年過7旬的老翁騎車發生意外，以致右側第4至6根肋骨的多重性骨折合併肩胛骨骨折，送至林口長庚醫院急診，家屬最初考慮老年人骨折恢復問題，並未進行肋骨骨折手術，但老翁因為肋骨多重性骨折的疼痛劇烈影響呼吸，引起肺部併發症，必須進行插管、送進加護病房持續觀察。最後在取得家屬同意，進行肋骨骨折固定手術，術後一周就大幅改善「連呼吸都痛」的問題，也免除未來恐長期配戴呼吸器或氣切手術的風險。
一般肋骨骨折的傳統作法是不開刀，讓斷裂的肋骨慢慢自行癒合，但在忍受疼痛的過程中，恐產生肺炎或肺部併發症。林口長庚外傷科對肋骨骨折經驗豐富的鄭啟桐醫師說明，老翁在受傷後一周才進行肋骨手術，已產生的肺炎和併發症會較慢復原，而醫學臨床文獻多數建議，若有多重性肋骨骨折導致影響呼吸、骨頭移位，應於72小時進行肋骨固定手術，不僅能避免無法咳痰的肺部併發症，也能降低手術難度和風險性。
肋骨骨折手術的重點，除了精準找出骨折斷裂位置，就是將斷裂、移位的肋體進行復位。鄭啟桐解釋，手術中病患的身體會受交互移動以及軟組織影響，定位未能百分百精確，林口長庚醫院目前採用2種定位方式的微創手術，即術前利用的3D電腦斷層先進行掃描，術中再用超音波即時定位，即使釘了5支肋骨，也只需打開與骨材同長約8公分、甚至更小的傷口，併用胸腔鏡幫助清理血塊。相較於傳統手術需打開10到20公分的傷口，新技術的胸骨固定系統能大幅縮短病患復原期。
隨著醫材日新月異，肋骨固定的材質更符合人體需求，早期使用金屬骨板矯正肋骨骨折，身體內的異物感非常明顯，固定幾個月後須二度開刀移除。新技術的骨板為鈦合金材質，輕薄又具堅韌性，手術中先將骨材塑型成肋骨形狀，再用鈦合金螺絲釘鎖在斷裂骨頭上，不須取出，留存體內也無異物感，穿過金屬探測器不會發出警示聲響，更不受核磁共振等電磁波的干擾，形同身體的一部分，大幅提升生活品質。
目前肋骨固定的醫材健保未給付，為減輕病患經濟負擔，鄭啟桐表示肋骨左右兩側各12支，對病患呼吸和疼痛改善最有幫助的是4到8肋的部位，通常會選擇關鍵位置進行固定，視病患受傷程度而定，平均釘3至4支肋骨，就可達到最大效益。術後建議應盡快回復正常活動和生活，利用呼吸訓練器幫助訓練呼吸，如每天走路逾30分鐘，暫時避開重量訓練和有氧運動即可。
鄭啟桐提醒，若肋骨僅輕微裂開、未產生移位性骨折，可不須手術、讓骨頭自行長好。此外多重性骨折病患術前的麻醉風險評估若有疑慮，或腦部受傷、併內出血情形，就不適合立即進行肋骨手術，需再審慎觀察。
The accident occurred in the 7-year-old man riding bicycle, resulting in multiple fractures of the 4th to 6th ribs on the right side combined with scapular fractures, and sent to the emergency department of Chang Gung Memorial Hospital in Linkou. The family initially considered the fracture recovery of the elderly and did not undergo rib fracture surgery. However, the old man suffers from pulmonary pain due to the pain of the rib multiple fracture, which causes pulmonary complications. It must be intubated and sent to the intensive care unit for continuous observation. Finally, with the consent of the family members, the rib fracture fixation operation was carried out, and the problem of "even breathing pain" was greatly improved after one week, and the risk of wearing a respirator or a gas-cut operation in the future was also avoided.
The traditional practice of rib fractures is to prevent the fractured ribs from healing spontaneously, but in the process of enduring pain, pneumonia or pulmonary complications may occur. Dr. Zheng Qitong, a well-experienced skeletal fracture in Linkou Chang Geng traumatology, explained that the old man had rib surgery only one week after the injury, and the pneumonia and complications that had developed would be slower, but most medical clinical literature suggested that if there were multiple rib fractures. Affecting breathing and bone displacement, rib fixation should be performed at 72 hours, which not only avoids lung complications that cannot cough, but also reduces the difficulty and risk of surgery.
The focus of rib fracture surgery, in addition to accurately identifying the location of the fracture, is to reset the fractured and displaced ribs. Zheng Qitong explained that the body of the patient in the operation will be affected by the interaction and soft tissue, and the positioning is not 100% accurate. The Lin Geng Chang Geng Hospital currently uses two kinds of positioning methods for minimally invasive surgery, that is, the 3D computerized tomography used before surgery. In the operation, ultrasound is used for immediate positioning. Even if 5 ribs are nailed, it is only necessary to open a wound with a length of about 8 cm or less, and use a thoracoscope to help clear the blood clot. The new technology of the sternal fixation system can significantly shorten the patient's recovery period compared to traditional surgery requiring 10 to 20 cm of wounds.
With the rapid development of medical materials, the materials fixed by the ribs are more in line with the needs of the human body. Early use of metal plates to correct rib fractures, the body's foreign body sensation is very obvious, and must be removed twice after a few months of fixation. The bone plate of the new technology is made of titanium alloy, which is light and tough. In the operation, the bone material is shaped into a rib shape, and then the titanium alloy screw is locked on the broken bone, and it is not necessary to take out, and there is no foreign body sensation in the body. Passing through the metal detector will not give a warning sound, and it will not be interfered by electromagnetic waves such as nuclear magnetic resonance. It is part of the body and greatly enhances the quality of life.
At present, the ribs fixed medical materials are not paid. In order to reduce the economic burden of patients, Zheng Qitong said that there are 12 left and right sides of the ribs. The most helpful part of the patient's breathing and pain improvement is the 4 to 8 ribs. The position is fixed, depending on the degree of injury to the patient, and the average benefit is obtained by nailing 3 to 4 ribs on average. Postoperative recommendations should return to normal activities and life as soon as possible, use breathing trainer to help train breathing, such as walking more than 30 minutes a day, temporarily avoid weight training and aerobic exercise.
Zheng Qitong reminded that if the ribs are only slightly split and there is no displacement fracture, the surgery can be done without the bones being self-sustained. In addition, if there is doubt in the preoperative anesthesia risk assessment of multiple fracture patients, or brain injury, internal bleeding, it is not suitable for immediate rib surgery, and need to be carefully observed.
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