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Hershey Medical Center, likes to drop in on his doctors at work, and on that day in early he was watching as staff surgeon Dr. Don Mackay affixed thin metal plates to the broken ribs of an elderly patient.
Mackay had modified the standard way of fixing ribs, making it less traumatic for patients, but the procedure was still long, laborious, and somewhat bloody.
A typical scene of the conventional method, which attaches a plate to the outer surface of a broken rib, has the patient on his side, a slab of flesh from waist to armpit folded back to reveal the pale ribs and the red intercostal muscles. The broken ribs have to be stabilized, or the person runs a high risk of dying due to pneumonia or other infections.
Image Injuries to the ribs can occur anywhere on the ribcage, including the back and the sides. Even a single broken rib can make breathing very painful.
As a result, people with a broken rib tend to avoid breathing deeply, which can lead to fluid build-up in the lungs, infection, and even death. A few years ago he broke several ribs in a car accident.
A broken rib hurts like hell every time the broken ends move, which is every time you breathe. That can lead to more serious problems, especially for older patients and others whose lung capacity is limited.
To minimize the pain, you breathe as shallowly as possible, which leads to fluid build-up in the lungs, which leads to infections, which puts you on a ventilator—or in the morgue.
Because of how much they compromise the ability to breathe normally, broken ribs are the second leading cause of trauma deaths. Randy Haluck, chief of minimally invasive surgery at the Medical Center, and Barry Fell, a biomedical engineer whose company, TPC Design, specializes in orthopedic devices such as artificial hips and knees.
Like Mackay, Fell has gone through the pain of broken ribs—in his case, many times, most due to his lifelong enthusiasm for playing ice hockey.
The Penn State group thought attaching the plate to the inner surface of the broken rib, the side facing the lungs, would be less traumatic than the standard procedure, because it would leave the overlying tissue largely undisturbed.
A device already existed for doing some types of minimally invasive surgery in the chest: The view from a thoracoscope inserted low in the ribcage looks like a room in a cave, the smooth arched walls glistening pink and white.
From this vantage point, many of the ribs are visible and could be fixed without repositioning the scope.
The surgeon can see exactly where the break is—something not always possible from the outside or even with an x-ray. While the surgeons considered how to use a thoracoscope to fix ribs, Fell did what comes naturally to an engineer: I put some plates and screws into some ribs; what do you think?
Splinting ribs from the inside would work from a mechanical perspective. But was it do-able in real life? The thoracoscope would let them see into the chest; next they had to figure out how to get the hardware in and attach it to the broken ribs, without making a big incision. Consider all the angles that you have in here, and where the breaks might be.
Gallery The new procedure employs a thoracoscope, which gives surgeons a high-definition view of the inner surface of the ribcage; and a titanium plate attached to the broken rib by post-and-sleeve bolts.
The hardware is positioned and secured through a system of fine cables. The entire operation requires just a few short incisions.Systemwide Policy Prohibiting Discrimination, Harassment, Retaliation, Sexual Misconduct, Dating and Domestic Violence, and Stalking against Employees and Third Parties and Systemwide Procedure for Addressing Such Complaints by Employees and Third Parties.
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In the case of wedding receptions initial contact must be made with Dining, Conferences and Campus Events Office via Brenda Pelletier, either by e-mail at [email protected] or phone at () Assumptions and constraints form a foundational basis for project planning, filling in the gaps between known proven facts and total guesswork.
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