Mobile Rib Surgery

• The mobile rib plaque is the chest wall area that is no longer constantly with the thoracic cage, due to the loss of the firmness of the skeleton.
• The mobile rib plaque appears only when at least 3 adjacent ribs are broken, and fractures at both heads, and the fractures at each end must be on the same straight line. Since the ribs are broken at both sides, the solidity of the skeleton is lost, which in turn causes many respiratory disorders.
• Mobile rib plaque is most commonly encountered in the laterside plaque position, and clinical manifestations will also be most obvious. Other locations where mobile rib plaques may be encountered are the sternum plaque and later later rib plaque.

When there is a mobile rib plaque, severe respiratory disorders will appear, derived from the following phenomena:

2.1 Reverse respiration

The pressure in the pleural cavity decreases, the rib plaque is pulled in to press on the damaged lateral lung, pushing an amount of gas back into the pneumothorax and into the healing side of the lungs.

The above phenomenon occurs in the opposite direction, resulting in the appearance of a vicious amount of gas in the airways, completely not participating in gas exchange, leading to a decrease in the volume of air circulation, limiting the gas exchange of the lungs.

2.2 Swaying the mediass center

Breathe in, the mobile rib array will squeeze on the damaged lateral lung, causing the medias center to be pushed to the side of the lungs to heal. Exhaling, the damaged lateral lung is no longer pressed up by the mobile rib plaque, the medias center is no longer pushed off and will move backwards.

The medias center is constantly shifted back and back and back, causing irritation of the reflex centers of the heart and lungs and causing large blood vessels in the heart stalk to twist. From there, it leads to a series of serious cardiac disorders that result in apnea or cardiac arrest due to reflexes.

Due to hypoxia, the patient will try to breathe faster, and the faster he breathes, the stronger the two phenomena will occur, forming a pathology spiral.

When the mobile rib plaque appears, when the patient breathes in, the rib area can be seen concave (sucked in), while when the patient exhales, the rib area is bulging (when the rib area is always moving in the opposite direction to the chest).

When mobile ribs appear, the first thing to do on site is first aid so that the patient's mobile ribs are no longer mobile. The fixation of the mobile ribs can be done by simple methods, such as inserting cotton padding (or just enough sandbags) onto the position of the mobile rib array and then tape around the chest fixed, so that the patient is in an inclined position over the mobile rib array.

The patient's rib plaque will always be in an indented position without bulging, helping to prevent paralysed and respiratory disorders from taking place (although respiratory capacity will be limited in part).

True treatment of mobile rib plaque can be done by external fixation or inward fixation (by mechanical breathing), however external fixation is the most common method that usually applies. External fixity can be done in the following ways:

• Metal rib-ending surgery
• Continuous pulling of the rib plaque (usually applied to the sternum plaque)
• Stitching of the rib array on the frame
• Stitching the broken ribs together

In addition to mobile rib plaque treatment, patients will be treated for accompanying lesions (if any), such as pleural effusion, pleural cavity gas overflow,…

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