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Rib fracture fixation as a tool for extubation in a resource-poor environment
  1. Richard Alexander Dickson-Lowe1,
  2. Johannes Jacobus Petrus Buitendag1,2,
  3. Olamide Oluwafunsho Jolayemi1 and
  4. George Oosthuizen1
  1. 1 Department of General Surgery, Ngwelezana Hospital, Empangeni, KwaZulu Natal, South Africa
  2. 2 Department of General Surgery, Tygerberg Hospital, Tygerberg, South Africa
  1. Correspondence to Richard Alexander Dickson-Lowe, richarddickson-lowe{at}


An elderly female with multiple comorbidities was involved in a pedestrian vehicle accident and sustained blunt chest trauma, arriving at a resource-poor hospital in rural South Africa. She had multiple bilateral rib fractures with a unilateral flail segment that caused her to develop respiratory failure. She was intubated and sent to the intensive care unit (ICU) for ventilation. She developed hospital and ventilator acquired pneumonia. She subsequently had hypoxic arrests on two separate occasions and two failed extubations. Despite inadequate access to provisions, this patient was taken to theatre for rib fracture fixation as an attempt to improve her lung function and get her off the ventilator. She was extubated two days after the procedure and discharged from ICU 4 days thereafter. On her follow-up, she reported that she had returned to normal daily living and tasks.

  • surgery
  • orthopaedic and trauma surgery
  • pneumothorax
  • mechanical ventilation
  • adult intensive care

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  • Contributors JJPB and RAD-L wrote the article together including the case history and the literature search. RAD-L attained the images with 3D reconstruction. Both OOJ and GO were involved in the management of the case, operation and the overseeing of writing of the report. All authors made significant contribution to the writing of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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