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- Title
Minimally Invasive Surgical Management of Chronic Cough-Induced Rib Fracture Non- Union: A Case Report.
- Authors
Raveglia, Federico; Libretti, Lidia; Cioffi, Ugo; Guttadauro, Angelo; Petrella, Francesco
- Abstract
Patient: Male, 54-year-old Final Diagnosis: Rib fracture Symptoms: Chest pain Clinical Procedure: Rib resection Specialty: Surgery Objective: Rare disease Background: Nonunion of a rib fracture can cause chronic pain, and pharmacological pain management may lead to medication dependence. This report describes a 54-year-old man with a chronic cough and painful nonunion fracture of the left posterior 8th rib, managed with minimally invasive surgery and a rib splint. Case Report: A 54-year-old man presented with chronic cough-induced left chest wall pain. Three-dimensional chest computed tomography (CT) scan showed a nonunion of a fracture of the left posterior 8th rib. After medical management failure, we proposed a surgical approach with the aim to remove the tissue comprising the nonunion, release the nerve, and stabilize the bone stumps. To avoid the adverse effects of a large incision, we designed a minimally invasive strategy based on ultrasound fracture localization and the use of an intramedullary splint. The pain disappeared immediately after surgery. The patient was discharged in 24 hours. At 6-week followup, he was still asymptomatic, and a new CT scan reconfirmed the correct splint position. From the immediate postoperative evaluation until the last follow-up visit, he consistently reported full satisfaction. Conclusions: This report has highlighted the challenges of management of chronic pain in nonunion of a rib fracture, and has described the use of a minimally invasive surgical approach. In this single case, our tailored surgical strategy achieved definitive success in pain management, minimizing postoperative complications/adverse effects and avoiding the addition of pain medications despite a 24-hour hospital stay. Our goal is to share an alternative solution for colleagues facing similar cases.
- Subjects
RIB fractures; UNUNITED fractures; CHRONIC cough; MINIMALLY invasive procedures; CHEST pain; PAIN management
- Publication
American Journal of Case Reports, 2024, Vol 25, p1
- ISSN
1941-5923
- Publication type
Case Study
- DOI
10.12659/AJCR.943222