to pain and an intrathoracic volume restriction due to dislocated rib serial fractures. New osteosynthesis material and minimally invasive techniques standardize the procedure and minimize surgical trauma. In any case, adequate pain and respiratory therapy are always crucial for successful treatment.
Schlüsselwörter
Rippenfraktur - instabiler Thorax - Polytrauma - Rippenosteosynthese
Key words
rib fracture - flail chest - polytrauma - rib stabilization
