Rib Repair – Doctor Interview
First of all, how do doctors generally treat rib fractures?
Dr. Mayberry: Most physicians and the public, in general, believe rib fractures heal on their own within six to eight weeks. But, when I look back to see if that has actually been documented, there was very little, if anything, in medical literature to support that.
What do most doctors tell their patients about rib fractures?
Dr. Mayberry: That there is nothing they can do for them. “Just wait and see what happens.” They hand out a lot of pain medication. Of course, everybody knows rib fractures are very painful. The problem is, for some patients, the pain never stops. Those are the patients we hope to help with surgical repair.
So how do you make that decision? I assume you make the repair if the rib is puncturing a lung or internal organ?
Dr. Mayberry: That is right. We do an X-ray or CT scan to see the number of rib fractures and how bad they are. For example, one patient had very severe fractures. There was a deformity on his chest wall. His rib fractures were very displaced. Not only that, but every time he moved or took a deep breath, he could feel those rib fractures moving. It just makes common sense that they needed to be fixed.
So, what are the guidelines to develop in the study? Exactly when do you operate?
Dr. Mayberry: Guidelines now are very simple. For example, with a patient like [that], a number of days passed and the patient was not getting better. If the ribs are still moving, that means they are not healing rapidly. We could intervene and help them.
How do you come up with criteria for treatment?
Dr. Mayberry: We look at the number of ribs, how badly they are fractured, the level of displacement, and the patient’s other interests. These things will probably go into the equation and we will be able to predict which patients are not going to get better. See, I want to know which patients are not going to get better.
What are some of the things you are looking at?
Dr. Mayberry: We want to know how many ribs are fractured, how badly displaced they are. We look at the location of the fracture and whether there are other injuries. For example, if the patient has a fractured leg or if they have a head injury. We want to know if there are other medical problems. Do they have diabetes? What is their age? Even gender makes a difference. We could put all of those factors into the equation to help us predict which patients will not get better rapidly.
Is the U-plate the best option for all patients who need rib repair?
Dr. Mayberry: No, the U-plate is new. It is approved by the FDA. It can be placed through smaller incisions, and therefore, we want to see if it’s efficacious. We want to do it in a number of patients and then follow those patients for six months and document exactly what happens to them over the six months.
I understand the plate you were using before was not made specifically for ribs?
Dr. Mayberry: Correct, it was made to fix the jaw.
What was the difference between the U-plate and what you were doing before?
Dr. Mayberry: It’s a shorter plate. The standard they have been using is a plate that is about nine centimeters long. The U-plate is only 4.5 centimeters long, so it’s literally half the length. The previous plate that we have been using went just along the anterior surface of the rib. It was secured with six screws that went through the anterior surface of the rib. If they were any shorter than that, we found the plate would come off over time because the rib is flimsy and it moves a lot. Every time you breathe, it moves.
The U-plate is shaped like a U, so it cuts the rib. The screws go through the plate, through the rib and back through the plate again, so the plate is cupping the rib and holding it in place. We did some biomechanical studies in the orthopedics lab, and even though it was half the length, it actually was more durable in a test on cadaver ribs. It was more durable. It did not loosen over time like the previous technique.
What is the U-plate made of?
Dr. Mayberry: Titanium. Most orthopedic plates are made of titanium. The U-plate does not need to be removed because titanium is compatible with the body.
Now, are you are the only surgeon using this plate?
Dr. Mayberry: Yes. Currently.
How many other surgeons use this other hardware to repair a rib?
Dr. Mayberry: I am not 100 percent sure, but there are only about four or five surgeons in the entire country that fix rib fractures on a regular basis.
Will insurance not pay for a rib repair?
Dr. Mayberry: No, they will pay for it. It’s just a lack of knowledge, lack of expertise, and lack of awareness that repair is an option.
So what you are saying is that they are probably healed, they have probably gone back together but they are still having pain?
Dr. Mayberry: It’s called chronic pain. Chronic pain is not helped by surgery. It often gets worse with surgery.
Is there ever so much damage that you have to remove part of the lung?
Dr. Mayberry: In rare cases, yes, the lung is so damaged we have to remove it.
About how many patients are treated?
Dr. Mayberry: Nearly 300,000 people go to the ER with rib fractures each year in the United States.
What percentage could benefit from this the U-plate?
Dr. Mayberry: About 5 percent could potentially benefit from the U-plate.
How long does it take for patients to know they can benefit from the U-plate?
Dr. Mayberry: After two weeks, if the ribs are still moving and the patient is having pain associated with that movement, then it should be fixed.
How many U-plate procedures have you done?
Dr. Mayberry: Two patients have received the U-plate.
How many patients are enrolled in the study?
Dr. Mayberry: We would like to enroll 10 in the next year at least.
What have you used in the past to repair ribs?
Dr. Mayberry: I have used every possible combination of things over the past 10 years to fix rib fractures. Each one of them has its own problems. That is why I’m excited about the U-plate. It has potential to be a plate that really works. It’s small. I can put it in small incisions, and I’m not anticipating problems.
Is it FDA-approved?
Dr. Mayberry: Yes, it’s approved by the FDA for marketing and commercial use.
This article was reported by Ivanhoe, which offers Medical Alerts every day.